|
NM Bone Imaging Whole Body
|
Facility
|
OP
|
$2,666.00
|
|
|
Service Code
|
CPT 78306
|
| Hospital Charge Code |
627644
|
| Min. Negotiated Rate |
$420.71 |
| 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: Aetna Managed Medicare |
$420.71
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,802.22
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,386.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,330.87
|
| Rate for Payer: Anthem Medicare Advantage |
$420.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,469.50
|
| 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 |
$799.80
|
| Rate for Payer: Cash Price |
$799.80
|
| Rate for Payer: Cigna Commercial |
$2,550.83
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$420.71
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,551.61
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$420.71
|
| Rate for Payer: Health EOS Commercial |
$2,467.65
|
| Rate for Payer: HFN Commercial |
$2,550.83
|
| 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 |
$2,218.11
|
| Rate for Payer: NAPHCARE Commercial |
$631.07
|
| 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 |
$1,802.22
|
| 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 |
$1,524.95
|
| Rate for Payer: Wellcare Medicare |
$420.71
|
| Rate for Payer: WPS Commercial |
$2,053.62
|
|
|
NM Bone Imaging Whole Body
|
Professional
|
Both
|
$2,666.00
|
|
|
Service Code
|
CPT 78306
|
| Hospital Charge Code |
627644
|
| Min. Negotiated Rate |
$257.66 |
| Max. Negotiated Rate |
$2,634.01 |
| Rate for Payer: Aetna Commercial |
$2,634.01
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,384.47
|
| 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 |
$799.80
|
| Rate for Payer: Cash Price |
$799.80
|
| Rate for Payer: Cash Price |
$799.80
|
| Rate for Payer: Cigna Commercial |
$2,634.01
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,386.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$257.66
|
| Rate for Payer: Health EOS Commercial |
$2,523.10
|
| Rate for Payer: HFN Commercial |
$2,634.01
|
| 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 |
$2,218.11
|
| Rate for Payer: NAPHCARE Commercial |
$386.49
|
| Rate for Payer: Preferred Network Access Commercial |
$2,634.01
|
| Rate for Payer: Quartz Beloit One Network |
$1,219.96
|
| Rate for Payer: Quartz Commercial |
$1,580.40
|
| 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 |
$1,524.95
|
| Rate for Payer: WPS Commercial |
$1,288.30
|
|
|
NM Bone Imaging Whole Body
|
Facility
|
IP
|
$2,878.00
|
|
|
Service Code
|
CPT 78306
|
| Hospital Charge Code |
2586821
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,466.63 |
| Max. Negotiated Rate |
$2,753.67 |
| Rate for Payer: Aetna Commercial |
$2,693.81
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,574.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,586.35
|
| Rate for Payer: Cash Price |
$863.40
|
| Rate for Payer: Cigna Commercial |
$2,753.67
|
| Rate for Payer: Health EOS Commercial |
$2,663.88
|
| Rate for Payer: HFN Commercial |
$2,753.67
|
| Rate for Payer: Multiplan Commercial |
$2,394.50
|
| Rate for Payer: Preferred Network Access Commercial |
$2,753.67
|
| Rate for Payer: Quartz Beloit One Network |
$1,466.63
|
| Rate for Payer: Quartz Commercial |
$1,795.87
|
| Rate for Payer: WEA Trust Commercial |
$1,646.22
|
| Rate for Payer: WPS Commercial |
$2,216.92
|
|
|
NM Bone Imaging Whole Body
|
Facility
|
OP
|
$2,878.00
|
|
|
Service Code
|
CPT 78306
|
| Hospital Charge Code |
2586821
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$420.71 |
| Max. Negotiated Rate |
$2,753.67 |
| Rate for Payer: Aetna Commercial |
$2,693.81
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,574.08
|
| 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 |
$1,586.35
|
| 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 |
$863.40
|
| Rate for Payer: Cash Price |
$863.40
|
| Rate for Payer: Cash Price |
$863.40
|
| Rate for Payer: Cigna Commercial |
$2,753.67
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$420.71
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,675.00
