|
NM Gastric Mucosa Imaging
|
Facility
|
IP
|
$2,104.00
|
|
|
Service Code
|
CPT 78261
|
| Hospital Charge Code |
2586865
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,072.20 |
| Max. Negotiated Rate |
$2,013.11 |
| Rate for Payer: Aetna Commercial |
$1,969.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,881.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,159.72
|
| Rate for Payer: Cash Price |
$631.20
|
| Rate for Payer: Cigna Commercial |
$2,013.11
|
| Rate for Payer: Health EOS Commercial |
$1,947.46
|
| Rate for Payer: HFN Commercial |
$2,013.11
|
| Rate for Payer: Multiplan Commercial |
$1,750.53
|
| Rate for Payer: Preferred Network Access Commercial |
$2,013.11
|
| Rate for Payer: Quartz Beloit One Network |
$1,072.20
|
| Rate for Payer: Quartz Commercial |
$1,312.90
|
| Rate for Payer: WEA Trust Commercial |
$1,203.49
|
| Rate for Payer: WPS Commercial |
$1,620.71
|
|
|
NM Gastric Mucosa Imaging
|
Facility
|
OP
|
$2,104.00
|
|
|
Service Code
|
CPT 78261
|
| Hospital Charge Code |
2586865
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$420.71 |
| Max. Negotiated Rate |
$2,396.16 |
| Rate for Payer: Aetna Commercial |
$1,969.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,881.82
|
| 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 |
$1,159.72
|
| 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 |
$631.20
|
| Rate for Payer: Cash Price |
$631.20
|
| Rate for Payer: Cash Price |
$631.20
|
| Rate for Payer: Cigna Commercial |
$2,013.11
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$420.71
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,224.53
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$420.71
|
| Rate for Payer: Health EOS Commercial |
$1,947.46
|
| Rate for Payer: HFN Commercial |
$2,013.11
|
| 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 |
$1,750.53
|
| Rate for Payer: NAPHCARE Commercial |
$631.07
|
| Rate for Payer: Preferred Network Access Commercial |
$2,013.11
|
| Rate for Payer: Quartz Beloit One Network |
$1,072.20
|
| Rate for Payer: Quartz Commercial |
$1,422.30
|
| 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 |
$1,203.49
|
| Rate for Payer: Wellcare Medicare |
$420.71
|
| Rate for Payer: WPS Commercial |
$1,620.71
|
|
|
NM Gastrointestinal Blood Loss Imaging
|
Facility
|
OP
|
$2,664.00
|
|
|
Service Code
|
CPT 78278
|
| Hospital Charge Code |
631165
|
| Min. Negotiated Rate |
$420.71 |
| Max. Negotiated Rate |
$2,548.92 |
| Rate for Payer: Aetna Commercial |
$2,493.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,382.68
|
| Rate for Payer: Aetna Managed Medicare |
$420.71
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,800.86
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,385.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,329.87
|
| Rate for Payer: Anthem Medicare Advantage |
$420.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,468.40
|
| 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 |
$799.20
|
| Rate for Payer: Cash Price |
$799.20
|
| Rate for Payer: Cigna Commercial |
$2,548.92
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$420.71
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,550.45
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$420.71
|
| Rate for Payer: Health EOS Commercial |
$2,465.80
|
| Rate for Payer: HFN Commercial |
$2,548.92
|
| 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 |
$2,216.45
|
| Rate for Payer: NAPHCARE Commercial |
$631.07
|
| Rate for Payer: Preferred Network Access Commercial |
$2,548.92
|
| Rate for Payer: Quartz Beloit One Network |
$1,357.57
|
| Rate for Payer: Quartz Commercial |
$1,800.86
|
| 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 |
$1,523.81
|
| Rate for Payer: Wellcare Medicare |
$420.71
|
| Rate for Payer: WPS Commercial |
$2,052.08
|
|
|
NM Gastrointestinal Blood Loss Imaging
|
Facility
|
IP
|
$2,664.00
|
|
|
Service Code
|
CPT 78278
|
| Hospital Charge Code |
631165
|
| Min. Negotiated Rate |
$1,357.57 |
| Max. Negotiated Rate |
$2,548.92 |
| Rate for Payer: Aetna Commercial |
$2,493.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,382.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,468.40
|
| Rate for Payer: Cash Price |
$799.20
|
| Rate for Payer: Cigna Commercial |
$2,548.92
|
