|
NM Cerebrospinal Fluid Leakage Detection
|
Professional
|
Both
|
$2,688.00
|
|
|
Service Code
|
CPT 78650
|
| Hospital Charge Code |
2586853
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$243.54 |
| Max. Negotiated Rate |
$2,655.74 |
| Rate for Payer: Aetna Commercial |
$2,655.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,404.15
|
| 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 |
$806.40
|
| Rate for Payer: Cash Price |
$806.40
|
| Rate for Payer: Cash Price |
$806.40
|
| Rate for Payer: Cigna Commercial |
$2,655.74
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,397.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$243.54
|
| Rate for Payer: Health EOS Commercial |
$2,543.92
|
| Rate for Payer: HFN Commercial |
$2,655.74
|
| 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 |
$2,236.42
|
| Rate for Payer: NAPHCARE Commercial |
$365.31
|
| Rate for Payer: Preferred Network Access Commercial |
$2,655.74
|
| Rate for Payer: Quartz Beloit One Network |
$1,230.03
|
| Rate for Payer: Quartz Commercial |
$1,593.45
|
| 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 |
$1,537.54
|
| Rate for Payer: WPS Commercial |
$1,217.68
|
|
|
NM Cerebrospinal Fluid Leakage Detection
|
Facility
|
OP
|
$2,585.00
|
|
|
Service Code
|
CPT 78650
|
| Hospital Charge Code |
629686
|
| Min. Negotiated Rate |
$1,290.43 |
| Max. Negotiated Rate |
$5,449.89 |
| Rate for Payer: Aetna Commercial |
$2,419.56
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,312.02
|
| Rate for Payer: Aetna Managed Medicare |
$1,362.47
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,747.46
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,344.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,290.43
|
| Rate for Payer: Anthem Medicare Advantage |
$1,362.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,424.85
|
| 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 |
$775.50
|
| Rate for Payer: Cash Price |
$775.50
|
| Rate for Payer: Cigna Commercial |
$2,473.33
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$1,362.47
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,504.47
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$1,362.47
|
| Rate for Payer: Health EOS Commercial |
$2,392.68
|
| Rate for Payer: HFN Commercial |
$2,473.33
|
| 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 |
$2,150.72
|
| Rate for Payer: NAPHCARE Commercial |
$2,043.71
|
| 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 |
$1,747.46
|
| 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 |
$1,478.62
|
| Rate for Payer: Wellcare Medicare |
$1,362.47
|
| Rate for Payer: WPS Commercial |
$1,991.23
|
|
|
NM Cerebrospinal Fluid Leakage Detection
|
Facility
|
IP
|
$2,688.00
|
|
|
Service Code
|
CPT 78650
|
| Hospital Charge Code |
2586853
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,369.80 |
| Max. Negotiated Rate |
$2,571.88 |
| Rate for Payer: Aetna Commercial |
$2,515.97
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,404.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,481.63
|
| Rate for Payer: Cash Price |
$806.40
|
| Rate for Payer: Cigna Commercial |
$2,571.88
|
| Rate for Payer: Health EOS Commercial |
$2,488.01
|
| Rate for Payer: HFN Commercial |
$2,571.88
|
| Rate for Payer: Multiplan Commercial |
$2,236.42
|
| 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 |
$1,677.31
|
| Rate for Payer: WEA Trust Commercial |
$1,537.54
|
| Rate for Payer: WPS Commercial |
$2,070.57
|
|
|
NM Cisternography/Cerebrospinal
|
Facility
|
OP
|
$2,443.00
|
|
|
Service Code
|
CPT 78630
|
| Hospital Charge Code |
2586857
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$571.42 |
| Max. Negotiated Rate |
$2,396.16 |
| Rate for Payer: Aetna Commercial |
$2,286.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,185.02
|
| 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 |
$1,346.58
|
| 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 |
$732.90
|
| Rate for Payer: Cash Price |
$732.90
|
| Rate for Payer: Cash Price |
$732.90
|
| Rate for Payer: Cigna Commercial |
