|
NMIC/ID303
|
Facility
|
OP
|
$196.00
|
|
|
Service Code
|
CPT 87186
|
| Hospital Charge Code |
5313465
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.00 |
| Max. Negotiated Rate |
$187.53 |
| Rate for Payer: Aetna Commercial |
$183.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$175.30
|
| 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 |
$108.04
|
| 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 |
$187.53
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$9.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$114.07
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$9.00
|
| Rate for Payer: Health EOS Commercial |
$181.42
|
| Rate for Payer: HFN Commercial |
$187.53
|
| 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 |
$163.07
|
| Rate for Payer: NAPHCARE Commercial |
$13.49
|
| Rate for Payer: Preferred Network Access Commercial |
$187.53
|
| Rate for Payer: Quartz Beloit One Network |
$99.88
|
| Rate for Payer: Quartz Commercial |
$132.50
|
| 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 |
$152.88
|
| Rate for Payer: WEA Trust Commercial |
$112.11
|
| Rate for Payer: Wellcare Medicare |
$9.00
|
| Rate for Payer: WPS Commercial |
$150.98
|
|
|
NMIC/ID307
|
Facility
|
OP
|
$187.00
|
|
|
Service Code
|
CPT 87186
|
| Hospital Charge Code |
5581862
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.00 |
| Max. Negotiated Rate |
$178.92 |
| Rate for Payer: Aetna Commercial |
$175.03
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$167.25
|
| 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 |
$103.07
|
| 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 |
$56.10
|
| Rate for Payer: Cash Price |
$56.10
|
| Rate for Payer: Cigna Commercial |
$178.92
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$9.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$108.83
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$9.00
|
| Rate for Payer: Health EOS Commercial |
$173.09
|
| Rate for Payer: HFN Commercial |
$178.92
|
| 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 |
$155.58
|
| Rate for Payer: NAPHCARE Commercial |
$13.49
|
| Rate for Payer: Preferred Network Access Commercial |
$178.92
|
| Rate for Payer: Quartz Beloit One Network |
$95.30
|
| Rate for Payer: Quartz Commercial |
$126.41
|
| 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 |
$145.86
|
| Rate for Payer: WEA Trust Commercial |
$106.96
|
| Rate for Payer: Wellcare Medicare |
$9.00
|
| Rate for Payer: WPS Commercial |
$144.05
|
|
|
NMIC/ID307
|
Facility
|
IP
|
$187.00
|
|
|
Service Code
|
CPT 87186
|
| Hospital Charge Code |
5581862
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$95.30 |
| Max. Negotiated Rate |
$178.92 |
| Rate for Payer: Aetna Commercial |
$175.03
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$167.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$103.07
|
| Rate for Payer: Cash Price |
$56.10
|
| Rate for Payer: Cigna Commercial |
$178.92
|
| Rate for Payer: Health EOS Commercial |
$173.09
|
| Rate for Payer: HFN Commercial |
$178.92
|
| Rate for Payer: Multiplan Commercial |
$155.58
|
| Rate for Payer: Preferred Network Access Commercial |
$178.92
|
| Rate for Payer: Quartz Beloit One Network |
$95.30
|
| Rate for Payer: Quartz Commercial |
$116.69
|
| Rate for Payer: WEA Trust Commercial |
$106.96
|
| Rate for Payer: WPS Commercial |
$144.05
|
|
|
NMIC/ID307
|
Professional
|
Both
|
$187.00
|
|
|
Service Code
|
CPT 87186
|
| Hospital Charge Code |
5581862
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.00 |
| Max. Negotiated Rate |
$184.76 |
| Rate for Payer: Aetna Commercial |
$184.76
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$167.25
|
| 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 |
$56.10
|
| Rate for Payer: Cash Price |
$56.10
|
| Rate for Payer: Cigna Commercial |
$184.76