| Rate for Payer: Health EOS Commercial |
$2,465.80
|
| Rate for Payer: HFN Commercial |
$2,548.92
|
| Rate for Payer: Multiplan Commercial |
$2,216.45
|
| Rate for Payer: Preferred Network Access Commercial |
$2,548.92
|
| Rate for Payer: Quartz Beloit One Network |
$1,357.57
|
| Rate for Payer: Quartz Commercial |
$1,662.34
|
| Rate for Payer: WEA Trust Commercial |
$1,523.81
|
| Rate for Payer: WPS Commercial |
$2,052.08
|
|
|
NM Gastrointestinal Blood Loss Imaging
|
Facility
|
OP
|
$2,876.00
|
|
|
Service Code
|
CPT 78278
|
| Hospital Charge Code |
2586867
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$420.71 |
| Max. Negotiated Rate |
$2,751.76 |
| Rate for Payer: Aetna Commercial |
$2,691.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,572.29
|
| 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 |
$1,585.25
|
| 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 |
$862.80
|
| Rate for Payer: Cash Price |
$862.80
|
| Rate for Payer: Cash Price |
$862.80
|
| Rate for Payer: Cigna Commercial |
$2,751.76
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$420.71
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,673.83
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$420.71
|
| Rate for Payer: Health EOS Commercial |
$2,662.03
|
| Rate for Payer: HFN Commercial |
$2,751.76
|
| 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 |
$2,392.83
|
| Rate for Payer: NAPHCARE Commercial |
$631.07
|
| Rate for Payer: Preferred Network Access Commercial |
$2,751.76
|
| Rate for Payer: Quartz Beloit One Network |
$1,465.61
|
| Rate for Payer: Quartz Commercial |
$1,944.18
|
| 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 |
$1,645.07
|
| Rate for Payer: Wellcare Medicare |
$420.71
|
| Rate for Payer: WPS Commercial |
$2,215.38
|
|
|
NM Gastrointestinal Blood Loss Imaging
|
Professional
|
Both
|
$2,876.00
|
|
|
Service Code
|
CPT 78278
|
| Hospital Charge Code |
2586867
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$303.65 |
| Max. Negotiated Rate |
$2,841.49 |
| Rate for Payer: Aetna Commercial |
$2,841.49
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,572.29
|
| Rate for Payer: Aetna Managed Medicare |
$303.65
|
| Rate for Payer: Anthem Medicare Advantage |
$303.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$303.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$303.65
|
| Rate for Payer: Cash Price |
$862.80
|
| Rate for Payer: Cash Price |
$862.80
|
| Rate for Payer: Cash Price |
$862.80
|
| Rate for Payer: Cigna Commercial |
$2,841.49
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,495.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$303.65
|
| Rate for Payer: Health EOS Commercial |
$2,721.85
|
| Rate for Payer: HFN Commercial |
$2,841.49
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,235.58
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,235.58
|
| Rate for Payer: Independent Care Health Plan Medicare |
$303.65
|
| Rate for Payer: Multiplan Commercial |
$2,392.83
|
| Rate for Payer: NAPHCARE Commercial |
$455.47
|
| Rate for Payer: Preferred Network Access Commercial |
$2,841.49
|
| Rate for Payer: Quartz Beloit One Network |
$1,316.06
|
| Rate for Payer: Quartz Commercial |
$1,704.89
|
| Rate for Payer: Quartz Medicare Advantage |
$303.65
|
| Rate for Payer: The Alliance Commercial |
$1,153.87
|
| Rate for Payer: United Healthcare Medicare Advantage |
$303.65
|
| Rate for Payer: WEA Trust Commercial |
$1,645.07
|
| Rate for Payer: WPS Commercial |
$1,518.24
|
|
|
NM Gastrointestinal Blood Loss Imaging
|
Facility
|
IP
|
$2,876.00
|
|
|
Service Code
|
CPT 78278
|
| Hospital Charge Code |
2586867
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,465.61 |
| Max. Negotiated Rate |
$2,751.76 |
| Rate for Payer: Aetna Commercial |
$2,691.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,572.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,585.25
|
| Rate for Payer: Cash Price |
$862.80
|
| Rate for Payer: Cigna Commercial |
$2,751.76
|
| Rate for Payer: Health EOS Commercial |
$2,662.03
|
| Rate for Payer: HFN Commercial |
$2,751.76
|
| Rate for Payer: Multiplan Commercial |
$2,392.83
|
| Rate for Payer: Preferred Network Access Commercial |
$2,751.76
|
| Rate for Payer: Quartz Beloit One Network |
$1,465.61
|
| Rate for Payer: Quartz Commercial |