$2,337.46
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$571.42
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,421.83
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$571.42
|
| Rate for Payer: Health EOS Commercial |
$2,261.24
|
| Rate for Payer: HFN Commercial |
$2,337.46
|
| 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 |
$2,032.58
|
| Rate for Payer: NAPHCARE Commercial |
$857.13
|
| Rate for Payer: Preferred Network Access Commercial |
$2,337.46
|
| Rate for Payer: Quartz Beloit One Network |
$1,244.95
|
| Rate for Payer: Quartz Commercial |
$1,651.47
|
| 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 |
$1,397.40
|
| Rate for Payer: Wellcare Medicare |
$571.42
|
| Rate for Payer: WPS Commercial |
$1,881.84
|
|
|
NM Cisternography/Cerebrospinal
|
Professional
|
Both
|
$2,443.00
|
|
|
Service Code
|
CPT 78630
|
| Hospital Charge Code |
2586857
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$292.22 |
| Max. Negotiated Rate |
$2,413.68 |
| Rate for Payer: Aetna Commercial |
$2,413.68
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,185.02
|
| Rate for Payer: Aetna Managed Medicare |
$292.22
|
| Rate for Payer: Anthem Medicare Advantage |
$292.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$292.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$292.22
|
| Rate for Payer: Cash Price |
$732.90
|
| Rate for Payer: Cash Price |
$732.90
|
| Rate for Payer: Cash Price |
$732.90
|
| Rate for Payer: Cigna Commercial |
$2,413.68
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,270.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$292.22
|
| Rate for Payer: Health EOS Commercial |
$2,312.06
|
| Rate for Payer: HFN Commercial |
$2,413.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,195.85
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,195.85
|
| Rate for Payer: Independent Care Health Plan Medicare |
$292.22
|
| Rate for Payer: Multiplan Commercial |
$2,032.58
|
| Rate for Payer: NAPHCARE Commercial |
$438.33
|
| Rate for Payer: Preferred Network Access Commercial |
$2,413.68
|
| Rate for Payer: Quartz Beloit One Network |
$1,117.92
|
| Rate for Payer: Quartz Commercial |
$1,448.21
|
| Rate for Payer: Quartz Medicare Advantage |
$292.22
|
| Rate for Payer: The Alliance Commercial |
$1,110.43
|
| Rate for Payer: United Healthcare Medicare Advantage |
$292.22
|
| Rate for Payer: WEA Trust Commercial |
$1,397.40
|
| Rate for Payer: WPS Commercial |
$1,461.10
|
|
|
NM Cisternography/Cerebrospinal
|
Professional
|
Both
|
$2,349.00
|
|
|
Service Code
|
CPT 78630
|
| Hospital Charge Code |
629748
|
| Min. Negotiated Rate |
$292.22 |
| Max. Negotiated Rate |
$2,320.81 |
| Rate for Payer: Aetna Commercial |
$2,320.81
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,100.95
|
| Rate for Payer: Aetna Managed Medicare |
$292.22
|
| Rate for Payer: Anthem Medicare Advantage |
$292.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$292.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$292.22
|
| Rate for Payer: Cash Price |
$704.70
|
| Rate for Payer: Cash Price |
$704.70
|
| Rate for Payer: Cash Price |
$704.70
|
| Rate for Payer: Cigna Commercial |
$2,320.81
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,221.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$292.22
|
| Rate for Payer: Health EOS Commercial |
$2,223.09
|
| Rate for Payer: HFN Commercial |
$2,320.81
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,195.85
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,195.85
|
| Rate for Payer: Independent Care Health Plan Medicare |
$292.22
|
| Rate for Payer: Multiplan Commercial |
$1,954.37
|
| Rate for Payer: NAPHCARE Commercial |
$438.33
|
| Rate for Payer: Preferred Network Access Commercial |
$2,320.81
|
| Rate for Payer: Quartz Beloit One Network |
$1,074.90
|
| Rate for Payer: Quartz Commercial |
$1,392.49
|
| Rate for Payer: Quartz Medicare Advantage |
$292.22
|
| Rate for Payer: The Alliance Commercial |
$1,110.43
|
| Rate for Payer: United Healthcare Medicare Advantage |
$292.22
|
| Rate for Payer: WEA Trust Commercial |
