|
NM Abscess Loc/Whole Body - Gallium
|
Professional
|
Both
|
$3,504.00
|
|
|
Service Code
|
CPT 78804
|
| Hospital Charge Code |
2586807
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$557.56 |
| Max. Negotiated Rate |
$3,461.95 |
| Rate for Payer: Aetna Commercial |
$3,461.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,133.98
|
| Rate for Payer: Aetna Managed Medicare |
$557.56
|
| Rate for Payer: Anthem Medicare Advantage |
$557.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$557.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$557.56
|
| Rate for Payer: Cash Price |
$1,051.20
|
| Rate for Payer: Cash Price |
$1,051.20
|
| Rate for Payer: Cash Price |
$1,051.20
|
| Rate for Payer: Cigna Commercial |
$3,461.95
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,822.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$557.56
|
| Rate for Payer: Health EOS Commercial |
$3,316.19
|
| Rate for Payer: HFN Commercial |
$3,461.95
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,340.17
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$2,340.17
|
| Rate for Payer: Independent Care Health Plan Medicare |
$557.56
|
| Rate for Payer: Multiplan Commercial |
$2,915.33
|
| Rate for Payer: NAPHCARE Commercial |
$836.35
|
| Rate for Payer: Preferred Network Access Commercial |
$3,461.95
|
| Rate for Payer: Quartz Beloit One Network |
$1,603.43
|
| Rate for Payer: Quartz Commercial |
$2,077.17
|
| Rate for Payer: Quartz Medicare Advantage |
$557.56
|
| Rate for Payer: The Alliance Commercial |
$2,118.75
|
| Rate for Payer: United Healthcare Medicare Advantage |
$557.56
|
| Rate for Payer: WEA Trust Commercial |
$2,004.29
|
| Rate for Payer: WPS Commercial |
$2,787.82
|
|
|
NM Abscess Loc/Whole Body - Gallium
|
Professional
|
Both
|
$3,369.00
|
|
|
Service Code
|
CPT 78806
|
| Hospital Charge Code |
675691
|
| Min. Negotiated Rate |
$1,541.65 |
| Max. Negotiated Rate |
$3,328.57 |
| Rate for Payer: Aetna Commercial |
$3,328.57
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,013.23
|
| Rate for Payer: Cash Price |
$1,010.70
|
| Rate for Payer: Cigna Commercial |
$3,328.57
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,751.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,102.26
|
| Rate for Payer: Health EOS Commercial |
$3,188.42
|
| Rate for Payer: HFN Commercial |
$3,328.57
|
| Rate for Payer: Multiplan Commercial |
$2,803.01
|
| Rate for Payer: Preferred Network Access Commercial |
$3,328.57
|
| Rate for Payer: Quartz Beloit One Network |
$1,541.65
|
| Rate for Payer: Quartz Commercial |
$1,997.14
|
| Rate for Payer: The Alliance Commercial |
$1,751.88
|
| Rate for Payer: WEA Trust Commercial |
$1,927.07
|
| Rate for Payer: WPS Commercial |
$2,595.14
|
|
|
NM Abscess Loc/Whole Body - Gallium
|
Facility
|
IP
|
$3,369.00
|
|
|
Service Code
|
CPT 78806
|
| Hospital Charge Code |
675691
|
| Min. Negotiated Rate |
$1,716.84 |
| Max. Negotiated Rate |
$3,223.46 |
| Rate for Payer: Aetna Commercial |
$3,153.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,013.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,856.99
|
| Rate for Payer: Cash Price |
$1,010.70
|
| Rate for Payer: Cigna Commercial |
$3,223.46
|
| Rate for Payer: Health EOS Commercial |
$3,118.35
|
| Rate for Payer: HFN Commercial |
$3,223.46
|
| Rate for Payer: Multiplan Commercial |
$2,803.01
|
| Rate for Payer: Preferred Network Access Commercial |
$3,223.46
|
| Rate for Payer: Quartz Beloit One Network |
$1,716.84
|
| Rate for Payer: Quartz Commercial |
$2,102.26
|
| Rate for Payer: WEA Trust Commercial |
$1,927.07
|
| Rate for Payer: WPS Commercial |
$2,595.14
|
|
|
NM Abscess Loc/Whole Body - Gallium
|
Facility
|
OP
|
$3,504.00
|
|
|
Service Code
|
CPT 78804
|
| Hospital Charge Code |
2586807
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$571.42 |
| Max. Negotiated Rate |
$5,473.65 |
| Rate for Payer: Aetna Commercial |
$3,279.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,133.98
|
| Rate for Payer: Aetna Managed Medicare |
$571.42
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,473.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,378.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,159.97
|
| Rate for Payer: Anthem Medicare Advantage |
$571.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,931.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$571.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$571.42
|
| Rate for Payer: Cash Price |
$1,051.20
|
| Rate for Payer: Cash Price |
$1,051.20
|
| Rate for Payer: Cash Price |
$1,051.20
|
| Rate for Payer: Cigna Commercial |
$3,352.63