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$97.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$9.00
|
| Rate for Payer: Health EOS Commercial |
$176.98
|
| Rate for Payer: HFN Commercial |
$184.76
|
| 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 |
$155.58
|
| Rate for Payer: NAPHCARE Commercial |
$13.49
|
| Rate for Payer: Preferred Network Access Commercial |
$184.76
|
| Rate for Payer: Quartz Beloit One Network |
$85.57
|
| Rate for Payer: Quartz Commercial |
$110.85
|
| 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 |
$106.96
|
| Rate for Payer: WPS Commercial |
$39.58
|
|
|
NM Intestine Imaging
|
Facility
|
IP
|
$2,104.00
|
|
|
Service Code
|
CPT 78290
|
| Hospital Charge Code |
2586881
|
|
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 Intestine Imaging
|
Professional
|
Both
|
$2,104.00
|
|
|
Service Code
|
CPT 78290
|
| Hospital Charge Code |
2586881
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$288.79 |
| 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 |
$288.79
|
| Rate for Payer: Anthem Medicare Advantage |
$288.79
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$288.79
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$288.79
|
| 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 |
$288.79
|
| 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 |
$1,170.53
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,170.53
|
| Rate for Payer: Independent Care Health Plan Medicare |
$288.79
|
| Rate for Payer: Multiplan Commercial |
$1,750.53
|
| Rate for Payer: NAPHCARE Commercial |
$433.18
|
| 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 |
$288.79
|
| Rate for Payer: The Alliance Commercial |
$1,097.39
|
| Rate for Payer: United Healthcare Medicare Advantage |
$288.79
|
| Rate for Payer: WEA Trust Commercial |
$1,203.49
|
| Rate for Payer: WPS Commercial |
$1,443.94
|
|
|
NM Intestine Imaging
|
Facility
|
OP
|
$2,104.00
|
|
|
Service Code
|
CPT 78290
|
| Hospital Charge Code |
2586881
|
|
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 Intestine Imaging/Meckel's
|
Facility
|
OP
|
$2,023.00
|
|
|
Service Code
|
CPT 78290
|
| Hospital Charge Code |
631225
|
| Min. Negotiated Rate |
$420.71 |
| Max. Negotiated Rate |
$1,935.61 |
| Rate for Payer: Aetna Commercial |
$1,893.53
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,809.37
|
| Rate for Payer: Aetna Managed Medicare |
$420.71
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,367.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,051.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,009.88
|
| Rate for Payer: Anthem Medicare Advantage |
$420.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,115.08
|
| 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 |
$606.90
|
| Rate for Payer: Cash Price |
$606.90
|
| Rate for Payer: Cigna Commercial |
$1,935.61
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$420.71
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,177.39
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$420.71
|
| Rate for Payer: Health EOS Commercial |
$1,872.49
|
| Rate for Payer: HFN Commercial |
$1,935.61
|
| 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 |
$1,683.14
|
| Rate for Payer: NAPHCARE Commercial |
$631.07
|
| Rate for Payer: Preferred Network Access Commercial |
$1,935.61
|
| Rate for Payer: Quartz Beloit One Network |
$1,030.92
|
| Rate for Payer: Quartz Commercial |
$1,367.55
|
| 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 |
$1,157.16
|
| Rate for Payer: Wellcare Medicare |
$420.71
|
| Rate for Payer: WPS Commercial |
$1,558.32
|
|
|
NM Intestine Imaging/Meckel's
|
Professional
|
Both
|
$2,023.00
|
|
|
Service Code
|
CPT 78290
|
| Hospital Charge Code |
631225
|
| Min. Negotiated Rate |
$288.79 |
| Max. Negotiated Rate |
$1,998.72 |
| Rate for Payer: Aetna Commercial |