$1,794.62
|
| Rate for Payer: WEA Trust Commercial |
$1,645.07
|
| Rate for Payer: WPS Commercial |
$2,215.38
|
|
|
NM Gastrointestinal Blood Loss Imaging
|
Professional
|
Both
|
$2,664.00
|
|
|
Service Code
|
CPT 78278
|
| Hospital Charge Code |
631165
|
| Min. Negotiated Rate |
$303.65 |
| Max. Negotiated Rate |
$2,632.03 |
| Rate for Payer: Aetna Commercial |
$2,632.03
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,382.68
|
| Rate for Payer: Aetna Managed Medicare |
$303.65
|
| Rate for Payer: Anthem Medicare Advantage |
$303.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$303.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$303.65
|
| Rate for Payer: Cash Price |
$799.20
|
| Rate for Payer: Cash Price |
$799.20
|
| Rate for Payer: Cash Price |
$799.20
|
| Rate for Payer: Cigna Commercial |
$2,632.03
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,385.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$303.65
|
| Rate for Payer: Health EOS Commercial |
$2,521.21
|
| Rate for Payer: HFN Commercial |
$2,632.03
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,235.58
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,235.58
|
| Rate for Payer: Independent Care Health Plan Medicare |
$303.65
|
| Rate for Payer: Multiplan Commercial |
$2,216.45
|
| Rate for Payer: NAPHCARE Commercial |
$455.47
|
| Rate for Payer: Preferred Network Access Commercial |
$2,632.03
|
| Rate for Payer: Quartz Beloit One Network |
$1,219.05
|
| Rate for Payer: Quartz Commercial |
$1,579.22
|
| Rate for Payer: Quartz Medicare Advantage |
$303.65
|
| Rate for Payer: The Alliance Commercial |
$1,153.87
|
| Rate for Payer: United Healthcare Medicare Advantage |
$303.65
|
| Rate for Payer: WEA Trust Commercial |
$1,523.81
|
| Rate for Payer: WPS Commercial |
$1,518.24
|
|
|
NM Hepatobiliary Duct System Imaging
|
Facility
|
OP
|
$2,269.00
|
|
|
Service Code
|
CPT 78226
|
| Hospital Charge Code |
631211
|
| Min. Negotiated Rate |
$420.71 |
| Max. Negotiated Rate |
$2,170.98 |
| Rate for Payer: Aetna Commercial |
$2,123.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,029.39
|
| Rate for Payer: Aetna Managed Medicare |
$420.71
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,533.84
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,179.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,132.68
|
| Rate for Payer: Anthem Medicare Advantage |
$420.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,250.67
|
| 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 |
$680.70
|
| Rate for Payer: Cash Price |
$680.70
|
| Rate for Payer: Cigna Commercial |
$2,170.98
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$420.71
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,320.56
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$420.71
|
| Rate for Payer: Health EOS Commercial |
$2,100.19
|
| Rate for Payer: HFN Commercial |
$2,170.98
|
| 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 |
$1,887.81
|
| Rate for Payer: NAPHCARE Commercial |
$631.07
|
| Rate for Payer: Preferred Network Access Commercial |
$2,170.98
|
| Rate for Payer: Quartz Beloit One Network |
$1,156.28
|
| Rate for Payer: Quartz Commercial |
$1,533.84
|
| 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 |
$1,297.87
|
| Rate for Payer: Wellcare Medicare |
$420.71
|
| Rate for Payer: WPS Commercial |
$1,747.81
|
|
|
NM Hepatobiliary Duct System Imaging
|
Professional
|
Both
|
$2,450.00
|
|
|
Service Code
|
CPT 78226
|
| Hospital Charge Code |
2586873
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$282.88 |
| Max. Negotiated Rate |
$2,420.60 |
| Rate for Payer: Aetna Commercial |
$2,420.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,191.28
|
| Rate for Payer: Aetna Managed Medicare |
$282.88
|
| Rate for Payer: Anthem Medicare Advantage |
$282.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$282.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$282.88
|
| Rate for Payer: Cash Price |
$735.00
|
| Rate for Payer: Cash Price |
$735.00
|
| Rate for Payer: Cash Price |
$735.00
|
| Rate for Payer: Cigna Commercial |
$2,420.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,274.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$282.88
|
| Rate for Payer: Health EOS Commercial |
$2,318.68