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$571.42
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,039.33
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$571.42
|
| Rate for Payer: Health EOS Commercial |
$3,243.30
|
| Rate for Payer: HFN Commercial |
$3,352.63
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,125.67
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$571.42
|
| Rate for Payer: Independent Care Health Plan Medicare |
$571.42
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$571.42
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$571.42
|
| Rate for Payer: Multiplan Commercial |
$2,915.33
|
| Rate for Payer: NAPHCARE Commercial |
$857.13
|
| Rate for Payer: Preferred Network Access Commercial |
$3,352.63
|
| Rate for Payer: Quartz Beloit One Network |
$1,785.64
|
| Rate for Payer: Quartz Commercial |
$2,368.70
|
| Rate for Payer: Quartz Medicare Advantage |
$571.42
|
| Rate for Payer: The Alliance Commercial |
$2,285.67
|
| Rate for Payer: United Healthcare Medicare Advantage |
$571.42
|
| Rate for Payer: United Healthcare PPO |
$2,396.16
|
| Rate for Payer: WEA Trust Commercial |
$2,004.29
|
| Rate for Payer: Wellcare Medicare |
$571.42
|
| Rate for Payer: WPS Commercial |
$2,699.13
|
|
|
NM Abscess Loc/Whole Body - Gallium
|
Facility
|
OP
|
$3,369.00
|
|
|
Service Code
|
CPT 78806
|
| Hospital Charge Code |
675691
|
| Min. Negotiated Rate |
$981.05 |
| Max. Negotiated Rate |
$3,223.46 |
| Rate for Payer: Aetna Commercial |
$3,153.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,013.23
|
| Rate for Payer: Aetna Managed Medicare |
$981.05
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,277.44
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,751.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,681.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,856.99
|
| Rate for Payer: Cash Price |
$1,010.70
|
| Rate for Payer: Cigna Commercial |
$3,223.46
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,960.76
|
| Rate for Payer: Health EOS Commercial |
$3,118.35
|
| Rate for Payer: HFN Commercial |
$3,223.46
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,627.82
|
| Rate for Payer: Multiplan Commercial |
$2,803.01
|
| Rate for Payer: NAPHCARE Commercial |
$2,102.26
|
| Rate for Payer: Preferred Network Access Commercial |
$3,223.46
|
| Rate for Payer: Quartz Beloit One Network |
$1,716.84
|
| Rate for Payer: Quartz Commercial |
$2,277.44
|
| Rate for Payer: Quartz Medicare Advantage |
$2,102.26
|
| Rate for Payer: The Alliance Commercial |
$1,751.88
|
| Rate for Payer: WEA Trust Commercial |
$1,927.07
|
| Rate for Payer: WPS Commercial |
$2,595.14
|
|
|
NM Abscess Loc/Whole Body - Indium
|
Facility
|
OP
|
$3,504.00
|
|
|
Service Code
|
CPT 78804
|
| Hospital Charge Code |
2586809
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$571.42 |
| Max. Negotiated Rate |
$5,473.65 |
| Rate for Payer: Aetna Commercial |
$3,279.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,133.98
|
| Rate for Payer: Aetna Managed Medicare |
$571.42
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,473.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,378.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,159.97
|
| Rate for Payer: Anthem Medicare Advantage |
$571.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,931.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$571.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$571.42
|
| Rate for Payer: Cash Price |
$1,051.20
|
| Rate for Payer: Cash Price |
$1,051.20
|
| Rate for Payer: Cash Price |
$1,051.20
|
| Rate for Payer: Cigna Commercial |
$3,352.63
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$571.42
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,039.33
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$571.42
|
| Rate for Payer: Health EOS Commercial |
$3,243.30
|
| Rate for Payer: HFN Commercial |
$3,352.63
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,125.67
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$571.42
|
| Rate for Payer: Independent Care Health Plan Medicare |
$571.42
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$571.42
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$571.42
|
| Rate for Payer: Multiplan Commercial |
$2,915.33
|
| Rate for Payer: NAPHCARE Commercial |
$857.13
|
| Rate for Payer: Preferred Network Access Commercial |
$3,352.63
|
| Rate for Payer: Quartz Beloit One Network |
$1,785.64
|
| Rate for Payer: Quartz Commercial |
$2,368.70
|
| Rate for Payer: Quartz Medicare Advantage |
$571.42
|
| Rate for Payer: The Alliance Commercial |
$2,285.67
|