$1,343.63
|
| Rate for Payer: WPS Commercial |
$1,461.10
|
|
|
NM Cisternography/Cerebrospinal
|
Facility
|
IP
|
$2,443.00
|
|
|
Service Code
|
CPT 78630
|
| Hospital Charge Code |
2586857
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,244.95 |
| Max. Negotiated Rate |
$2,337.46 |
| Rate for Payer: Aetna Commercial |
$2,286.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,185.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,346.58
|
| Rate for Payer: Cash Price |
$732.90
|
| Rate for Payer: Cigna Commercial |
$2,337.46
|
| Rate for Payer: Health EOS Commercial |
$2,261.24
|
| Rate for Payer: HFN Commercial |
$2,337.46
|
| Rate for Payer: Multiplan Commercial |
$2,032.58
|
| Rate for Payer: Preferred Network Access Commercial |
$2,337.46
|
| Rate for Payer: Quartz Beloit One Network |
$1,244.95
|
| Rate for Payer: Quartz Commercial |
$1,524.43
|
| Rate for Payer: WEA Trust Commercial |
$1,397.40
|
| Rate for Payer: WPS Commercial |
$1,881.84
|
|
|
NM Cisternography/Cerebrospinal
|
Facility
|
OP
|
$2,349.00
|
|
|
Service Code
|
CPT 78630
|
| Hospital Charge Code |
629748
|
| Min. Negotiated Rate |
$571.42 |
| Max. Negotiated Rate |
$2,285.67 |
| Rate for Payer: Aetna Commercial |
$2,198.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,100.95
|
| Rate for Payer: Aetna Managed Medicare |
$571.42
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,587.92
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,221.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,172.62
|
| Rate for Payer: Anthem Medicare Advantage |
$571.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,294.77
|
| 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 |
$704.70
|
| Rate for Payer: Cash Price |
$704.70
|
| Rate for Payer: Cigna Commercial |
$2,247.52
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$571.42
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,367.12
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$571.42
|
| Rate for Payer: Health EOS Commercial |
$2,174.23
|
| Rate for Payer: HFN Commercial |
$2,247.52
|
| 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 |
$1,954.37
|
| Rate for Payer: NAPHCARE Commercial |
$857.13
|
| Rate for Payer: Preferred Network Access Commercial |
$2,247.52
|
| Rate for Payer: Quartz Beloit One Network |
$1,197.05
|
| Rate for Payer: Quartz Commercial |
$1,587.92
|
| 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 |
$1,343.63
|
| Rate for Payer: Wellcare Medicare |
$571.42
|
| Rate for Payer: WPS Commercial |
$1,809.43
|
|
|
NM Cisternography/Cerebrospinal
|
Facility
|
IP
|
$2,349.00
|
|
|
Service Code
|
CPT 78630
|
| Hospital Charge Code |
629748
|
| Min. Negotiated Rate |
$1,197.05 |
| Max. Negotiated Rate |
$2,247.52 |
| Rate for Payer: Aetna Commercial |
$2,198.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,100.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,294.77
|
| Rate for Payer: Cash Price |
$704.70
|
| Rate for Payer: Cigna Commercial |
$2,247.52
|
| Rate for Payer: Health EOS Commercial |
$2,174.23
|
| Rate for Payer: HFN Commercial |
$2,247.52
|
| Rate for Payer: Multiplan Commercial |
$1,954.37
|
| Rate for Payer: Preferred Network Access Commercial |
$2,247.52
|
| Rate for Payer: Quartz Beloit One Network |
$1,197.05
|
| Rate for Payer: Quartz Commercial |
$1,465.78
|
| Rate for Payer: WEA Trust Commercial |
$1,343.63
|
| Rate for Payer: WPS Commercial |
$1,809.43
|
|
|
N. meningitidis Group A/Y Antigen
|
Facility
|
IP
|
$92.00
|
|
|
Service Code
|
CPT 86403
|
| Hospital Charge Code |
5096645
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$46.88 |
| Max. Negotiated Rate |
$88.03 |
| Rate for Payer: Aetna Commercial |
$86.11
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$82.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$50.71
|
| Rate for Payer: Cash Price |
$27.60
|
| Rate for Payer: Cigna Commercial |
$88.03
|
| Rate for Payer: Health EOS Commercial |
$85.16
|
| Rate for Payer: HFN Commercial |
$88.03
|
| Rate for Payer: Multiplan Commercial |
$76.54
|