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$420.71
|
| Rate for Payer: Health EOS Commercial |
$2,663.88
|
| Rate for Payer: HFN Commercial |
$2,753.67
|
| 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 |
$2,394.50
|
| Rate for Payer: NAPHCARE Commercial |
$631.07
|
| Rate for Payer: Preferred Network Access Commercial |
$2,753.67
|
| Rate for Payer: Quartz Beloit One Network |
$1,466.63
|
| Rate for Payer: Quartz Commercial |
$1,945.53
|
| 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 |
$1,646.22
|
| Rate for Payer: Wellcare Medicare |
$420.71
|
| Rate for Payer: WPS Commercial |
$2,216.92
|
|
|
NM Bone Three Phase Study
|
Professional
|
Both
|
$2,606.00
|
|
|
Service Code
|
CPT 78315
|
| Hospital Charge Code |
627664
|
| Min. Negotiated Rate |
$301.35 |
| Max. Negotiated Rate |
$2,574.73 |
| Rate for Payer: Aetna Commercial |
$2,574.73
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,330.81
|
| Rate for Payer: Aetna Managed Medicare |
$301.35
|
| Rate for Payer: Anthem Medicare Advantage |
$301.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$301.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$301.35
|
| Rate for Payer: Cash Price |
$781.80
|
| Rate for Payer: Cash Price |
$781.80
|
| Rate for Payer: Cash Price |
$781.80
|
| Rate for Payer: Cigna Commercial |
$2,574.73
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,355.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$301.35
|
| Rate for Payer: Health EOS Commercial |
$2,466.32
|
| Rate for Payer: HFN Commercial |
$2,574.73
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,228.56
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,228.56
|
| Rate for Payer: Independent Care Health Plan Medicare |
$301.35
|
| Rate for Payer: Multiplan Commercial |
$2,168.19
|
| Rate for Payer: NAPHCARE Commercial |
$452.03
|
| Rate for Payer: Preferred Network Access Commercial |
$2,574.73
|
| Rate for Payer: Quartz Beloit One Network |
$1,192.51
|
| Rate for Payer: Quartz Commercial |
$1,544.84
|
| Rate for Payer: Quartz Medicare Advantage |
$301.35
|
| Rate for Payer: The Alliance Commercial |
$1,145.13
|
| Rate for Payer: United Healthcare Medicare Advantage |
$301.35
|
| Rate for Payer: WEA Trust Commercial |
$1,490.63
|
| Rate for Payer: WPS Commercial |
$1,506.75
|
|
|
NM Bone Three Phase Study
|
Professional
|
Both
|
$2,814.00
|
|
|
Service Code
|
CPT 78315
|
| Hospital Charge Code |
2586831
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$301.35 |
| Max. Negotiated Rate |
$2,780.23 |
| Rate for Payer: Aetna Commercial |
$2,780.23
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,516.84
|
| Rate for Payer: Aetna Managed Medicare |
$301.35
|
| Rate for Payer: Anthem Medicare Advantage |
$301.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$301.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$301.35
|
| Rate for Payer: Cash Price |
$844.20
|
| Rate for Payer: Cash Price |
$844.20
|
| Rate for Payer: Cash Price |
$844.20
|
| Rate for Payer: Cigna Commercial |
$2,780.23
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,463.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$301.35
|
| Rate for Payer: Health EOS Commercial |
$2,663.17
|
| Rate for Payer: HFN Commercial |
$2,780.23
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,228.56
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,228.56
|
| Rate for Payer: Independent Care Health Plan Medicare |
$301.35
|
| Rate for Payer: Multiplan Commercial |
$2,341.25
|
| Rate for Payer: NAPHCARE Commercial |
$452.03
|
| Rate for Payer: Preferred Network Access Commercial |
$2,780.23
|
| Rate for Payer: Quartz Beloit One Network |
$1,287.69
|
| Rate for Payer: Quartz Commercial |
$1,668.14
|
| Rate for Payer: Quartz Medicare Advantage |
$301.35
|
| Rate for Payer: The Alliance Commercial |
$1,145.13
|
| Rate for Payer: United Healthcare Medicare Advantage |
$301.35
|
| Rate for Payer: WEA Trust Commercial |
$1,609.61
|
| Rate for Payer: WPS Commercial |
$1,506.75
|
|
|
NM Bone Three Phase Study
|
Facility
|
IP
|
$2,814.00
|
|
|
Service Code
|
CPT 78315
|
| Hospital Charge Code |
2586831