$1,998.72
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,809.37
|
| Rate for Payer: Aetna Managed Medicare |
$288.79
|
| Rate for Payer: Anthem Medicare Advantage |
$288.79
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$288.79
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$288.79
|
| Rate for Payer: Cash Price |
$606.90
|
| Rate for Payer: Cash Price |
$606.90
|
| Rate for Payer: Cash Price |
$606.90
|
| Rate for Payer: Cigna Commercial |
$1,998.72
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,051.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$288.79
|
| Rate for Payer: Health EOS Commercial |
$1,914.57
|
| Rate for Payer: HFN Commercial |
$1,998.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,170.53
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,170.53
|
| Rate for Payer: Independent Care Health Plan Medicare |
$288.79
|
| Rate for Payer: Multiplan Commercial |
$1,683.14
|
| Rate for Payer: NAPHCARE Commercial |
$433.18
|
| Rate for Payer: Preferred Network Access Commercial |
$1,998.72
|
| Rate for Payer: Quartz Beloit One Network |
$925.72
|
| Rate for Payer: Quartz Commercial |
$1,199.23
|
| Rate for Payer: Quartz Medicare Advantage |
$288.79
|
| Rate for Payer: The Alliance Commercial |
$1,097.39
|
| Rate for Payer: United Healthcare Medicare Advantage |
$288.79
|
| Rate for Payer: WEA Trust Commercial |
$1,157.16
|
| Rate for Payer: WPS Commercial |
$1,443.94
|
|
|
NM Intestine Imaging/Meckel's
|
Facility
|
IP
|
$2,023.00
|
|
|
Service Code
|
CPT 78290
|
| Hospital Charge Code |
631225
|
| Min. Negotiated Rate |
$1,030.92 |
| Max. Negotiated Rate |
$1,935.61 |
| Rate for Payer: Aetna Commercial |
$1,893.53
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,809.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,115.08
|
| Rate for Payer: Cash Price |
$606.90
|
| Rate for Payer: Cigna Commercial |
$1,935.61
|
| Rate for Payer: Health EOS Commercial |
$1,872.49
|
| Rate for Payer: HFN Commercial |
$1,935.61
|
| Rate for Payer: Multiplan Commercial |
$1,683.14
|
| Rate for Payer: Preferred Network Access Commercial |
$1,935.61
|
| Rate for Payer: Quartz Beloit One Network |
$1,030.92
|
| Rate for Payer: Quartz Commercial |
$1,262.35
|
| Rate for Payer: WEA Trust Commercial |
$1,157.16
|
| Rate for Payer: WPS Commercial |
$1,558.32
|
|
|
NM Kidney Imaging Static
|
Facility
|
OP
|
$1,918.00
|
|
|
Service Code
|
CPT 78700
|
| Hospital Charge Code |
2586883
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$420.71 |
| Max. Negotiated Rate |
$2,396.16 |
| Rate for Payer: Aetna Commercial |
$1,795.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,715.46
|
| Rate for Payer: Aetna Managed Medicare |
$420.71
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,589.87
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,271.90
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,208.30
|
| Rate for Payer: Anthem Medicare Advantage |
$420.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,057.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$420.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$420.71
|
| Rate for Payer: Cash Price |
$575.40
|
| Rate for Payer: Cash Price |
$575.40
|
| Rate for Payer: Cash Price |
$575.40
|
| Rate for Payer: Cigna Commercial |
$1,835.14
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$420.71
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,116.28
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$420.71
|
| Rate for Payer: Health EOS Commercial |
$1,775.30
|
| Rate for Payer: HFN Commercial |
$1,835.14
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,565.05
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$420.71
|
| Rate for Payer: Independent Care Health Plan Medicare |
$420.71
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$420.71