| Rate for Payer: United Healthcare Medicare Advantage |
$571.42
|
| Rate for Payer: United Healthcare PPO |
$2,396.16
|
| Rate for Payer: WEA Trust Commercial |
$2,004.29
|
| Rate for Payer: Wellcare Medicare |
$571.42
|
| Rate for Payer: WPS Commercial |
$2,699.13
|
|
|
NM Abscess Loc/Whole Body - Indium
|
Facility
|
IP
|
$3,369.00
|
|
| Hospital Charge Code |
675689
|
| Min. Negotiated Rate |
$1,716.84 |
| Max. Negotiated Rate |
$3,223.46 |
| Rate for Payer: Aetna Commercial |
$3,153.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,013.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,856.99
|
| Rate for Payer: Cash Price |
$1,010.70
|
| Rate for Payer: Cigna Commercial |
$3,223.46
|
| Rate for Payer: Health EOS Commercial |
$3,118.35
|
| Rate for Payer: HFN Commercial |
$3,223.46
|
| Rate for Payer: Multiplan Commercial |
$2,803.01
|
| Rate for Payer: Preferred Network Access Commercial |
$3,223.46
|
| Rate for Payer: Quartz Beloit One Network |
$1,716.84
|
| Rate for Payer: Quartz Commercial |
$2,102.26
|
| Rate for Payer: WEA Trust Commercial |
$1,927.07
|
| Rate for Payer: WPS Commercial |
$2,595.14
|
|
|
NM Abscess Loc/Whole Body - Indium
|
Professional
|
Both
|
$3,504.00
|
|
|
Service Code
|
CPT 78804
|
| Hospital Charge Code |
2586809
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$557.56 |
| Max. Negotiated Rate |
$3,461.95 |
| Rate for Payer: Aetna Commercial |
$3,461.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,133.98
|
| Rate for Payer: Aetna Managed Medicare |
$557.56
|
| Rate for Payer: Anthem Medicare Advantage |
$557.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$557.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$557.56
|
| Rate for Payer: Cash Price |
$1,051.20
|
| Rate for Payer: Cash Price |
$1,051.20
|
| Rate for Payer: Cash Price |
$1,051.20
|
| Rate for Payer: Cigna Commercial |
$3,461.95
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,822.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$557.56
|
| Rate for Payer: Health EOS Commercial |
$3,316.19
|
| Rate for Payer: HFN Commercial |
$3,461.95
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,340.17
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$2,340.17
|
| Rate for Payer: Independent Care Health Plan Medicare |
$557.56
|
| Rate for Payer: Multiplan Commercial |
$2,915.33
|
| Rate for Payer: NAPHCARE Commercial |
$836.35
|
| Rate for Payer: Preferred Network Access Commercial |
$3,461.95
|
| Rate for Payer: Quartz Beloit One Network |
$1,603.43
|
| Rate for Payer: Quartz Commercial |
$2,077.17
|
| Rate for Payer: Quartz Medicare Advantage |
$557.56
|
| Rate for Payer: The Alliance Commercial |
$2,118.75
|
| Rate for Payer: United Healthcare Medicare Advantage |
$557.56
|
| Rate for Payer: WEA Trust Commercial |
$2,004.29
|
| Rate for Payer: WPS Commercial |
$2,787.82
|
|
|
NM Abscess Loc/Whole Body - Indium
|
Facility
|
IP
|
$3,504.00
|
|
|
Service Code
|
CPT 78804
|
| Hospital Charge Code |
2586809
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,785.64 |
| Max. Negotiated Rate |
$3,352.63 |
| Rate for Payer: Aetna Commercial |
$3,279.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,133.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,931.40
|
| Rate for Payer: Cash Price |
$1,051.20
|
| Rate for Payer: Cigna Commercial |
$3,352.63
|
| Rate for Payer: Health EOS Commercial |
$3,243.30
|
| Rate for Payer: HFN Commercial |
$3,352.63
|
| Rate for Payer: Multiplan Commercial |
$2,915.33
|
| Rate for Payer: Preferred Network Access Commercial |
$3,352.63
|
| Rate for Payer: Quartz Beloit One Network |
$1,785.64
|
| Rate for Payer: Quartz Commercial |
$2,186.50
|
| Rate for Payer: WEA Trust Commercial |
$2,004.29
|
| Rate for Payer: WPS Commercial |
$2,699.13
|
|
|
NM Abscess Loc/Whole Body - Indium
|
Professional
|
Both
|
$3,369.00
|
|
| Hospital Charge Code |
675689
|
| Min. Negotiated Rate |
$1,541.65 |
| Max. Negotiated Rate |
$3,328.57 |
| Rate for Payer: Aetna Commercial |
$3,328.57
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,013.23
|
| Rate for Payer: Cash Price |
$1,010.70
|
| Rate for Payer: Cigna Commercial |
$3,328.57
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,751.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,102.26
|
| Rate for Payer: Health EOS Commercial |
$3,188.42
|
| Rate for Payer: HFN Commercial |
$3,328.57
|
| Rate for Payer: Multiplan Commercial |
$2,803.01
|
| Rate for Payer: Preferred Network Access Commercial |
$3,328.57
|
| Rate for Payer: Quartz Beloit One Network |
$1,541.65
|
| Rate for Payer: Quartz Commercial |
$1,997.14
|
| Rate for Payer: The Alliance Commercial |