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,434.01 |
| Max. Negotiated Rate |
$2,692.44 |
| Rate for Payer: Aetna Commercial |
$2,633.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,516.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,551.08
|
| Rate for Payer: Cash Price |
$844.20
|
| Rate for Payer: Cigna Commercial |
$2,692.44
|
| Rate for Payer: Health EOS Commercial |
$2,604.64
|
| Rate for Payer: HFN Commercial |
$2,692.44
|
| Rate for Payer: Multiplan Commercial |
$2,341.25
|
| Rate for Payer: Preferred Network Access Commercial |
$2,692.44
|
| Rate for Payer: Quartz Beloit One Network |
$1,434.01
|
| Rate for Payer: Quartz Commercial |
$1,755.94
|
| Rate for Payer: WEA Trust Commercial |
$1,609.61
|
| Rate for Payer: WPS Commercial |
$2,167.62
|
|
|
NM Bone Three Phase Study
|
Facility
|
OP
|
$2,814.00
|
|
|
Service Code
|
CPT 78315
|
| Hospital Charge Code |
2586831
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$420.71 |
| Max. Negotiated Rate |
$2,692.44 |
| Rate for Payer: Aetna Commercial |
$2,633.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,516.84
|
| 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 |
$1,551.08
|
| 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 |
$844.20
|
| Rate for Payer: Cash Price |
$844.20
|
| Rate for Payer: Cash Price |
$844.20
|
| Rate for Payer: Cigna Commercial |
$2,692.44
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$420.71
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,637.75
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$420.71
|
| Rate for Payer: Health EOS Commercial |
$2,604.64
|
| Rate for Payer: HFN Commercial |
$2,692.44
|
| 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 |
$2,341.25
|
| Rate for Payer: NAPHCARE Commercial |
$631.07
|
| Rate for Payer: Preferred Network Access Commercial |
$2,692.44
|
| Rate for Payer: Quartz Beloit One Network |
$1,434.01
|
| Rate for Payer: Quartz Commercial |
$1,902.26
|
| 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 |
$1,609.61
|
| Rate for Payer: Wellcare Medicare |
$420.71
|
| Rate for Payer: WPS Commercial |
$2,167.62
|
|
|
NM Bone Three Phase Study
|
Facility
|
IP
|
$2,606.00
|
|
|
Service Code
|
CPT 78315
|
| Hospital Charge Code |
627664
|
| Min. Negotiated Rate |
$1,328.02 |
| Max. Negotiated Rate |
$2,493.42 |
| Rate for Payer: Aetna Commercial |
$2,439.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,330.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,436.43
|
| Rate for Payer: Cash Price |
$781.80
|
| Rate for Payer: Cigna Commercial |
$2,493.42
|
| Rate for Payer: Health EOS Commercial |
$2,412.11
|
| Rate for Payer: HFN Commercial |
$2,493.42
|
| Rate for Payer: Multiplan Commercial |
$2,168.19
|
| Rate for Payer: Preferred Network Access Commercial |
$2,493.42
|
| Rate for Payer: Quartz Beloit One Network |
$1,328.02
|
| Rate for Payer: Quartz Commercial |
$1,626.14
|
| Rate for Payer: WEA Trust Commercial |
$1,490.63
|
| Rate for Payer: WPS Commercial |
$2,007.40
|
|
|
NM Bone Three Phase Study
|
Facility
|
OP
|
$2,606.00
|
|
|
Service Code
|
CPT 78315
|
| Hospital Charge Code |
627664
|
| Min. Negotiated Rate |
$420.71 |
| Max. Negotiated Rate |
$2,493.42 |
| Rate for Payer: Aetna Commercial |
$2,439.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,330.81
|
| Rate for Payer: Aetna Managed Medicare |
$420.71
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,761.66
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,355.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,300.92
|
| Rate for Payer: Anthem Medicare Advantage |
$420.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,436.43
|
| 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 |
$781.80
|
| Rate for Payer: Cash Price |
$781.80
|
| Rate for Payer: Cigna Commercial |
$2,493.42
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$420.71
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,516.69
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$420.71
|
| Rate for Payer: Health EOS Commercial |
$2,412.11
|
| Rate for Payer: HFN Commercial |
$2,493.42
|
| 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 |