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$420.71
|
| Rate for Payer: Multiplan Commercial |
$1,595.78
|
| Rate for Payer: NAPHCARE Commercial |
$631.07
|
| Rate for Payer: Preferred Network Access Commercial |
$1,835.14
|
| Rate for Payer: Quartz Beloit One Network |
$977.41
|
| Rate for Payer: Quartz Commercial |
$1,296.57
|
| Rate for Payer: Quartz Medicare Advantage |
$420.71
|
| Rate for Payer: The Alliance Commercial |
$1,682.84
|
| Rate for Payer: United Healthcare Medicare Advantage |
$420.71
|
| Rate for Payer: United Healthcare PPO |
$2,396.16
|
| Rate for Payer: WEA Trust Commercial |
$1,097.10
|
| Rate for Payer: Wellcare Medicare |
$420.71
|
| Rate for Payer: WPS Commercial |
$1,477.44
|
|
|
NM Kidney Imaging Static
|
Facility
|
OP
|
$1,844.00
|
|
|
Service Code
|
CPT 78700
|
| Hospital Charge Code |
631437
|
| Min. Negotiated Rate |
$420.71 |
| Max. Negotiated Rate |
$1,764.34 |
| Rate for Payer: Aetna Commercial |
$1,725.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,649.27
|
| Rate for Payer: Aetna Managed Medicare |
$420.71
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,246.54
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$958.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$920.52
|
| Rate for Payer: Anthem Medicare Advantage |
$420.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,016.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$420.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$420.71
|
| Rate for Payer: Cash Price |
$553.20
|
| Rate for Payer: Cash Price |
$553.20
|
| Rate for Payer: Cigna Commercial |
$1,764.34
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$420.71
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,073.21
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$420.71
|
| Rate for Payer: Health EOS Commercial |
$1,706.81
|
| Rate for Payer: HFN Commercial |
$1,764.34
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,565.05
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$420.71
|
| Rate for Payer: Independent Care Health Plan Medicare |
$420.71
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$420.71
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$420.71
|
| Rate for Payer: Multiplan Commercial |
$1,534.21
|
| Rate for Payer: NAPHCARE Commercial |
$631.07
|
| Rate for Payer: Preferred Network Access Commercial |
$1,764.34
|
| Rate for Payer: Quartz Beloit One Network |
$939.70
|
| Rate for Payer: Quartz Commercial |
$1,246.54
|
| Rate for Payer: Quartz Medicare Advantage |
$420.71
|
| Rate for Payer: The Alliance Commercial |
$1,682.84
|
| Rate for Payer: United Healthcare Medicare Advantage |
$420.71
|
| Rate for Payer: WEA Trust Commercial |
$1,054.77
|
| Rate for Payer: Wellcare Medicare |
$420.71
|
| Rate for Payer: WPS Commercial |
$1,420.43
|
|
|
NM Kidney Imaging Static
|
Professional
|
Both
|
$1,844.00
|
|
|
Service Code
|
CPT 78700
|
| Hospital Charge Code |
631437
|
| Min. Negotiated Rate |
$152.04 |
| Max. Negotiated Rate |
$1,821.87 |
| Rate for Payer: Aetna Commercial |
$1,821.87
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,649.27
|
| Rate for Payer: Aetna Managed Medicare |
$152.04
|
| Rate for Payer: Anthem Medicare Advantage |
$152.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$152.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$152.04
|
| Rate for Payer: Cash Price |
$553.20
|
| Rate for Payer: Cash Price |
$553.20
|
| Rate for Payer: Cash Price |
$553.20
|
| Rate for Payer: Cigna Commercial |
$1,821.87
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$958.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$152.04
|
| Rate for Payer: Health EOS Commercial |
$1,745.16
|
| Rate for Payer: HFN Commercial |
$1,821.87
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$607.77
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$607.77
|