$1,751.88
|
| Rate for Payer: WEA Trust Commercial |
$1,927.07
|
| Rate for Payer: WPS Commercial |
$2,595.14
|
|
|
NM Abscess Loc/Whole Body - Indium
|
Facility
|
OP
|
$3,369.00
|
|
| Hospital Charge Code |
675689
|
| Min. Negotiated Rate |
$981.05 |
| Max. Negotiated Rate |
$3,223.46 |
| Rate for Payer: Aetna Commercial |
$3,153.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,013.23
|
| Rate for Payer: Aetna Managed Medicare |
$981.05
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,277.44
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,751.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,681.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,856.99
|
| Rate for Payer: Cash Price |
$1,010.70
|
| Rate for Payer: Cigna Commercial |
$3,223.46
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,960.76
|
| Rate for Payer: Health EOS Commercial |
$3,118.35
|
| Rate for Payer: HFN Commercial |
$3,223.46
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,627.82
|
| Rate for Payer: Multiplan Commercial |
$2,803.01
|
| Rate for Payer: NAPHCARE Commercial |
$2,102.26
|
| Rate for Payer: Preferred Network Access Commercial |
$3,223.46
|
| Rate for Payer: Quartz Beloit One Network |
$1,716.84
|
| Rate for Payer: Quartz Commercial |
$2,277.44
|
| Rate for Payer: Quartz Medicare Advantage |
$2,102.26
|
| Rate for Payer: The Alliance Commercial |
$1,751.88
|
| Rate for Payer: WEA Trust Commercial |
$1,927.07
|
| Rate for Payer: WPS Commercial |
$2,595.14
|
|
|
NM Acute Venous Thrombosis Imaging
|
Professional
|
Both
|
$2,815.00
|
|
|
Service Code
|
CPT 78456
|
| Hospital Charge Code |
625650
|
| Min. Negotiated Rate |
$282.82 |
| Max. Negotiated Rate |
$2,781.22 |
| Rate for Payer: Aetna Commercial |
$2,781.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,517.74
|
| Rate for Payer: Aetna Managed Medicare |
$282.82
|
| Rate for Payer: Anthem Medicare Advantage |
$282.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$282.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$282.82
|
| Rate for Payer: Cash Price |
$844.50
|
| Rate for Payer: Cash Price |
$844.50
|
| Rate for Payer: Cash Price |
$844.50
|
| Rate for Payer: Cigna Commercial |
$2,781.22
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,463.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$282.82
|
| Rate for Payer: Health EOS Commercial |
$2,664.12
|
| Rate for Payer: HFN Commercial |
$2,781.22
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,112.56
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,112.56
|
| Rate for Payer: Independent Care Health Plan Medicare |
$282.82
|
| Rate for Payer: Multiplan Commercial |
$2,342.08
|
| Rate for Payer: NAPHCARE Commercial |
$424.23
|
| Rate for Payer: Preferred Network Access Commercial |
$2,781.22
|
| Rate for Payer: Quartz Beloit One Network |
$1,288.14
|
| Rate for Payer: Quartz Commercial |
$1,668.73
|
| Rate for Payer: Quartz Medicare Advantage |
$282.82
|
| Rate for Payer: The Alliance Commercial |
$1,074.71
|
| Rate for Payer: United Healthcare Medicare Advantage |
$282.82
|
| Rate for Payer: WEA Trust Commercial |
$1,610.18
|
| Rate for Payer: WPS Commercial |
$1,414.09
|
|
|
NM Acute Venous Thrombosis Imaging
|
Facility
|
OP
|
$2,815.00
|
|
|
Service Code
|
CPT 78456
|
| Hospital Charge Code |
625650
|
| Min. Negotiated Rate |
$1,362.47 |
| Max. Negotiated Rate |
$5,449.89 |
| Rate for Payer: Aetna Commercial |
$2,634.84
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,517.74
|
| Rate for Payer: Aetna Managed Medicare |
$1,362.47
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,902.94
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,463.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,405.25
|
| Rate for Payer: Anthem Medicare Advantage |
$1,362.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,551.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$1,362.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$1,362.47
|
| Rate for Payer: Cash Price |
$844.50
|
| Rate for Payer: Cash Price |
$844.50
|
| Rate for Payer: Cigna Commercial |
$2,693.39
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$1,362.47
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,638.33
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$1,362.47
|
| Rate for Payer: Health EOS Commercial |
$2,605.56
|
| Rate for Payer: HFN Commercial |
$2,693.39
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,068.40
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,362.47
|
| Rate for Payer: Independent Care Health Plan Medicare |
$1,362.47
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$1,362.47