$2,168.19
|
| Rate for Payer: NAPHCARE Commercial |
$631.07
|
| Rate for Payer: Preferred Network Access Commercial |
$2,493.42
|
| Rate for Payer: Quartz Beloit One Network |
$1,328.02
|
| Rate for Payer: Quartz Commercial |
$1,761.66
|
| 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 |
$1,490.63
|
| Rate for Payer: Wellcare Medicare |
$420.71
|
| Rate for Payer: WPS Commercial |
$2,007.40
|
|
|
NM Brain Imaging Comp w/ Vascular Flow
|
Professional
|
Both
|
$2,076.00
|
|
|
Service Code
|
CPT 78606
|
| Hospital Charge Code |
631503
|
| Min. Negotiated Rate |
$285.96 |
| Max. Negotiated Rate |
$2,051.09 |
| Rate for Payer: Aetna Commercial |
$2,051.09
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,856.77
|
| Rate for Payer: Aetna Managed Medicare |
$285.96
|
| Rate for Payer: Anthem Medicare Advantage |
$285.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$285.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$285.96
|
| Rate for Payer: Cash Price |
$622.80
|
| Rate for Payer: Cash Price |
$622.80
|
| Rate for Payer: Cash Price |
$622.80
|
| Rate for Payer: Cigna Commercial |
$2,051.09
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,079.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$285.96
|
| Rate for Payer: Health EOS Commercial |
$1,964.73
|
| Rate for Payer: HFN Commercial |
$2,051.09
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,175.04
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,175.04
|
| Rate for Payer: Independent Care Health Plan Medicare |
$285.96
|
| Rate for Payer: Multiplan Commercial |
$1,727.23
|
| Rate for Payer: NAPHCARE Commercial |
$428.94
|
| Rate for Payer: Preferred Network Access Commercial |
$2,051.09
|
| Rate for Payer: Quartz Beloit One Network |
$949.98
|
| Rate for Payer: Quartz Commercial |
$1,230.65
|
| Rate for Payer: Quartz Medicare Advantage |
$285.96
|
| Rate for Payer: The Alliance Commercial |
$1,086.64
|
| Rate for Payer: United Healthcare Medicare Advantage |
$285.96
|
| Rate for Payer: WEA Trust Commercial |
$1,187.47
|
| Rate for Payer: WPS Commercial |
$1,429.79
|
|
|
NM Brain Imaging Comp w/ Vascular Flow
|
Facility
|
OP
|
$2,076.00
|
|
|
Service Code
|
CPT 78606
|
| Hospital Charge Code |
631503
|
| Min. Negotiated Rate |
$571.42 |
| Max. Negotiated Rate |
$2,285.67 |
| Rate for Payer: Aetna Commercial |
$1,943.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,856.77
|
| Rate for Payer: Aetna Managed Medicare |
$571.42
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,403.38
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,079.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,036.34
|
| Rate for Payer: Anthem Medicare Advantage |
$571.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,144.29
|
| 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 |
$622.80
|
| Rate for Payer: Cash Price |
$622.80
|
| Rate for Payer: Cigna Commercial |
$1,986.32
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$571.42
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,208.23
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$571.42
|
| Rate for Payer: Health EOS Commercial |
$1,921.55
|
| Rate for Payer: HFN Commercial |
$1,986.32
|
| 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 |
$1,727.23
|
| Rate for Payer: NAPHCARE Commercial |
$857.13
|
| Rate for Payer: Preferred Network Access Commercial |
$1,986.32
|
| Rate for Payer: Quartz Beloit One Network |
$1,057.93
|
| Rate for Payer: Quartz Commercial |
$1,403.38
|
| 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: WEA Trust Commercial |
$1,187.47
|
| Rate for Payer: Wellcare Medicare |
$571.42
|
| Rate for Payer: WPS Commercial |
$1,599.14
|
|
|
NM Brain Imaging Comp w/ Vascular Flow
|
Professional
|
Both
|
$2,242.00
|
|
|
Service Code
|
CPT 78606
|
| Hospital Charge Code |
2586833
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$285.96 |
| Max. Negotiated Rate |
$2,215.10 |
| Rate for Payer: Aetna Commercial |
$2,215.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,005.24
|
| Rate for Payer: Aetna Managed Medicare |
$285.96
|
| Rate for Payer: Anthem Medicare Advantage |