| Rate for Payer: Independent Care Health Plan Medicare |
$152.04
|
| Rate for Payer: Multiplan Commercial |
$1,534.21
|
| Rate for Payer: NAPHCARE Commercial |
$228.06
|
| Rate for Payer: Preferred Network Access Commercial |
$1,821.87
|
| Rate for Payer: Quartz Beloit One Network |
$843.81
|
| Rate for Payer: Quartz Commercial |
$1,093.12
|
| Rate for Payer: Quartz Medicare Advantage |
$152.04
|
| Rate for Payer: The Alliance Commercial |
$577.74
|
| Rate for Payer: United Healthcare Medicare Advantage |
$152.04
|
| Rate for Payer: WEA Trust Commercial |
$1,054.77
|
| Rate for Payer: WPS Commercial |
$760.19
|
|
|
NM Kidney Imaging Static
|
Facility
|
IP
|
$1,844.00
|
|
|
Service Code
|
CPT 78700
|
| Hospital Charge Code |
631437
|
| Min. Negotiated Rate |
$939.70 |
| Max. Negotiated Rate |
$1,764.34 |
| Rate for Payer: Aetna Commercial |
$1,725.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,649.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,016.41
|
| Rate for Payer: Cash Price |
$553.20
|
| Rate for Payer: Cigna Commercial |
$1,764.34
|
| Rate for Payer: Health EOS Commercial |
$1,706.81
|
| Rate for Payer: HFN Commercial |
$1,764.34
|
| Rate for Payer: Multiplan Commercial |
$1,534.21
|
| Rate for Payer: Preferred Network Access Commercial |
$1,764.34
|
| Rate for Payer: Quartz Beloit One Network |
$939.70
|
| Rate for Payer: Quartz Commercial |
$1,150.66
|
| Rate for Payer: WEA Trust Commercial |
$1,054.77
|
| Rate for Payer: WPS Commercial |
$1,420.43
|
|
|
NM Kidney Imaging Static
|
Facility
|
IP
|
$1,918.00
|
|
|
Service Code
|
CPT 78700
|
| Hospital Charge Code |
2586883
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$977.41 |
| Max. Negotiated Rate |
$1,835.14 |
| Rate for Payer: Aetna Commercial |
$1,795.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,715.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,057.20
|
| Rate for Payer: Cash Price |
$575.40
|
| Rate for Payer: Cigna Commercial |
$1,835.14
|
| Rate for Payer: Health EOS Commercial |
$1,775.30
|
| Rate for Payer: HFN Commercial |
$1,835.14
|
| Rate for Payer: Multiplan Commercial |
$1,595.78
|
| Rate for Payer: Preferred Network Access Commercial |
$1,835.14
|
| Rate for Payer: Quartz Beloit One Network |
$977.41
|
| Rate for Payer: Quartz Commercial |
$1,196.83
|
| Rate for Payer: WEA Trust Commercial |
$1,097.10
|
| Rate for Payer: WPS Commercial |
$1,477.44
|
|
|
NM Kidney Imaging Static
|
Professional
|
Both
|
$1,918.00
|
|
|
Service Code
|
CPT 78700
|
| Hospital Charge Code |
2586883
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$152.04 |
| Max. Negotiated Rate |
$1,894.98 |
| Rate for Payer: Aetna Commercial |
$1,894.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,715.46
|
| Rate for Payer: Aetna Managed Medicare |
$152.04
|
| Rate for Payer: Anthem Medicare Advantage |
$152.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$152.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$152.04
|
| Rate for Payer: Cash Price |
$575.40
|
| Rate for Payer: Cash Price |
$575.40
|
| Rate for Payer: Cash Price |
$575.40
|
| Rate for Payer: Cigna Commercial |
$1,894.98
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$997.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$152.04
|
| Rate for Payer: Health EOS Commercial |
$1,815.20
|
| Rate for Payer: HFN Commercial |
$1,894.98
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$607.77
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$607.77
|
| Rate for Payer: Independent Care Health Plan Medicare |
$152.04
|
| Rate for Payer: Multiplan Commercial |
$1,595.78
|
| Rate for Payer: NAPHCARE Commercial |
$228.06
|
| Rate for Payer: Preferred Network Access Commercial |
$1,894.98
|
| Rate for Payer: Quartz Beloit One Network |
$877.68
|
| Rate for Payer: Quartz Commercial |
$1,136.99
|
| Rate for Payer: Quartz Medicare Advantage |