|
| Rate for Payer: HFN Commercial |
$2,420.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,160.10
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,160.10
|
| Rate for Payer: Independent Care Health Plan Medicare |
$282.88
|
| Rate for Payer: Multiplan Commercial |
$2,038.40
|
| Rate for Payer: NAPHCARE Commercial |
$424.32
|
| Rate for Payer: Preferred Network Access Commercial |
$2,420.60
|
| Rate for Payer: Quartz Beloit One Network |
$1,121.12
|
| Rate for Payer: Quartz Commercial |
$1,452.36
|
| Rate for Payer: Quartz Medicare Advantage |
$282.88
|
| Rate for Payer: The Alliance Commercial |
$1,074.94
|
| Rate for Payer: United Healthcare Medicare Advantage |
$282.88
|
| Rate for Payer: WEA Trust Commercial |
$1,401.40
|
| Rate for Payer: WPS Commercial |
$1,414.40
|
|
|
NM Hepatobiliary Duct System Imaging
|
Facility
|
OP
|
$2,450.00
|
|
|
Service Code
|
CPT 78226
|
| Hospital Charge Code |
2586873
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$420.71 |
| Max. Negotiated Rate |
$2,396.16 |
| Rate for Payer: Aetna Commercial |
$2,293.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,191.28
|
| 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 |
$1,350.44
|
| 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 |
$735.00
|
| Rate for Payer: Cash Price |
$735.00
|
| Rate for Payer: Cash Price |
$735.00
|
| Rate for Payer: Cigna Commercial |
$2,344.16
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$420.71
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,425.90
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$420.71
|
| Rate for Payer: Health EOS Commercial |
$2,267.72
|
| Rate for Payer: HFN Commercial |
$2,344.16
|
| 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 |
$2,038.40
|
| Rate for Payer: NAPHCARE Commercial |
$631.07
|
| Rate for Payer: Preferred Network Access Commercial |
$2,344.16
|
| Rate for Payer: Quartz Beloit One Network |
$1,248.52
|
| Rate for Payer: Quartz Commercial |
$1,656.20
|
| 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 |
$1,401.40
|
| Rate for Payer: Wellcare Medicare |
$420.71
|
| Rate for Payer: WPS Commercial |
$1,887.23
|
|
|
NM Hepatobiliary Duct System Imaging
|
Facility
|
IP
|
$2,269.00
|
|
|
Service Code
|
CPT 78226
|
| Hospital Charge Code |
631211
|
| Min. Negotiated Rate |
$1,156.28 |
| Max. Negotiated Rate |
$2,170.98 |
| Rate for Payer: Aetna Commercial |
$2,123.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,029.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,250.67
|
| Rate for Payer: Cash Price |
$680.70
|
| Rate for Payer: Cigna Commercial |
$2,170.98
|
| Rate for Payer: Health EOS Commercial |
$2,100.19
|
| Rate for Payer: HFN Commercial |
$2,170.98
|
| Rate for Payer: Multiplan Commercial |
$1,887.81
|
| Rate for Payer: Preferred Network Access Commercial |
$2,170.98
|
| Rate for Payer: Quartz Beloit One Network |
$1,156.28
|
| Rate for Payer: Quartz Commercial |
$1,415.86
|
| Rate for Payer: WEA Trust Commercial |
$1,297.87
|
| Rate for Payer: WPS Commercial |
$1,747.81
|
|
|
NM Hepatobiliary Duct System Imaging
|
Facility
|
IP
|
$2,450.00
|
|
|
Service Code
|
CPT 78226
|
| Hospital Charge Code |
2586873
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,248.52 |
| Max. Negotiated Rate |
$2,344.16 |
| Rate for Payer: Aetna Commercial |
$2,293.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,191.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,350.44
|
| Rate for Payer: Cash Price |
$735.00
|
| Rate for Payer: Cigna Commercial |
$2,344.16
|
| Rate for Payer: Health EOS Commercial |
$2,267.72
|
| Rate for Payer: HFN Commercial |
$2,344.16
|
| Rate for Payer: Multiplan Commercial |
$2,038.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,344.16
|
| Rate for Payer: Quartz Beloit One Network |
$1,248.52
|
| Rate for Payer: Quartz Commercial |
$1,528.80
|
| Rate for Payer: WEA Trust Commercial |
$1,401.40
|
| Rate for Payer: WPS Commercial |
$1,887.23
|
|
|
NM Hepatobiliary Duct System Imaging
|
Professional
|
Both
|
$2,269.00
|
|
|
Service Code
|
CPT 78226
|
| Hospital Charge Code |
631211
|
| Min. Negotiated Rate |
$282.88 |
| Max. Negotiated Rate |
$2,241.77 |
| Rate for Payer: Aetna Commercial |
$2,241.77
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,029.39
|