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$1,362.47
|
| Rate for Payer: Multiplan Commercial |
$2,342.08
|
| Rate for Payer: NAPHCARE Commercial |
$2,043.71
|
| Rate for Payer: Preferred Network Access Commercial |
$2,693.39
|
| Rate for Payer: Quartz Beloit One Network |
$1,434.52
|
| Rate for Payer: Quartz Commercial |
$1,902.94
|
| Rate for Payer: Quartz Medicare Advantage |
$1,362.47
|
| Rate for Payer: The Alliance Commercial |
$5,449.89
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,362.47
|
| Rate for Payer: WEA Trust Commercial |
$1,610.18
|
| Rate for Payer: Wellcare Medicare |
$1,362.47
|
| Rate for Payer: WPS Commercial |
$2,168.39
|
|
|
NM Acute Venous Thrombosis Imaging
|
Facility
|
IP
|
$2,815.00
|
|
|
Service Code
|
CPT 78456
|
| Hospital Charge Code |
625650
|
| Min. Negotiated Rate |
$1,434.52 |
| Max. Negotiated Rate |
$2,693.39 |
| Rate for Payer: Aetna Commercial |
$2,634.84
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,517.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,551.63
|
| Rate for Payer: Cash Price |
$844.50
|
| Rate for Payer: Cigna Commercial |
$2,693.39
|
| Rate for Payer: Health EOS Commercial |
$2,605.56
|
| Rate for Payer: HFN Commercial |
$2,693.39
|
| Rate for Payer: Multiplan Commercial |
$2,342.08
|
| Rate for Payer: Preferred Network Access Commercial |
$2,693.39
|
| Rate for Payer: Quartz Beloit One Network |
$1,434.52
|
| Rate for Payer: Quartz Commercial |
$1,756.56
|
| Rate for Payer: WEA Trust Commercial |
$1,610.18
|
| Rate for Payer: WPS Commercial |
$2,168.39
|
|
|
NM Acute Venous Thrombosis Imaging
|
Facility
|
IP
|
$2,928.00
|
|
|
Service Code
|
CPT 78456
|
| Hospital Charge Code |
2586813
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,492.11 |
| Max. Negotiated Rate |
$2,801.51 |
| Rate for Payer: Aetna Commercial |
$2,740.61
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,618.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,613.91
|
| Rate for Payer: Cash Price |
$878.40
|
| Rate for Payer: Cigna Commercial |
$2,801.51
|
| Rate for Payer: Health EOS Commercial |
$2,710.16
|
| Rate for Payer: HFN Commercial |
$2,801.51
|
| Rate for Payer: Multiplan Commercial |
$2,436.10
|
| Rate for Payer: Preferred Network Access Commercial |
$2,801.51
|
| Rate for Payer: Quartz Beloit One Network |
$1,492.11
|
| Rate for Payer: Quartz Commercial |
$1,827.07
|
| Rate for Payer: WEA Trust Commercial |
$1,674.82
|
| Rate for Payer: WPS Commercial |
$2,255.44
|
|
|
NM Acute Venous Thrombosis Imaging
|
Professional
|
Both
|
$2,928.00
|
|
|
Service Code
|
CPT 78456
|
| Hospital Charge Code |
2586813
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$282.82 |
| Max. Negotiated Rate |
$2,892.86 |
| Rate for Payer: Aetna Commercial |
$2,892.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,618.80
|
| Rate for Payer: Aetna Managed Medicare |
$282.82
|
| Rate for Payer: Anthem Medicare Advantage |
$282.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$282.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$282.82
|
| Rate for Payer: Cash Price |
$878.40
|
| Rate for Payer: Cash Price |
$878.40
|
| Rate for Payer: Cash Price |
$878.40
|
| Rate for Payer: Cigna Commercial |
$2,892.86
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,522.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$282.82
|
| Rate for Payer: Health EOS Commercial |
$2,771.06
|
| Rate for Payer: HFN Commercial |
$2,892.86
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,112.56
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,112.56
|
| Rate for Payer: Independent Care Health Plan Medicare |
$282.82
|
| Rate for Payer: Multiplan Commercial |
$2,436.10
|
| Rate for Payer: NAPHCARE Commercial |
$424.23
|
| Rate for Payer: Preferred Network Access Commercial |
$2,892.86
|
| Rate for Payer: Quartz Beloit One Network |
$1,339.85
|
| Rate for Payer: Quartz Commercial |
$1,735.72
|
| Rate for Payer: Quartz Medicare Advantage |
$282.82
|
| Rate for Payer: The Alliance Commercial |
$1,074.71
|
| Rate for Payer: United Healthcare Medicare Advantage |
$282.82
|
| Rate for Payer: WEA Trust Commercial |
$1,674.82
|
| Rate for Payer: WPS Commercial |
$1,414.09
|
|
|
NM Acute Venous Thrombosis Imaging
|
Facility
|
OP
|
$2,928.00
|
|
|
Service Code
|
CPT 78456
|
| Hospital Charge Code |
2586813
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,362.47 |
| Max. Negotiated Rate |
$5,473.65 |
| Rate for Payer: Aetna Commercial |
$2,740.61
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,618.80
|
| Rate for Payer: Aetna Managed Medicare |
$1,362.47