$285.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$285.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$285.96
|
| Rate for Payer: Cash Price |
$672.60
|
| Rate for Payer: Cash Price |
$672.60
|
| Rate for Payer: Cash Price |
$672.60
|
| Rate for Payer: Cigna Commercial |
$2,215.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,165.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$285.96
|
| Rate for Payer: Health EOS Commercial |
$2,121.83
|
| Rate for Payer: HFN Commercial |
$2,215.10
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,175.04
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,175.04
|
| Rate for Payer: Independent Care Health Plan Medicare |
$285.96
|
| Rate for Payer: Multiplan Commercial |
$1,865.34
|
| Rate for Payer: NAPHCARE Commercial |
$428.94
|
| Rate for Payer: Preferred Network Access Commercial |
$2,215.10
|
| Rate for Payer: Quartz Beloit One Network |
$1,025.94
|
| Rate for Payer: Quartz Commercial |
$1,329.06
|
| Rate for Payer: Quartz Medicare Advantage |
$285.96
|
| Rate for Payer: The Alliance Commercial |
$1,086.64
|
| Rate for Payer: United Healthcare Medicare Advantage |
$285.96
|
| Rate for Payer: WEA Trust Commercial |
$1,282.42
|
| Rate for Payer: WPS Commercial |
$1,429.79
|
|
|
NM Brain Imaging Comp w/ Vascular Flow
|
Facility
|
OP
|
$2,242.00
|
|
|
Service Code
|
CPT 78606
|
| Hospital Charge Code |
2586833
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$571.42 |
| Max. Negotiated Rate |
$2,396.16 |
| Rate for Payer: Aetna Commercial |
$2,098.51
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,005.24
|
| Rate for Payer: Aetna Managed Medicare |
$571.42
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,083.54
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,666.83
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,583.49
|
| Rate for Payer: Anthem Medicare Advantage |
$571.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,235.79
|
| 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 |
$672.60
|
| Rate for Payer: Cash Price |
$672.60
|
| Rate for Payer: Cash Price |
$672.60
|
| Rate for Payer: Cigna Commercial |
$2,145.15
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$571.42
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,304.84
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$571.42
|
| Rate for Payer: Health EOS Commercial |
$2,075.20
|
| Rate for Payer: HFN Commercial |
$2,145.15
|
| 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 |
$1,865.34
|
| Rate for Payer: NAPHCARE Commercial |
$857.13
|
| Rate for Payer: Preferred Network Access Commercial |
$2,145.15
|
| Rate for Payer: Quartz Beloit One Network |
$1,142.52
|
| Rate for Payer: Quartz Commercial |
$1,515.59
|
| 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 |
$1,282.42
|
| Rate for Payer: Wellcare Medicare |
$571.42
|
| Rate for Payer: WPS Commercial |
$1,727.01
|
|
|
NM Brain Imaging Comp w/ Vascular Flow
|
Facility
|
IP
|
$2,242.00
|
|
|
Service Code
|
CPT 78606
|
| Hospital Charge Code |
2586833
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,142.52 |
| Max. Negotiated Rate |
$2,145.15 |
| Rate for Payer: Aetna Commercial |
$2,098.51
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,005.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,235.79
|
| Rate for Payer: Cash Price |
$672.60
|
| Rate for Payer: Cigna Commercial |
$2,145.15
|
| Rate for Payer: Health EOS Commercial |
$2,075.20
|
| Rate for Payer: HFN Commercial |
$2,145.15
|
| Rate for Payer: Multiplan Commercial |
$1,865.34
|
| Rate for Payer: Preferred Network Access Commercial |
$2,145.15
|
| Rate for Payer: Quartz Beloit One Network |
$1,142.52
|
| Rate for Payer: Quartz Commercial |
$1,399.01
|
| Rate for Payer: WEA Trust Commercial |
$1,282.42
|
| Rate for Payer: WPS Commercial |
$1,727.01
|
|
|
NM Brain Imaging Comp w/ Vascular Flow
|
Facility
|
IP
|
$2,076.00
|
|
|
Service Code
|
CPT 78606
|
| Hospital Charge Code |
631503
|
| Min. Negotiated Rate |
$1,057.93 |
| Max. Negotiated Rate |
$1,986.32 |
| Rate for Payer: Aetna Commercial |