| Rate for Payer: Aetna Managed Medicare |
$282.88
|
| Rate for Payer: Anthem Medicare Advantage |
$282.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$282.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$282.88
|
| Rate for Payer: Cash Price |
$680.70
|
| Rate for Payer: Cash Price |
$680.70
|
| Rate for Payer: Cash Price |
$680.70
|
| Rate for Payer: Cigna Commercial |
$2,241.77
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,179.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$282.88
|
| Rate for Payer: Health EOS Commercial |
$2,147.38
|
| Rate for Payer: HFN Commercial |
$2,241.77
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,160.10
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,160.10
|
| Rate for Payer: Independent Care Health Plan Medicare |
$282.88
|
| Rate for Payer: Multiplan Commercial |
$1,887.81
|
| Rate for Payer: NAPHCARE Commercial |
$424.32
|
| Rate for Payer: Preferred Network Access Commercial |
$2,241.77
|
| Rate for Payer: Quartz Beloit One Network |
$1,038.29
|
| Rate for Payer: Quartz Commercial |
$1,345.06
|
| Rate for Payer: Quartz Medicare Advantage |
$282.88
|
| Rate for Payer: The Alliance Commercial |
$1,074.94
|
| Rate for Payer: United Healthcare Medicare Advantage |
$282.88
|
| Rate for Payer: WEA Trust Commercial |
$1,297.87
|
| Rate for Payer: WPS Commercial |
$1,414.40
|
|
|
NM Hepatobiliary System Imaging w Pharm
|
Facility
|
IP
|
$2,360.00
|
|
|
Service Code
|
CPT 78227
|
| Hospital Charge Code |
2586875
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,202.66 |
| Max. Negotiated Rate |
$2,258.05 |
| Rate for Payer: Aetna Commercial |
$2,208.96
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,110.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,300.83
|
| Rate for Payer: Cash Price |
$708.00
|
| Rate for Payer: Cigna Commercial |
$2,258.05
|
| Rate for Payer: Health EOS Commercial |
$2,184.42
|
| Rate for Payer: HFN Commercial |
$2,258.05
|
| Rate for Payer: Multiplan Commercial |
$1,963.52
|
| Rate for Payer: Preferred Network Access Commercial |
$2,258.05
|
| Rate for Payer: Quartz Beloit One Network |
$1,202.66
|
| Rate for Payer: Quartz Commercial |
$1,472.64
|
| Rate for Payer: WEA Trust Commercial |
$1,349.92
|
| Rate for Payer: WPS Commercial |
$1,817.91
|
|
|
NM Hepatobiliary System Imaging w Pharm
|
Professional
|
Both
|
$2,360.00
|
|
|
Service Code
|
CPT 78227
|
| Hospital Charge Code |
2586875
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$379.94 |
| Max. Negotiated Rate |
$2,331.68 |
| Rate for Payer: Aetna Commercial |
$2,331.68
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,110.78
|
| Rate for Payer: Aetna Managed Medicare |
$379.94
|
| Rate for Payer: Anthem Medicare Advantage |
$379.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$379.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$379.94
|
| Rate for Payer: Cash Price |
$708.00
|
| Rate for Payer: Cash Price |
$708.00
|
| Rate for Payer: Cash Price |
$708.00
|
| Rate for Payer: Cigna Commercial |
$2,331.68
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,227.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$379.94
|
| Rate for Payer: Health EOS Commercial |
$2,233.50
|
| Rate for Payer: HFN Commercial |
$2,331.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,563.12
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,563.12
|
| Rate for Payer: Independent Care Health Plan Medicare |
$379.94
|
| Rate for Payer: Multiplan Commercial |
$1,963.52
|
| Rate for Payer: NAPHCARE Commercial |
$569.91
|
| Rate for Payer: Preferred Network Access Commercial |
$2,331.68
|
| Rate for Payer: Quartz Beloit One Network |
$1,079.94
|
| Rate for Payer: Quartz Commercial |
$1,399.01
|
| Rate for Payer: Quartz Medicare Advantage |
$379.94
|
| Rate for Payer: The Alliance Commercial |
$1,443.78
|
| Rate for Payer: United Healthcare Medicare Advantage |
$379.94
|
| Rate for Payer: WEA Trust Commercial |
$1,349.92
|
| Rate for Payer: WPS Commercial |
$1,899.72
|
|
|
NM Hepatobiliary System Imaging w Pharm
|
Facility
|
OP
|
$2,360.00
|
|
|
Service Code
|
CPT 78227
|
| Hospital Charge Code |
2586875
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$571.42 |
| Max. Negotiated Rate |
$2,396.16 |
| Rate for Payer: Aetna Commercial |
$2,208.96