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,473.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,378.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,159.97
|
| Rate for Payer: Anthem Medicare Advantage |
$1,362.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,613.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$1,362.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$1,362.47
|
| Rate for Payer: Cash Price |
$878.40
|
| Rate for Payer: Cash Price |
$878.40
|
| Rate for Payer: Cash Price |
$878.40
|
| Rate for Payer: Cigna Commercial |
$2,801.51
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$1,362.47
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,704.10
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$1,362.47
|
| Rate for Payer: Health EOS Commercial |
$2,710.16
|
| Rate for Payer: HFN Commercial |
$2,801.51
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,068.40
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,362.47
|
| Rate for Payer: Independent Care Health Plan Medicare |
$1,362.47
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$1,362.47
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$1,362.47
|
| Rate for Payer: Multiplan Commercial |
$2,436.10
|
| Rate for Payer: NAPHCARE Commercial |
$2,043.71
|
| Rate for Payer: Preferred Network Access Commercial |
$2,801.51
|
| Rate for Payer: Quartz Beloit One Network |
$1,492.11
|
| Rate for Payer: Quartz Commercial |
$1,979.33
|
| Rate for Payer: Quartz Medicare Advantage |
$1,362.47
|
| Rate for Payer: The Alliance Commercial |
$5,449.89
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,362.47
|
| Rate for Payer: United Healthcare PPO |
$2,396.16
|
| Rate for Payer: WEA Trust Commercial |
$1,674.82
|
| Rate for Payer: Wellcare Medicare |
$1,362.47
|
| Rate for Payer: WPS Commercial |
$2,255.44
|
|
|
NM Bone Imaging Limited
|
Facility
|
OP
|
$1,918.00
|
|
|
Service Code
|
CPT 78300
|
| Hospital Charge Code |
2586817
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$420.71 |
| Max. Negotiated Rate |
$2,396.16 |
| Rate for Payer: Aetna Commercial |
$1,795.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,715.46
|
| Rate for Payer: Aetna Managed Medicare |
$420.71
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,589.87
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,271.90
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,208.30
|
| Rate for Payer: Anthem Medicare Advantage |
$420.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,057.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$420.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$420.71
|
| Rate for Payer: Cash Price |
$575.40
|
| Rate for Payer: Cash Price |
$575.40
|
| Rate for Payer: Cash Price |
$575.40
|
| Rate for Payer: Cigna Commercial |
$1,835.14
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$420.71
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,116.28
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$420.71
|
| Rate for Payer: Health EOS Commercial |
$1,775.30
|
| Rate for Payer: HFN Commercial |
$1,835.14
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,565.05
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$420.71
|
| Rate for Payer: Independent Care Health Plan Medicare |
$420.71
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$420.71
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$420.71
|
| Rate for Payer: Multiplan Commercial |
$1,595.78
|
| Rate for Payer: NAPHCARE Commercial |
$631.07
|
| Rate for Payer: Preferred Network Access Commercial |
$1,835.14
|
| Rate for Payer: Quartz Beloit One Network |
$977.41
|
| Rate for Payer: Quartz Commercial |
$1,296.57
|
| Rate for Payer: Quartz Medicare Advantage |
$420.71
|
| Rate for Payer: The Alliance Commercial |
$1,682.84
|
| Rate for Payer: United Healthcare Medicare Advantage |
$420.71
|
| Rate for Payer: United Healthcare PPO |
$2,396.16
|
| Rate for Payer: WEA Trust Commercial |
$1,097.10
|
| Rate for Payer: Wellcare Medicare |
$420.71
|
| Rate for Payer: WPS Commercial |
$1,477.44
|
|
|
NM Bone Imaging Limited
|
Facility
|
IP
|
$1,844.00
|
|
|
Service Code
|
CPT 78300
|
| Hospital Charge Code |
627640
|
| Min. Negotiated Rate |
$939.70 |
| Max. Negotiated Rate |
$1,764.34 |
| Rate for Payer: Aetna Commercial |
$1,725.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,649.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,016.41
|
| Rate for Payer: Cash Price |
$553.20
|
| Rate for Payer: Cigna Commercial |
$1,764.34
|
| Rate for Payer: Health EOS Commercial |
$1,706.81
|
| Rate for Payer: HFN Commercial |
$1,764.34
|