| Rate for Payer: Preferred Network Access Commercial |
$88.03
|
| Rate for Payer: Quartz Beloit One Network |
$46.88
|
| Rate for Payer: Quartz Commercial |
$57.41
|
| Rate for Payer: WEA Trust Commercial |
$52.62
|
| Rate for Payer: WPS Commercial |
$70.87
|
|
|
N. meningitidis Group A/Y Antigen
|
Facility
|
OP
|
$92.00
|
|
|
Service Code
|
CPT 86403
|
| Hospital Charge Code |
5096645
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.00 |
| Max. Negotiated Rate |
$88.03 |
| Rate for Payer: Aetna Commercial |
$86.11
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$82.28
|
| Rate for Payer: Aetna Managed Medicare |
$12.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$45.01
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$21.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$19.92
|
| Rate for Payer: Anthem Medicare Advantage |
$12.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$50.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12.00
|
| Rate for Payer: Cash Price |
$27.60
|
| Rate for Payer: Cash Price |
$27.60
|
| Rate for Payer: Cigna Commercial |
$88.03
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$12.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$53.54
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$12.00
|
| Rate for Payer: Health EOS Commercial |
$85.16
|
| Rate for Payer: HFN Commercial |
$88.03
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$44.65
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$12.00
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12.00
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$12.00
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$12.00
|
| Rate for Payer: Multiplan Commercial |
$76.54
|
| Rate for Payer: NAPHCARE Commercial |
$18.00
|
| Rate for Payer: Preferred Network Access Commercial |
$88.03
|
| Rate for Payer: Quartz Beloit One Network |
$46.88
|
| Rate for Payer: Quartz Commercial |
$62.19
|
| Rate for Payer: Quartz Medicare Advantage |
$12.00
|
| Rate for Payer: The Alliance Commercial |
$48.01
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.00
|
| Rate for Payer: United Healthcare PPO |
$71.76
|
| Rate for Payer: WEA Trust Commercial |
$52.62
|
| Rate for Payer: Wellcare Medicare |
$12.00
|
| Rate for Payer: WPS Commercial |
$70.87
|
|
|
N. meningitidis Group A/Y Antigen
|
Professional
|
Both
|
$92.00
|
|
|
Service Code
|
CPT 86403
|
| Hospital Charge Code |
5096645
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.00 |
| Max. Negotiated Rate |
$90.90 |
| Rate for Payer: Aetna Commercial |
$90.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$82.28
|
| Rate for Payer: Aetna Managed Medicare |
$12.00
|
| Rate for Payer: Anthem Medicare Advantage |
$12.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12.00
|
| Rate for Payer: Cash Price |
$27.60
|
| Rate for Payer: Cash Price |
$27.60
|
| Rate for Payer: Cigna Commercial |
$90.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$47.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12.00
|
| Rate for Payer: Health EOS Commercial |
$87.07
|
| Rate for Payer: HFN Commercial |
$90.90
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$42.37
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$42.37
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12.00
|
| Rate for Payer: Multiplan Commercial |
$76.54
|
| Rate for Payer: NAPHCARE Commercial |
$18.00
|
| Rate for Payer: Preferred Network Access Commercial |
$90.90
|
| Rate for Payer: Quartz Beloit One Network |
$42.10
|
| Rate for Payer: Quartz Commercial |
$54.54
|
| Rate for Payer: Quartz Medicare Advantage |
$12.00
|
| Rate for Payer: The Alliance Commercial |
$47.41
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.00
|
| Rate for Payer: WEA Trust Commercial |
$52.62
|
| Rate for Payer: WPS Commercial |
$52.81
|
|
|
N. meningitidis Group B/E, Coli K1 Antigen
|
Facility
|
IP
|
$92.00
|
|
|
Service Code
|
CPT 86403
|
| Hospital Charge Code |
5096646
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$46.88 |
| Max. Negotiated Rate |
$88.03 |
| Rate for Payer: Aetna Commercial |