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,110.78
|
| 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 |
$1,300.83
|
| 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 |
$708.00
|
| Rate for Payer: Cash Price |
$708.00
|
| Rate for Payer: Cash Price |
$708.00
|
| Rate for Payer: Cigna Commercial |
$2,258.05
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$571.42
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,373.52
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$571.42
|
| Rate for Payer: Health EOS Commercial |
$2,184.42
|
| Rate for Payer: HFN Commercial |
$2,258.05
|
| 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 |
$1,963.52
|
| Rate for Payer: NAPHCARE Commercial |
$857.13
|
| Rate for Payer: Preferred Network Access Commercial |
$2,258.05
|
| Rate for Payer: Quartz Beloit One Network |
$1,202.66
|
| Rate for Payer: Quartz Commercial |
$1,595.36
|
| 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 |
$1,349.92
|
| Rate for Payer: Wellcare Medicare |
$571.42
|
| Rate for Payer: WPS Commercial |
$1,817.91
|
|
|
NM Hyperthyroid Oral Therapy
|
Facility
|
OP
|
$2,396.00
|
|
|
Service Code
|
CPT 79005
|
| Hospital Charge Code |
2586878
|
|
Hospital Revenue Code
|
342
|
| Min. Negotiated Rate |
$245.56 |
| Max. Negotiated Rate |
$2,396.16 |
| Rate for Payer: Aetna Commercial |
$2,242.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,142.98
|
| Rate for Payer: Aetna Managed Medicare |
$245.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$959.01
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$767.21
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$728.85
|
| Rate for Payer: Anthem Medicare Advantage |
$245.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,320.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$245.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$245.56
|
| Rate for Payer: Cash Price |
$718.80
|
| Rate for Payer: Cash Price |
$718.80
|
| Rate for Payer: Cash Price |
$718.80
|
| Rate for Payer: Cigna Commercial |
$2,292.49
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$245.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,394.47
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$245.56
|
| Rate for Payer: Health EOS Commercial |
$2,217.74
|
| Rate for Payer: HFN Commercial |
$2,292.49
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$913.50
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$245.56
|
| Rate for Payer: Independent Care Health Plan Medicare |
$245.56
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$245.56
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$245.56
|
| Rate for Payer: Multiplan Commercial |
$1,993.47
|
| Rate for Payer: NAPHCARE Commercial |
$368.35
|
| Rate for Payer: Preferred Network Access Commercial |
$2,292.49
|
| Rate for Payer: Quartz Beloit One Network |
$1,221.00
|
| Rate for Payer: Quartz Commercial |
$1,619.70
|
| Rate for Payer: Quartz Medicare Advantage |
$245.56
|
| Rate for Payer: The Alliance Commercial |
$982.26
|
| Rate for Payer: United Healthcare Medicare Advantage |
$245.56
|
| Rate for Payer: United Healthcare PPO |
$2,396.16
|
| Rate for Payer: WEA Trust Commercial |
$1,370.51
|
| Rate for Payer: Wellcare Medicare |
$245.56
|
| Rate for Payer: WPS Commercial |
$1,845.64
|
|
|
NM Hyperthyroid Oral Therapy
|
Professional
|
Both
|
$2,396.00
|
|
|
Service Code
|
CPT 79005
|
| Hospital Charge Code |
2586878
|
|
Hospital Revenue Code
|
342
|
| Min. Negotiated Rate |
$132.32 |
| Max. Negotiated Rate |
$2,367.25 |
| Rate for Payer: Aetna Commercial |
$2,367.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,142.98
|
| Rate for Payer: Aetna Managed Medicare |
$132.32
|
| Rate for Payer: Anthem Medicare Advantage |
$132.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$132.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$132.32
|
| Rate for Payer: Cash Price |
$718.80
|
| Rate for Payer: Cash Price |
$718.80
|
| Rate for Payer: Cash Price |
$718.80
|
| Rate for Payer: Cigna Commercial |
$2,367.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,245.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$132.32
|
| Rate for Payer: Health EOS Commercial |
$2,267.57
|
| Rate for Payer: HFN Commercial |
$2,367.25
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$487.02