| Rate for Payer: Multiplan Commercial |
$1,534.21
|
| Rate for Payer: Preferred Network Access Commercial |
$1,764.34
|
| Rate for Payer: Quartz Beloit One Network |
$939.70
|
| Rate for Payer: Quartz Commercial |
$1,150.66
|
| Rate for Payer: WEA Trust Commercial |
$1,054.77
|
| Rate for Payer: WPS Commercial |
$1,420.43
|
|
|
NM Bone Imaging Limited
|
Facility
|
OP
|
$1,844.00
|
|
|
Service Code
|
CPT 78300
|
| Hospital Charge Code |
627640
|
| Min. Negotiated Rate |
$420.71 |
| Max. Negotiated Rate |
$1,764.34 |
| Rate for Payer: Aetna Commercial |
$1,725.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,649.27
|
| Rate for Payer: Aetna Managed Medicare |
$420.71
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,246.54
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$958.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$920.52
|
| Rate for Payer: Anthem Medicare Advantage |
$420.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,016.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$420.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$420.71
|
| Rate for Payer: Cash Price |
$553.20
|
| Rate for Payer: Cash Price |
$553.20
|
| Rate for Payer: Cigna Commercial |
$1,764.34
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$420.71
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,073.21
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$420.71
|
| Rate for Payer: Health EOS Commercial |
$1,706.81
|
| Rate for Payer: HFN Commercial |
$1,764.34
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,565.05
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$420.71
|
| Rate for Payer: Independent Care Health Plan Medicare |
$420.71
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$420.71
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$420.71
|
| Rate for Payer: Multiplan Commercial |
$1,534.21
|
| Rate for Payer: NAPHCARE Commercial |
$631.07
|
| Rate for Payer: Preferred Network Access Commercial |
$1,764.34
|
| Rate for Payer: Quartz Beloit One Network |
$939.70
|
| Rate for Payer: Quartz Commercial |
$1,246.54
|
| Rate for Payer: Quartz Medicare Advantage |
$420.71
|
| Rate for Payer: The Alliance Commercial |
$1,682.84
|
| Rate for Payer: United Healthcare Medicare Advantage |
$420.71
|
| Rate for Payer: WEA Trust Commercial |
$1,054.77
|
| Rate for Payer: Wellcare Medicare |
$420.71
|
| Rate for Payer: WPS Commercial |
$1,420.43
|
|
|
NM Bone Imaging Limited
|
Professional
|
Both
|
$1,918.00
|
|
|
Service Code
|
CPT 78300
|
| Hospital Charge Code |
2586817
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$198.19 |
| Max. Negotiated Rate |
$1,894.98 |
| Rate for Payer: Aetna Commercial |
$1,894.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,715.46
|
| Rate for Payer: Aetna Managed Medicare |
$198.19
|
| Rate for Payer: Anthem Medicare Advantage |
$198.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$198.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$198.19
|
| Rate for Payer: Cash Price |
$575.40
|
| Rate for Payer: Cash Price |
$575.40
|
| Rate for Payer: Cash Price |
$575.40
|
| Rate for Payer: Cigna Commercial |
$1,894.98
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$997.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$198.19
|
| Rate for Payer: Health EOS Commercial |
$1,815.20
|
| Rate for Payer: HFN Commercial |
$1,894.98
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$813.72
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$813.72
|
| Rate for Payer: Independent Care Health Plan Medicare |
$198.19
|
| Rate for Payer: Multiplan Commercial |
$1,595.78
|
| Rate for Payer: NAPHCARE Commercial |
$297.29
|
| Rate for Payer: Preferred Network Access Commercial |
$1,894.98
|
| Rate for Payer: Quartz Beloit One Network |
$877.68
|
| Rate for Payer: Quartz Commercial |
$1,136.99
|
| Rate for Payer: Quartz Medicare Advantage |
$198.19
|
| Rate for Payer: The Alliance Commercial |
$753.13
|
| Rate for Payer: United Healthcare Medicare Advantage |
$198.19
|
| Rate for Payer: WEA Trust Commercial |
$1,097.10
|
| Rate for Payer: WPS Commercial |
$990.96
|
|
|
NM Bone Imaging Limited
|
Professional
|
Both
|
$1,844.00
|
|
|
Service Code
|
CPT 78300
|
| Hospital Charge Code |
627640
|
| Min. Negotiated Rate |
$198.19 |
| Max. Negotiated Rate |
$1,821.87 |
| Rate for Payer: Aetna Commercial |
$1,821.87
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,649.27
|
| Rate for Payer: Aetna Managed Medicare |
$198.19
|
| Rate for Payer: Anthem Medicare Advantage |
$198.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$198.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$198.19