$152.04
|
| Rate for Payer: The Alliance Commercial |
$577.74
|
| Rate for Payer: United Healthcare Medicare Advantage |
$152.04
|
| Rate for Payer: WEA Trust Commercial |
$1,097.10
|
| Rate for Payer: WPS Commercial |
$760.19
|
|
|
NM Kidney Imaging w/ Flow w/o Pharm
|
Facility
|
IP
|
$2,281.00
|
|
|
Service Code
|
CPT 78707
|
| Hospital Charge Code |
631451
|
| Min. Negotiated Rate |
$1,162.40 |
| Max. Negotiated Rate |
$2,182.46 |
| Rate for Payer: Aetna Commercial |
$2,135.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,040.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,257.29
|
| Rate for Payer: Cash Price |
$684.30
|
| Rate for Payer: Cigna Commercial |
$2,182.46
|
| Rate for Payer: Health EOS Commercial |
$2,111.29
|
| Rate for Payer: HFN Commercial |
$2,182.46
|
| Rate for Payer: Multiplan Commercial |
$1,897.79
|
| Rate for Payer: Preferred Network Access Commercial |
$2,182.46
|
| Rate for Payer: Quartz Beloit One Network |
$1,162.40
|
| Rate for Payer: Quartz Commercial |
$1,423.34
|
| Rate for Payer: WEA Trust Commercial |
$1,304.73
|
| Rate for Payer: WPS Commercial |
$1,757.05
|
|
|
NM Kidney Imaging w/ Flow w/o Pharm
|
Facility
|
OP
|
$2,464.00
|
|
|
Service Code
|
CPT 78707
|
| Hospital Charge Code |
2586889
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$571.42 |
| Max. Negotiated Rate |
$2,396.16 |
| Rate for Payer: Aetna Commercial |
$2,306.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,203.80
|
| 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 |
$1,358.16
|
| 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 |
$739.20
|
| Rate for Payer: Cash Price |
$739.20
|
| Rate for Payer: Cash Price |
$739.20
|
| Rate for Payer: Cigna Commercial |
$2,357.56
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$571.42
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,434.05
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$571.42
|
| Rate for Payer: Health EOS Commercial |
$2,280.68
|
| Rate for Payer: HFN Commercial |
$2,357.56
|
| 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 |
$2,050.05
|
| Rate for Payer: NAPHCARE Commercial |
$857.13
|
| Rate for Payer: Preferred Network Access Commercial |
$2,357.56
|
| Rate for Payer: Quartz Beloit One Network |
$1,255.65
|
| Rate for Payer: Quartz Commercial |
$1,665.66
|
| 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 |
$1,409.41
|
| Rate for Payer: Wellcare Medicare |
$571.42
|
| Rate for Payer: WPS Commercial |
$1,898.02
|
|
|
NM Kidney Imaging w/ Flow w/o Pharm
|
Professional
|
Both
|
$2,281.00
|
|
|
Service Code
|
CPT 78707
|
| Hospital Charge Code |
631451
|
| Min. Negotiated Rate |
$207.99 |
| Max. Negotiated Rate |
$2,253.63 |
| Rate for Payer: Aetna Commercial |
$2,253.63
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,040.13
|
| Rate for Payer: Aetna Managed Medicare |
$207.99
|
| Rate for Payer: Anthem Medicare Advantage |
$207.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$207.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$207.99
|
| Rate for Payer: Cash Price |
$684.30
|
| Rate for Payer: Cash Price |
$684.30
|
| Rate for Payer: Cash Price |
$684.30
|
| Rate for Payer: Cigna Commercial |
$2,253.63
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,186.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$207.99
|
| Rate for Payer: Health EOS Commercial |
$2,158.74
|
| Rate for Payer: HFN Commercial |
$2,253.63
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$821.06
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$821.06
|
| Rate for Payer: Independent Care Health Plan Medicare |
$207.99
|
| Rate for Payer: Multiplan Commercial |
$1,897.79
|
| Rate for Payer: NAPHCARE Commercial |
$311.98
|
| Rate for Payer: Preferred Network Access Commercial |
$2,253.63
|
| Rate for Payer: Quartz Beloit One Network |
$1,043.79