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$487.02
|
| Rate for Payer: Independent Care Health Plan Medicare |
$132.32
|
| Rate for Payer: Multiplan Commercial |
$1,993.47
|
| Rate for Payer: NAPHCARE Commercial |
$198.48
|
| Rate for Payer: Preferred Network Access Commercial |
$2,367.25
|
| Rate for Payer: Quartz Beloit One Network |
$1,096.41
|
| Rate for Payer: Quartz Commercial |
$1,420.35
|
| Rate for Payer: Quartz Medicare Advantage |
$132.32
|
| Rate for Payer: The Alliance Commercial |
$502.81
|
| Rate for Payer: United Healthcare Medicare Advantage |
$132.32
|
| Rate for Payer: WEA Trust Commercial |
$1,370.51
|
| Rate for Payer: WPS Commercial |
$661.60
|
|
|
NM Hyperthyroid Oral Therapy
|
Facility
|
IP
|
$2,396.00
|
|
|
Service Code
|
CPT 79005
|
| Hospital Charge Code |
2586878
|
|
Hospital Revenue Code
|
342
|
| Min. Negotiated Rate |
$1,221.00 |
| Max. Negotiated Rate |
$2,292.49 |
| Rate for Payer: Aetna Commercial |
$2,242.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,142.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,320.68
|
| Rate for Payer: Cash Price |
$718.80
|
| Rate for Payer: Cigna Commercial |
$2,292.49
|
| Rate for Payer: Health EOS Commercial |
$2,217.74
|
| Rate for Payer: HFN Commercial |
$2,292.49
|
| Rate for Payer: Multiplan Commercial |
$1,993.47
|
| Rate for Payer: Preferred Network Access Commercial |
$2,292.49
|
| Rate for Payer: Quartz Beloit One Network |
$1,221.00
|
| Rate for Payer: Quartz Commercial |
$1,495.10
|
| Rate for Payer: WEA Trust Commercial |
$1,370.51
|
| Rate for Payer: WPS Commercial |
$1,845.64
|
|
|
NMIC 306
|
Professional
|
Both
|
$104.00
|
|
|
Service Code
|
CPT 87186
|
| Hospital Charge Code |
6196550
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.00 |
| Max. Negotiated Rate |
$102.75 |
| Rate for Payer: Aetna Commercial |
$102.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$93.02
|
| Rate for Payer: Aetna Managed Medicare |
$9.00
|
| Rate for Payer: Anthem Medicare Advantage |
$9.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$9.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$9.00
|
| Rate for Payer: Cash Price |
$31.20
|
| Rate for Payer: Cash Price |
$31.20
|
| Rate for Payer: Cigna Commercial |
$102.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$54.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$9.00
|
| Rate for Payer: Health EOS Commercial |
$98.43
|
| Rate for Payer: HFN Commercial |
$102.75
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$31.75
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$31.75
|
| Rate for Payer: Independent Care Health Plan Medicare |
$9.00
|
| Rate for Payer: Multiplan Commercial |
$86.53
|
| Rate for Payer: NAPHCARE Commercial |
$13.49
|
| Rate for Payer: Preferred Network Access Commercial |
$102.75
|
| Rate for Payer: Quartz Beloit One Network |
$47.59
|
| Rate for Payer: Quartz Commercial |
$61.65
|
| Rate for Payer: Quartz Medicare Advantage |
$9.00
|
| Rate for Payer: The Alliance Commercial |
$35.53
|
| Rate for Payer: United Healthcare Medicare Advantage |
$9.00
|
| Rate for Payer: WEA Trust Commercial |
$59.49
|
| Rate for Payer: WPS Commercial |
$39.58
|
|
|
NMIC 306
|
Facility
|
OP
|
$104.00
|
|
|
Service Code
|
CPT 87186
|
| Hospital Charge Code |
6196550
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.00 |
| Max. Negotiated Rate |
$99.51 |
| Rate for Payer: Aetna Commercial |
$97.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$93.02
|
| Rate for Payer: Aetna Managed Medicare |
$9.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$33.73
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$15.74
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$14.93
|
| Rate for Payer: Anthem Medicare Advantage |
$9.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$57.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$9.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$9.00
|
| Rate for Payer: Cash Price |
$31.20
|
| Rate for Payer: Cash Price |
$31.20
|
| Rate for Payer: Cigna Commercial |
$99.51
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$9.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$60.53
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$9.00
|
| Rate for Payer: Health EOS Commercial |