$86.11
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$82.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$50.71
|
| Rate for Payer: Cash Price |
$27.60
|
| Rate for Payer: Cigna Commercial |
$88.03
|
| Rate for Payer: Health EOS Commercial |
$85.16
|
| Rate for Payer: HFN Commercial |
$88.03
|
| Rate for Payer: Multiplan Commercial |
$76.54
|
| Rate for Payer: Preferred Network Access Commercial |
$88.03
|
| Rate for Payer: Quartz Beloit One Network |
$46.88
|
| Rate for Payer: Quartz Commercial |
$57.41
|
| Rate for Payer: WEA Trust Commercial |
$52.62
|
| Rate for Payer: WPS Commercial |
$70.87
|
|
|
N. meningitidis Group B/E, Coli K1 Antigen
|
Professional
|
Both
|
$92.00
|
|
|
Service Code
|
CPT 86403
|
| Hospital Charge Code |
5096646
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.00 |
| Max. Negotiated Rate |
$90.90 |
| Rate for Payer: Aetna Commercial |
$90.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$82.28
|
| Rate for Payer: Aetna Managed Medicare |
$12.00
|
| Rate for Payer: Anthem Medicare Advantage |
$12.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12.00
|
| Rate for Payer: Cash Price |
$27.60
|
| Rate for Payer: Cash Price |
$27.60
|
| Rate for Payer: Cigna Commercial |
$90.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$47.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12.00
|
| Rate for Payer: Health EOS Commercial |
$87.07
|
| Rate for Payer: HFN Commercial |
$90.90
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$42.37
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$42.37
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12.00
|
| Rate for Payer: Multiplan Commercial |
$76.54
|
| Rate for Payer: NAPHCARE Commercial |
$18.00
|
| Rate for Payer: Preferred Network Access Commercial |
$90.90
|
| Rate for Payer: Quartz Beloit One Network |
$42.10
|
| Rate for Payer: Quartz Commercial |
$54.54
|
| Rate for Payer: Quartz Medicare Advantage |
$12.00
|
| Rate for Payer: The Alliance Commercial |
$47.41
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.00
|
| Rate for Payer: WEA Trust Commercial |
$52.62
|
| Rate for Payer: WPS Commercial |
$52.81
|
|
|
N. meningitidis Group B/E, Coli K1 Antigen
|
Facility
|
OP
|
$92.00
|
|
|
Service Code
|
CPT 86403
|
| Hospital Charge Code |
5096646
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.00 |
| Max. Negotiated Rate |
$88.03 |
| Rate for Payer: Aetna Commercial |
$86.11
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$82.28
|
| Rate for Payer: Aetna Managed Medicare |
$12.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$45.01
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$21.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$19.92
|
| Rate for Payer: Anthem Medicare Advantage |
$12.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$50.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12.00
|
| Rate for Payer: Cash Price |
$27.60
|
| Rate for Payer: Cash Price |
$27.60
|
| Rate for Payer: Cigna Commercial |
$88.03
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$12.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$53.54
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$12.00
|
| Rate for Payer: Health EOS Commercial |
$85.16
|
| Rate for Payer: HFN Commercial |
$88.03
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$44.65
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$12.00
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12.00
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$12.00
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$12.00
|
| Rate for Payer: Multiplan Commercial |
$76.54
|
| Rate for Payer: NAPHCARE Commercial |
$18.00
|
| Rate for Payer: Preferred Network Access Commercial |
$88.03
|
| Rate for Payer: Quartz Beloit One Network |
$46.88
|
| Rate for Payer: Quartz Commercial |
$62.19
|
| Rate for Payer: Quartz Medicare Advantage |
$12.00
|
| Rate for Payer: The Alliance Commercial |
$48.01
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.00
|
| Rate for Payer: United Healthcare PPO |