$1,943.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,856.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,144.29
|
| Rate for Payer: Cash Price |
$622.80
|
| Rate for Payer: Cigna Commercial |
$1,986.32
|
| Rate for Payer: Health EOS Commercial |
$1,921.55
|
| Rate for Payer: HFN Commercial |
$1,986.32
|
| Rate for Payer: Multiplan Commercial |
$1,727.23
|
| Rate for Payer: Preferred Network Access Commercial |
$1,986.32
|
| Rate for Payer: Quartz Beloit One Network |
$1,057.93
|
| Rate for Payer: Quartz Commercial |
$1,295.42
|
| Rate for Payer: WEA Trust Commercial |
$1,187.47
|
| Rate for Payer: WPS Commercial |
$1,599.14
|
|
|
NM Breast Tumor Localization
|
Professional
|
Both
|
$2,293.00
|
|
|
Service Code
|
CPT 78800
|
| Hospital Charge Code |
2586843
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$229.60 |
| Max. Negotiated Rate |
$2,265.48 |
| Rate for Payer: Aetna Commercial |
$2,265.48
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,050.86
|
| Rate for Payer: Aetna Managed Medicare |
$229.60
|
| Rate for Payer: Anthem Medicare Advantage |
$229.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$229.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$229.60
|
| 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 |
$2,265.48
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,192.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$229.60
|
| Rate for Payer: Health EOS Commercial |
$2,170.10
|
| Rate for Payer: HFN Commercial |
$2,265.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$905.94
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$905.94
|
| Rate for Payer: Independent Care Health Plan Medicare |
$229.60
|
| Rate for Payer: Multiplan Commercial |
$1,907.78
|
| Rate for Payer: NAPHCARE Commercial |
$344.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,265.48
|
| Rate for Payer: Quartz Beloit One Network |
$1,049.28
|
| Rate for Payer: Quartz Commercial |
$1,359.29
|
| Rate for Payer: Quartz Medicare Advantage |
$229.60
|
| Rate for Payer: The Alliance Commercial |
$872.48
|
| Rate for Payer: United Healthcare Medicare Advantage |
$229.60
|
| Rate for Payer: WEA Trust Commercial |
$1,311.60
|
| Rate for Payer: WPS Commercial |
$1,148.00
|
|
|
NM Breast Tumor Localization
|
Facility
|
OP
|
$2,205.00
|
|
|
Service Code
|
CPT 78800
|
| Hospital Charge Code |
675701
|
| Min. Negotiated Rate |
$420.71 |
| Max. Negotiated Rate |
$2,109.74 |
| Rate for Payer: Aetna Commercial |
$2,063.88
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,972.15
|
| Rate for Payer: Aetna Managed Medicare |
$420.71
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,490.58
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,146.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,100.74
|
| Rate for Payer: Anthem Medicare Advantage |
$420.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,215.40
|
| 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 |
$661.50
|
| Rate for Payer: Cash Price |
$661.50
|
| Rate for Payer: Cigna Commercial |
$2,109.74
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$420.71
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,283.31
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$420.71
|
| Rate for Payer: Health EOS Commercial |
$2,040.95
|
| Rate for Payer: HFN Commercial |
$2,109.74
|
| 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 |
$1,834.56
|
| Rate for Payer: NAPHCARE Commercial |
$631.07
|
| Rate for Payer: Preferred Network Access Commercial |
$2,109.74
|
| Rate for Payer: Quartz Beloit One Network |
$1,123.67
|
| Rate for Payer: Quartz Commercial |
$1,490.58
|
| 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 |
$1,261.26
|
| Rate for Payer: Wellcare Medicare |
$420.71
|
| Rate for Payer: WPS Commercial |
$1,698.51
|
|
|
NM Breast Tumor Localization
|
Facility
|
IP
|
$2,293.00
|
|
|
Service Code
|
CPT 78800
|
| Hospital Charge Code |
2586843
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,168.51 |
| Max. Negotiated Rate |
$2,193.94 |
| Rate for Payer: Aetna Commercial |
$2,146.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,050.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,263.90
|