$96.26
|
| Rate for Payer: HFN Commercial |
$99.51
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$33.47
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$9.00
|
| Rate for Payer: Independent Care Health Plan Medicare |
$9.00
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$9.00
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$9.00
|
| Rate for Payer: Multiplan Commercial |
$86.53
|
| Rate for Payer: NAPHCARE Commercial |
$13.49
|
| Rate for Payer: Preferred Network Access Commercial |
$99.51
|
| Rate for Payer: Quartz Beloit One Network |
$53.00
|
| Rate for Payer: Quartz Commercial |
$70.30
|
| Rate for Payer: Quartz Medicare Advantage |
$9.00
|
| Rate for Payer: The Alliance Commercial |
$35.98
|
| Rate for Payer: United Healthcare Medicare Advantage |
$9.00
|
| Rate for Payer: United Healthcare PPO |
$81.12
|
| Rate for Payer: WEA Trust Commercial |
$59.49
|
| Rate for Payer: Wellcare Medicare |
$9.00
|
| Rate for Payer: WPS Commercial |
$80.11
|
|
|
NMIC 306
|
Facility
|
IP
|
$104.00
|
|
|
Service Code
|
CPT 87186
|
| Hospital Charge Code |
6196550
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$53.00 |
| Max. Negotiated Rate |
$99.51 |
| Rate for Payer: Aetna Commercial |
$97.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$93.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$57.32
|
| Rate for Payer: Cash Price |
$31.20
|
| Rate for Payer: Cigna Commercial |
$99.51
|
| Rate for Payer: Health EOS Commercial |
$96.26
|
| Rate for Payer: HFN Commercial |
$99.51
|
| Rate for Payer: Multiplan Commercial |
$86.53
|
| Rate for Payer: Preferred Network Access Commercial |
$99.51
|
| Rate for Payer: Quartz Beloit One Network |
$53.00
|
| Rate for Payer: Quartz Commercial |
$64.90
|
| Rate for Payer: WEA Trust Commercial |
$59.49
|
| Rate for Payer: WPS Commercial |
$80.11
|
|
|
NMIC/ID303
|
Facility
|
IP
|
$196.00
|
|
|
Service Code
|
CPT 87186
|
| Hospital Charge Code |
5313465
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$99.88 |
| Max. Negotiated Rate |
$187.53 |
| Rate for Payer: Aetna Commercial |
$183.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$175.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$108.04
|
| Rate for Payer: Cash Price |
$58.80
|
| Rate for Payer: Cigna Commercial |
$187.53
|
| Rate for Payer: Health EOS Commercial |
$181.42
|
| Rate for Payer: HFN Commercial |
$187.53
|
| Rate for Payer: Multiplan Commercial |
$163.07
|
| Rate for Payer: Preferred Network Access Commercial |
$187.53
|
| Rate for Payer: Quartz Beloit One Network |
$99.88
|
| Rate for Payer: Quartz Commercial |
$122.30
|
| Rate for Payer: WEA Trust Commercial |
$112.11
|
| Rate for Payer: WPS Commercial |
$150.98
|
|
|
NMIC/ID303
|
Professional
|
Both
|
$196.00
|
|
|
Service Code
|
CPT 87186
|
| Hospital Charge Code |
5313465
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.00 |
| Max. Negotiated Rate |
$193.65 |
| Rate for Payer: Aetna Commercial |
$193.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$175.30
|
| Rate for Payer: Aetna Managed Medicare |
$9.00
|
| Rate for Payer: Anthem Medicare Advantage |
$9.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$9.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$9.00
|
| Rate for Payer: Cash Price |
$58.80
|
| Rate for Payer: Cash Price |
$58.80
|
| Rate for Payer: Cigna Commercial |
$193.65
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$101.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$9.00
|
| Rate for Payer: Health EOS Commercial |
$185.49
|
| Rate for Payer: HFN Commercial |
$193.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$31.75
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$31.75
|
| Rate for Payer: Independent Care Health Plan Medicare |
$9.00
|
| Rate for Payer: Multiplan Commercial |
$163.07
|
| Rate for Payer: NAPHCARE Commercial |
$13.49
|
| Rate for Payer: Preferred Network Access Commercial |
$193.65
|
| Rate for Payer: Quartz Beloit One Network |
$89.69
|
| Rate for Payer: Quartz Commercial |
$116.19
|
| Rate for Payer: Quartz Medicare Advantage |
$9.00
|
| Rate for Payer: The Alliance Commercial |
$35.53
|
| Rate for Payer: United Healthcare Medicare Advantage |
$9.00
|
| Rate for Payer: WEA Trust Commercial |
$112.11
|
| Rate for Payer: WPS Commercial |
$39.58
|
|