|
| Rate for Payer: Cash Price |
$553.20
|
| Rate for Payer: Cash Price |
$553.20
|
| Rate for Payer: Cash Price |
$553.20
|
| Rate for Payer: Cigna Commercial |
$1,821.87
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$958.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$198.19
|
| Rate for Payer: Health EOS Commercial |
$1,745.16
|
| Rate for Payer: HFN Commercial |
$1,821.87
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$813.72
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$813.72
|
| Rate for Payer: Independent Care Health Plan Medicare |
$198.19
|
| Rate for Payer: Multiplan Commercial |
$1,534.21
|
| Rate for Payer: NAPHCARE Commercial |
$297.29
|
| Rate for Payer: Preferred Network Access Commercial |
$1,821.87
|
| Rate for Payer: Quartz Beloit One Network |
$843.81
|
| Rate for Payer: Quartz Commercial |
$1,093.12
|
| Rate for Payer: Quartz Medicare Advantage |
$198.19
|
| Rate for Payer: The Alliance Commercial |
$753.13
|
| Rate for Payer: United Healthcare Medicare Advantage |
$198.19
|
| Rate for Payer: WEA Trust Commercial |
$1,054.77
|
| Rate for Payer: WPS Commercial |
$990.96
|
|
|
NM Bone Imaging Limited
|
Facility
|
IP
|
$1,918.00
|
|
|
Service Code
|
CPT 78300
|
| Hospital Charge Code |
2586817
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$977.41 |
| Max. Negotiated Rate |
$1,835.14 |
| Rate for Payer: Aetna Commercial |
$1,795.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,715.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,057.20
|
| Rate for Payer: Cash Price |
$575.40
|
| Rate for Payer: Cigna Commercial |
$1,835.14
|
| Rate for Payer: Health EOS Commercial |
$1,775.30
|
| Rate for Payer: HFN Commercial |
$1,835.14
|
| Rate for Payer: Multiplan Commercial |
$1,595.78
|
| Rate for Payer: Preferred Network Access Commercial |
$1,835.14
|
| Rate for Payer: Quartz Beloit One Network |
$977.41
|
| Rate for Payer: Quartz Commercial |
$1,196.83
|
| Rate for Payer: WEA Trust Commercial |
$1,097.10
|
| Rate for Payer: WPS Commercial |
$1,477.44
|
|
|
NM Bone Imaging Whole Body
|
Professional
|
Both
|
$2,878.00
|
|
|
Service Code
|
CPT 78306
|
| Hospital Charge Code |
2586821
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$257.66 |
| Max. Negotiated Rate |
$2,843.46 |
| Rate for Payer: Aetna Commercial |
$2,843.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,574.08
|
| Rate for Payer: Aetna Managed Medicare |
$257.66
|
| Rate for Payer: Anthem Medicare Advantage |
$257.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$257.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$257.66
|
| Rate for Payer: Cash Price |
$863.40
|
| Rate for Payer: Cash Price |
$863.40
|
| Rate for Payer: Cash Price |
$863.40
|
| Rate for Payer: Cigna Commercial |
$2,843.46
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,496.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$257.66
|
| Rate for Payer: Health EOS Commercial |
$2,723.74
|
| Rate for Payer: HFN Commercial |
$2,843.46
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,061.67
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,061.67
|
| Rate for Payer: Independent Care Health Plan Medicare |
$257.66
|
| Rate for Payer: Multiplan Commercial |
$2,394.50
|
| Rate for Payer: NAPHCARE Commercial |
$386.49
|
| Rate for Payer: Preferred Network Access Commercial |
$2,843.46
|
| Rate for Payer: Quartz Beloit One Network |
$1,316.97
|
| Rate for Payer: Quartz Commercial |
$1,706.08
|
| Rate for Payer: Quartz Medicare Advantage |
$257.66
|
| Rate for Payer: The Alliance Commercial |
$979.11
|
| Rate for Payer: United Healthcare Medicare Advantage |
$257.66
|
| Rate for Payer: WEA Trust Commercial |
$1,646.22
|
| Rate for Payer: WPS Commercial |
$1,288.30
|
|
|
NM Bone Imaging Whole Body
|
Facility
|
IP
|
$2,666.00
|
|
|
Service Code
|
CPT 78306
|
| Hospital Charge Code |
627644
|
| Min. Negotiated Rate |
$1,358.59 |
| Max. Negotiated Rate |
$2,550.83 |
| Rate for Payer: Aetna Commercial |
$2,495.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,384.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,469.50
|
| Rate for Payer: Cash Price |
$799.80
|
| Rate for Payer: Cigna Commercial |
$2,550.83
|
| Rate for Payer: Health EOS Commercial |
$2,467.65
|
| Rate for Payer: HFN Commercial |
$2,550.83
|
| Rate for Payer: Multiplan Commercial |
$2,218.11
|
| Rate for Payer: Preferred Network Access Commercial |
$2,550.83
|
| Rate for Payer: Quartz Beloit One Network |
$1,358.59
|
| Rate for Payer: Quartz Commercial |
$1,663.58
|
| Rate for Payer: WEA Trust Commercial |
$1,524.95
|
| Rate for Payer: WPS Commercial |
$2,053.62
|
|