$71.76
|
| Rate for Payer: WEA Trust Commercial |
$52.62
|
| Rate for Payer: Wellcare Medicare |
$12.00
|
| Rate for Payer: WPS Commercial |
$70.87
|
|
|
N-Methylhistamine, 24 Hr Urine
|
Facility
|
IP
|
$105.00
|
|
|
Service Code
|
CPT 82542
|
| Hospital Charge Code |
5098624
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$53.51 |
| Max. Negotiated Rate |
$100.46 |
| Rate for Payer: Aetna Commercial |
$98.28
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$93.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$57.88
|
| Rate for Payer: Cash Price |
$31.50
|
| Rate for Payer: Cigna Commercial |
$100.46
|
| Rate for Payer: Health EOS Commercial |
$97.19
|
| Rate for Payer: HFN Commercial |
$100.46
|
| Rate for Payer: Multiplan Commercial |
$87.36
|
| Rate for Payer: Preferred Network Access Commercial |
$100.46
|
| Rate for Payer: Quartz Beloit One Network |
$53.51
|
| Rate for Payer: Quartz Commercial |
$65.52
|
| Rate for Payer: WEA Trust Commercial |
$60.06
|
| Rate for Payer: WPS Commercial |
$80.88
|
|
|
N-Methylhistamine, 24 Hr Urine
|
Facility
|
OP
|
$105.00
|
|
|
Service Code
|
CPT 82542
|
| Hospital Charge Code |
5098624
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$25.05 |
| Max. Negotiated Rate |
$100.46 |
| Rate for Payer: Aetna Commercial |
$98.28
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$93.91
|
| Rate for Payer: Aetna Managed Medicare |
$25.05
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$93.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$43.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$41.59
|
| Rate for Payer: Anthem Medicare Advantage |
$25.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$57.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$25.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$25.05
|
| Rate for Payer: Cash Price |
$31.50
|
| Rate for Payer: Cash Price |
$31.50
|
| Rate for Payer: Cigna Commercial |
$100.46
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$25.05
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$61.11
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$25.05
|
| Rate for Payer: Health EOS Commercial |
$97.19
|
| Rate for Payer: HFN Commercial |
$100.46
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$93.20
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$25.05
|
| Rate for Payer: Independent Care Health Plan Medicare |
$25.05
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$25.05
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$25.05
|
| Rate for Payer: Multiplan Commercial |
$87.36
|
| Rate for Payer: NAPHCARE Commercial |
$37.58
|
| Rate for Payer: Preferred Network Access Commercial |
$100.46
|
| Rate for Payer: Quartz Beloit One Network |
$53.51
|
| Rate for Payer: Quartz Commercial |
$70.98
|
| Rate for Payer: Quartz Medicare Advantage |
$25.05
|
| Rate for Payer: The Alliance Commercial |
$100.21
|
| Rate for Payer: United Healthcare Medicare Advantage |
$25.05
|
| Rate for Payer: United Healthcare PPO |
$81.90
|
| Rate for Payer: WEA Trust Commercial |
$60.06
|
| Rate for Payer: Wellcare Medicare |
$25.05
|
| Rate for Payer: WPS Commercial |
$80.88
|
|
|
N-Methylhistamine, 24 Hr Urine
|
Professional
|
Both
|
$105.00
|
|
|
Service Code
|
CPT 82542
|
| Hospital Charge Code |
5098624
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$25.05 |
| Max. Negotiated Rate |
$110.24 |
| Rate for Payer: Aetna Commercial |
$103.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$93.91
|
| Rate for Payer: Aetna Managed Medicare |
$25.05
|
| Rate for Payer: Anthem Medicare Advantage |
$25.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$25.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$25.05
|
| Rate for Payer: Cash Price |
$31.50
|
| Rate for Payer: Cash Price |
$31.50
|
| Rate for Payer: Cigna Commercial |
$103.74
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$54.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$25.05
|
| Rate for Payer: Health EOS Commercial |
$99.37
|
| Rate for Payer: HFN Commercial |
$103.74