| Rate for Payer: Cash Price |
$687.90
|
| Rate for Payer: Cigna Commercial |
$2,193.94
|
| Rate for Payer: Health EOS Commercial |
$2,122.40
|
| Rate for Payer: HFN Commercial |
$2,193.94
|
| Rate for Payer: Multiplan Commercial |
$1,907.78
|
| Rate for Payer: Preferred Network Access Commercial |
$2,193.94
|
| Rate for Payer: Quartz Beloit One Network |
$1,168.51
|
| Rate for Payer: Quartz Commercial |
$1,430.83
|
| Rate for Payer: WEA Trust Commercial |
$1,311.60
|
| Rate for Payer: WPS Commercial |
$1,766.30
|
|
|
NM Breast Tumor Localization
|
Professional
|
Both
|
$2,205.00
|
|
|
Service Code
|
CPT 78800
|
| Hospital Charge Code |
675701
|
| Min. Negotiated Rate |
$229.60 |
| Max. Negotiated Rate |
$2,178.54 |
| Rate for Payer: Aetna Commercial |
$2,178.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,972.15
|
| Rate for Payer: Aetna Managed Medicare |
$229.60
|
| Rate for Payer: Anthem Medicare Advantage |
$229.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$229.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$229.60
|
| 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 |
$2,178.54
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,146.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$229.60
|
| Rate for Payer: Health EOS Commercial |
$2,086.81
|
| Rate for Payer: HFN Commercial |
$2,178.54
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$905.94
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$905.94
|
| Rate for Payer: Independent Care Health Plan Medicare |
$229.60
|
| Rate for Payer: Multiplan Commercial |
$1,834.56
|
| Rate for Payer: NAPHCARE Commercial |
$344.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,178.54
|
| Rate for Payer: Quartz Beloit One Network |
$1,009.01
|
| Rate for Payer: Quartz Commercial |
$1,307.12
|
| Rate for Payer: Quartz Medicare Advantage |
$229.60
|
| Rate for Payer: The Alliance Commercial |
$872.48
|
| Rate for Payer: United Healthcare Medicare Advantage |
$229.60
|
| Rate for Payer: WEA Trust Commercial |
$1,261.26
|
| Rate for Payer: WPS Commercial |
$1,148.00
|
|
|
NM Breast Tumor Localization
|
Facility
|
IP
|
$2,205.00
|
|
|
Service Code
|
CPT 78800
|
| Hospital Charge Code |
675701
|
| Min. Negotiated Rate |
$1,123.67 |
| Max. Negotiated Rate |
$2,109.74 |
| Rate for Payer: Aetna Commercial |
$2,063.88
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,972.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,215.40
|
| Rate for Payer: Cash Price |
$661.50
|
| Rate for Payer: Cigna Commercial |
$2,109.74
|
| Rate for Payer: Health EOS Commercial |
$2,040.95
|
| Rate for Payer: HFN Commercial |
$2,109.74
|
| Rate for Payer: Multiplan Commercial |
$1,834.56
|
| Rate for Payer: Preferred Network Access Commercial |
$2,109.74
|
| Rate for Payer: Quartz Beloit One Network |
$1,123.67
|
| Rate for Payer: Quartz Commercial |
$1,375.92
|
| Rate for Payer: WEA Trust Commercial |
$1,261.26
|
| Rate for Payer: WPS Commercial |
$1,698.51
|
|
|
NM Breast Tumor Localization
|
Facility
|
OP
|
$2,293.00
|
|
|
Service Code
|
CPT 78800
|
| Hospital Charge Code |
2586843
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$420.71 |
| Max. Negotiated Rate |
$2,396.16 |
| Rate for Payer: Aetna Commercial |
$2,146.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,050.86
|
| 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 |
$1,263.90
|
| 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 |
$687.90
|
| Rate for Payer: Cash Price |
$687.90
|
| Rate for Payer: Cash Price |
$687.90
|
| Rate for Payer: Cigna Commercial |
$2,193.94
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$420.71
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,334.53
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$420.71
|
| Rate for Payer: Health EOS Commercial |
$2,122.40
|
| Rate for Payer: HFN Commercial |
$2,193.94
|
| 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 |
$1,907.78
|
| Rate for Payer: NAPHCARE Commercial |
$631.07
|
| Rate for Payer: Preferred Network Access Commercial |
$2,193.94
|
| Rate for Payer: Quartz Beloit One Network |
$1,168.51
|
| Rate for Payer: Quartz Commercial |