|
| Rate for Payer: Quartz Commercial |
$1,352.18
|
| Rate for Payer: Quartz Medicare Advantage |
$207.99
|
| Rate for Payer: The Alliance Commercial |
$790.36
|
| Rate for Payer: United Healthcare Medicare Advantage |
$207.99
|
| Rate for Payer: WEA Trust Commercial |
$1,304.73
|
| Rate for Payer: WPS Commercial |
$1,039.95
|
|
|
NM Kidney Imaging w/ Flow w/o Pharm
|
Professional
|
Both
|
$2,464.00
|
|
|
Service Code
|
CPT 78707
|
| Hospital Charge Code |
2586889
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$207.99 |
| Max. Negotiated Rate |
$2,434.43 |
| Rate for Payer: Aetna Commercial |
$2,434.43
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,203.80
|
| Rate for Payer: Aetna Managed Medicare |
$207.99
|
| Rate for Payer: Anthem Medicare Advantage |
$207.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$207.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$207.99
|
| Rate for Payer: Cash Price |
$739.20
|
| Rate for Payer: Cash Price |
$739.20
|
| Rate for Payer: Cash Price |
$739.20
|
| Rate for Payer: Cigna Commercial |
$2,434.43
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,281.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$207.99
|
| Rate for Payer: Health EOS Commercial |
$2,331.93
|
| Rate for Payer: HFN Commercial |
$2,434.43
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$821.06
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$821.06
|
| Rate for Payer: Independent Care Health Plan Medicare |
$207.99
|
| Rate for Payer: Multiplan Commercial |
$2,050.05
|
| Rate for Payer: NAPHCARE Commercial |
$311.98
|
| Rate for Payer: Preferred Network Access Commercial |
$2,434.43
|
| Rate for Payer: Quartz Beloit One Network |
$1,127.53
|
| Rate for Payer: Quartz Commercial |
$1,460.66
|
| Rate for Payer: Quartz Medicare Advantage |
$207.99
|
| Rate for Payer: The Alliance Commercial |
$790.36
|
| Rate for Payer: United Healthcare Medicare Advantage |
$207.99
|
| Rate for Payer: WEA Trust Commercial |
$1,409.41
|
| Rate for Payer: WPS Commercial |
$1,039.95
|
|
|
NM Kidney Imaging w/ Flow w/o Pharm
|
Facility
|
IP
|
$2,464.00
|
|
|
Service Code
|
CPT 78707
|
| Hospital Charge Code |
2586889
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,255.65 |
| Max. Negotiated Rate |
$2,357.56 |
| Rate for Payer: Aetna Commercial |
$2,306.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,203.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,358.16
|
| Rate for Payer: Cash Price |
$739.20
|
| Rate for Payer: Cigna Commercial |
$2,357.56
|
| Rate for Payer: Health EOS Commercial |
$2,280.68
|
| Rate for Payer: HFN Commercial |
$2,357.56
|
| Rate for Payer: Multiplan Commercial |
$2,050.05
|
| Rate for Payer: Preferred Network Access Commercial |
$2,357.56
|
| Rate for Payer: Quartz Beloit One Network |
$1,255.65
|
| Rate for Payer: Quartz Commercial |
$1,537.54
|
| Rate for Payer: WEA Trust Commercial |
$1,409.41
|
| Rate for Payer: WPS Commercial |
$1,898.02
|
|
|
NM Kidney Imaging w/ Flow w/o Pharm
|
Facility
|
OP
|
$2,281.00
|
|
|
Service Code
|
CPT 78707
|
| Hospital Charge Code |
631451
|
| Min. Negotiated Rate |
$571.42 |
| Max. Negotiated Rate |
$2,285.67 |
| Rate for Payer: Aetna Commercial |
$2,135.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,040.13
|
| Rate for Payer: Aetna Managed Medicare |
$571.42
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,541.96
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,186.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,138.68
|
| Rate for Payer: Anthem Medicare Advantage |
$571.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,257.29
|
| 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 |
$684.30
|
| Rate for Payer: Cash Price |
$684.30
|
| Rate for Payer: Cigna Commercial |
$2,182.46
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$571.42