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$88.44
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$88.44
|
| Rate for Payer: Independent Care Health Plan Medicare |
$25.05
|
| Rate for Payer: Multiplan Commercial |
$87.36
|
| Rate for Payer: NAPHCARE Commercial |
$37.58
|
| Rate for Payer: Preferred Network Access Commercial |
$103.74
|
| Rate for Payer: Quartz Beloit One Network |
$48.05
|
| Rate for Payer: Quartz Commercial |
$62.24
|
| Rate for Payer: Quartz Medicare Advantage |
$25.05
|
| Rate for Payer: The Alliance Commercial |
$98.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$25.05
|
| Rate for Payer: WEA Trust Commercial |
$60.06
|
| Rate for Payer: WPS Commercial |
$110.24
|
|
|
NM Gastric Emptying Study
|
Facility
|
OP
|
$2,878.00
|
|
|
Service Code
|
CPT 78264
|
| Hospital Charge Code |
631161
|
| 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 |
$1,945.53
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,496.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,436.70
|
| 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: 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: WEA Trust Commercial |
$1,646.22
|
| Rate for Payer: Wellcare Medicare |
$420.71
|
| Rate for Payer: WPS Commercial |
$2,216.92
|
|
|
NM Gastric Emptying Study
|
Facility
|
IP
|
$2,878.00
|
|
|
Service Code
|
CPT 78264
|
| Hospital Charge Code |
631161
|
| 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 Gastric Emptying Study
|
Facility
|
OP
|
$3,110.00
|
|
|
Service Code
|
CPT 78264
|
| Hospital Charge Code |
2586863
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$420.71 |
| Max. Negotiated Rate |
$2,975.65 |
| Rate for Payer: Aetna Commercial |
$2,910.96
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,781.58
|
| 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 |
$1,714.23
|
| 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 |
$933.00
|
| Rate for Payer: Cash Price |
$933.00
|
| Rate for Payer: Cash Price |
$933.00
|
| Rate for Payer: Cigna Commercial |
$2,975.65
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$420.71
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,810.02
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$420.71
|
| Rate for Payer: Health EOS Commercial |
$2,878.62
|
| Rate for Payer: HFN Commercial |
$2,975.65
|
| 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 |
$2,587.52
|
| Rate for Payer: NAPHCARE Commercial |
$631.07
|
| Rate for Payer: Preferred Network Access Commercial |
$2,975.65
|
| Rate for Payer: Quartz Beloit One Network |
$1,584.86
|
| Rate for Payer: Quartz Commercial |
$2,102.36
|
| 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 |
$1,778.92
|
| Rate for Payer: Wellcare Medicare |
$420.71
|
| Rate for Payer: WPS Commercial |
$2,395.63
|
|
|
NM Gastric Emptying Study
|
Professional
|
Both
|
$3,110.00
|
|
|
Service Code
|
CPT 78264
|
| Hospital Charge Code |
2586863
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$287.94 |
| Max. Negotiated Rate |
$3,072.68 |
| Rate for Payer: Aetna Commercial |
$3,072.68
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,781.58
|
| Rate for Payer: Aetna Managed Medicare |
$287.94
|
| Rate for Payer: Anthem Medicare Advantage |
$287.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$287.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$287.94
|
| Rate for Payer: Cash Price |
$933.00
|
| Rate for Payer: Cash Price |
$933.00
|
| Rate for Payer: Cash Price |
$933.00
|
| Rate for Payer: Cigna Commercial |
$3,072.68
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,617.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$287.94
|
| Rate for Payer: Health EOS Commercial |
$2,943.30
|
| Rate for Payer: HFN Commercial |
$3,072.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,177.35
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,177.35
|
| Rate for Payer: Independent Care Health Plan Medicare |
$287.94
|
| Rate for Payer: Multiplan Commercial |
$2,587.52
|
| Rate for Payer: NAPHCARE Commercial |
$431.92
|
| Rate for Payer: Preferred Network Access Commercial |