$1,550.07
|
| 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 |
$1,311.60
|
| Rate for Payer: Wellcare Medicare |
$420.71
|
| Rate for Payer: WPS Commercial |
$1,766.30
|
|
|
NM Cerebrospinal Fluid Leakage Detection
|
Professional
|
Both
|
$2,585.00
|
|
|
Service Code
|
CPT 78650
|
| Hospital Charge Code |
629686
|
| Min. Negotiated Rate |
$243.54 |
| Max. Negotiated Rate |
$2,553.98 |
| Rate for Payer: Aetna Commercial |
$2,553.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,312.02
|
| Rate for Payer: Aetna Managed Medicare |
$243.54
|
| Rate for Payer: Anthem Medicare Advantage |
$243.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$243.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$243.54
|
| Rate for Payer: Cash Price |
$775.50
|
| Rate for Payer: Cash Price |
$775.50
|
| Rate for Payer: Cash Price |
$775.50
|
| Rate for Payer: Cigna Commercial |
$2,553.98
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,344.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$243.54
|
| Rate for Payer: Health EOS Commercial |
$2,446.44
|
| Rate for Payer: HFN Commercial |
$2,553.98
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$985.42
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$985.42
|
| Rate for Payer: Independent Care Health Plan Medicare |
$243.54
|
| Rate for Payer: Multiplan Commercial |
$2,150.72
|
| Rate for Payer: NAPHCARE Commercial |
$365.31
|
| Rate for Payer: Preferred Network Access Commercial |
$2,553.98
|
| Rate for Payer: Quartz Beloit One Network |
$1,182.90
|
| Rate for Payer: Quartz Commercial |
$1,532.39
|
| Rate for Payer: Quartz Medicare Advantage |
$243.54
|
| Rate for Payer: The Alliance Commercial |
$925.44
|
| Rate for Payer: United Healthcare Medicare Advantage |
$243.54
|
| Rate for Payer: WEA Trust Commercial |
$1,478.62
|
| Rate for Payer: WPS Commercial |
$1,217.68
|
|
|
NM Cerebrospinal Fluid Leakage Detection
|
Facility
|
IP
|
$2,585.00
|
|
|
Service Code
|
CPT 78650
|
| Hospital Charge Code |
629686
|
| Min. Negotiated Rate |
$1,317.32 |
| Max. Negotiated Rate |
$2,473.33 |
| Rate for Payer: Aetna Commercial |
$2,419.56
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,312.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,424.85
|
| Rate for Payer: Cash Price |
$775.50
|
| Rate for Payer: Cigna Commercial |
$2,473.33
|
| Rate for Payer: Health EOS Commercial |
$2,392.68
|
| Rate for Payer: HFN Commercial |
$2,473.33
|
| Rate for Payer: Multiplan Commercial |
$2,150.72
|
| Rate for Payer: Preferred Network Access Commercial |
$2,473.33
|
| Rate for Payer: Quartz Beloit One Network |
$1,317.32
|
| Rate for Payer: Quartz Commercial |
$1,613.04
|
| Rate for Payer: WEA Trust Commercial |
$1,478.62
|
| Rate for Payer: WPS Commercial |
$1,991.23
|
|
|
NM Cerebrospinal Fluid Leakage Detection
|
Facility
|
OP
|
$2,688.00
|
|
|
Service Code
|
CPT 78650
|
| Hospital Charge Code |
2586853
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,362.47 |
| Max. Negotiated Rate |
$5,473.65 |
| Rate for Payer: Aetna Commercial |
$2,515.97
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,404.15
|
| 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 |
$1,481.63
|
| 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 |
$806.40
|
| Rate for Payer: Cash Price |
$806.40
|
| Rate for Payer: Cash Price |
$806.40
|
| Rate for Payer: Cigna Commercial |
$2,571.88
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$1,362.47
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,564.42
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$1,362.47
|
| Rate for Payer: Health EOS Commercial |
$2,488.01
|
| Rate for Payer: HFN Commercial |
$2,571.88
|
| 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 |
$2,236.42
|
| Rate for Payer: NAPHCARE Commercial |
$2,043.71
|
| Rate for Payer: Preferred Network Access Commercial |
$2,571.88
|
| Rate for Payer: Quartz Beloit One Network |
$1,369.80
|
| Rate for Payer: Quartz Commercial |
$1,817.09
|
| 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 |
$1,537.54
|
| Rate for Payer: Wellcare Medicare |
$1,362.47
|
| Rate for Payer: WPS Commercial |
$2,070.57
|
|