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,327.54
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$571.42
|
| Rate for Payer: Health EOS Commercial |
$2,111.29
|
| Rate for Payer: HFN Commercial |
$2,182.46
|
| 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 |
$1,897.79
|
| Rate for Payer: NAPHCARE Commercial |
$857.13
|
| Rate for Payer: Preferred Network Access Commercial |
$2,182.46
|
| Rate for Payer: Quartz Beloit One Network |
$1,162.40
|
| Rate for Payer: Quartz Commercial |
$1,541.96
|
| 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 |
$1,304.73
|
| Rate for Payer: Wellcare Medicare |
$571.42
|
| Rate for Payer: WPS Commercial |
$1,757.05
|
|
|
NM Kidney Imaging w/ Flow w/ Pharm
|
Facility
|
IP
|
$2,742.00
|
|
|
Service Code
|
CPT 78708
|
| Hospital Charge Code |
631440
|
| Min. Negotiated Rate |
$1,397.32 |
| Max. Negotiated Rate |
$2,623.55 |
| Rate for Payer: Aetna Commercial |
$2,566.51
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,452.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,511.39
|
| Rate for Payer: Cash Price |
$822.60
|
| Rate for Payer: Cigna Commercial |
$2,623.55
|
| Rate for Payer: Health EOS Commercial |
$2,538.00
|
| Rate for Payer: HFN Commercial |
$2,623.55
|
| Rate for Payer: Multiplan Commercial |
$2,281.34
|
| Rate for Payer: Preferred Network Access Commercial |
$2,623.55
|
| Rate for Payer: Quartz Beloit One Network |
$1,397.32
|
| Rate for Payer: Quartz Commercial |
$1,711.01
|
| Rate for Payer: WEA Trust Commercial |
$1,568.42
|
| Rate for Payer: WPS Commercial |
$2,112.16
|
|
|
NM Kidney Imaging w/ Flow w/ Pharm
|
Facility
|
IP
|
$2,812.00
|
|
|
Service Code
|
CPT 78708
|
| Hospital Charge Code |
2586887
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,433.00 |
| Max. Negotiated Rate |
$2,690.52 |
| Rate for Payer: Aetna Commercial |
$2,632.03
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,515.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,549.97
|
| Rate for Payer: Cash Price |
$843.60
|
| Rate for Payer: Cigna Commercial |
$2,690.52
|
| Rate for Payer: Health EOS Commercial |
$2,602.79
|
| Rate for Payer: HFN Commercial |
$2,690.52
|
| Rate for Payer: Multiplan Commercial |
$2,339.58
|
| Rate for Payer: Preferred Network Access Commercial |
$2,690.52
|
| Rate for Payer: Quartz Beloit One Network |
$1,433.00
|
| Rate for Payer: Quartz Commercial |
$1,754.69
|
| Rate for Payer: WEA Trust Commercial |
$1,608.46
|
| Rate for Payer: WPS Commercial |
$2,166.08
|
|
|
NM Kidney Imaging w/ Flow w/ Pharm
|
Facility
|
OP
|
$2,812.00
|
|
|
Service Code
|
CPT 78708
|
| Hospital Charge Code |
2586887
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$571.42 |
| Max. Negotiated Rate |
$2,690.52 |
| Rate for Payer: Aetna Commercial |
$2,632.03
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,515.05
|
| 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 |
$1,549.97
|
| 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 |
$843.60
|
| Rate for Payer: Cash Price |
$843.60
|
| Rate for Payer: Cash Price |
$843.60
|
| Rate for Payer: Cigna Commercial |
$2,690.52
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$571.42
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,636.58
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$571.42
|
| Rate for Payer: Health EOS Commercial |
$2,602.79
|
| Rate for Payer: HFN Commercial |
$2,690.52
|
| 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 |
$2,339.58
|
| Rate for Payer: NAPHCARE Commercial |
$857.13
|
| Rate for Payer: Preferred Network Access Commercial |
$2,690.52
|
| Rate for Payer: Quartz Beloit One Network |
$1,433.00
|
| Rate for Payer: Quartz Commercial |
$1,900.91
|
| 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 |
$1,608.46
|
| Rate for Payer: Wellcare Medicare |
$571.42
|
| Rate for Payer: WPS Commercial |
$2,166.08
|
|