$3,072.68
|
| Rate for Payer: Quartz Beloit One Network |
$1,423.14
|
| Rate for Payer: Quartz Commercial |
$1,843.61
|
| Rate for Payer: Quartz Medicare Advantage |
$287.94
|
| Rate for Payer: The Alliance Commercial |
$1,094.19
|
| Rate for Payer: United Healthcare Medicare Advantage |
$287.94
|
| Rate for Payer: WEA Trust Commercial |
$1,778.92
|
| Rate for Payer: WPS Commercial |
$1,439.72
|
|
|
NM Gastric Emptying Study
|
Facility
|
IP
|
$3,110.00
|
|
|
Service Code
|
CPT 78264
|
| Hospital Charge Code |
2586863
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,584.86 |
| Max. Negotiated Rate |
$2,975.65 |
| Rate for Payer: Aetna Commercial |
$2,910.96
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,781.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,714.23
|
| Rate for Payer: Cash Price |
$933.00
|
| Rate for Payer: Cigna Commercial |
$2,975.65
|
| Rate for Payer: Health EOS Commercial |
$2,878.62
|
| Rate for Payer: HFN Commercial |
$2,975.65
|
| Rate for Payer: Multiplan Commercial |
$2,587.52
|
| Rate for Payer: Preferred Network Access Commercial |
$2,975.65
|
| Rate for Payer: Quartz Beloit One Network |
$1,584.86
|
| Rate for Payer: Quartz Commercial |
$1,940.64
|
| Rate for Payer: WEA Trust Commercial |
$1,778.92
|
| Rate for Payer: WPS Commercial |
$2,395.63
|
|
|
NM Gastric Emptying Study
|
Professional
|
Both
|
$2,878.00
|
|
|
Service Code
|
CPT 78264
|
| Hospital Charge Code |
631161
|
| Min. Negotiated Rate |
$287.94 |
| 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 |
$287.94
|
| Rate for Payer: Anthem Medicare Advantage |
$287.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$287.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$287.94
|
| 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 |
$287.94
|
| 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 |
$1,177.35
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,177.35
|
| Rate for Payer: Independent Care Health Plan Medicare |
$287.94
|
| Rate for Payer: Multiplan Commercial |
$2,394.50
|
| Rate for Payer: NAPHCARE Commercial |
$431.92
|
| 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 |
$287.94
|
| Rate for Payer: The Alliance Commercial |
$1,094.19
|
| Rate for Payer: United Healthcare Medicare Advantage |
$287.94
|
| Rate for Payer: WEA Trust Commercial |
$1,646.22
|
| Rate for Payer: WPS Commercial |
$1,439.72
|
|
|
NM Gastric Mucosa Imaging
|
Professional
|
Both
|
$2,104.00
|
|
|
Service Code
|
CPT 78261
|
| Hospital Charge Code |
2586865
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$182.87 |
| Max. Negotiated Rate |
$2,078.75 |
| Rate for Payer: Aetna Commercial |
$2,078.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,881.82
|
| Rate for Payer: Aetna Managed Medicare |
$182.87
|
| Rate for Payer: Anthem Medicare Advantage |
$182.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$182.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$182.87
|
| Rate for Payer: Cash Price |
$631.20
|
| Rate for Payer: Cash Price |
$631.20
|
| Rate for Payer: Cash Price |
$631.20
|
| Rate for Payer: Cigna Commercial |
$2,078.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,094.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$182.87
|
| Rate for Payer: Health EOS Commercial |
$1,991.23
|
| Rate for Payer: HFN Commercial |
$2,078.75
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$728.62
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$728.62
|
| Rate for Payer: Independent Care Health Plan Medicare |
$182.87
|
| Rate for Payer: Multiplan Commercial |
$1,750.53
|
| Rate for Payer: NAPHCARE Commercial |
$274.31
|
| Rate for Payer: Preferred Network Access Commercial |
$2,078.75
|
| Rate for Payer: Quartz Beloit One Network |
$962.79
|
| Rate for Payer: Quartz Commercial |
$1,247.25
|
| Rate for Payer: Quartz Medicare Advantage |
$182.87
|
| Rate for Payer: The Alliance Commercial |
$694.92
|
| Rate for Payer: United Healthcare Medicare Advantage |
$182.87
|
| Rate for Payer: WEA Trust Commercial |
$1,203.49
|
| Rate for Payer: WPS Commercial |
$914.37
|
|
