|
NM Kidney Imaging w/ Flow w/ Pharm
|
Facility
|
OP
|
$2,742.00
|
|
|
Service Code
|
CPT 78708
|
| Hospital Charge Code |
631440
|
| Min. Negotiated Rate |
$571.42 |
| 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: Aetna Managed Medicare |
$571.42
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,853.59
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,425.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,368.81
|
| Rate for Payer: Anthem Medicare Advantage |
$571.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,511.39
|
| 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 |
$822.60
|
| Rate for Payer: Cash Price |
$822.60
|
| Rate for Payer: Cigna Commercial |
$2,623.55
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$571.42
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,595.84
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$571.42
|
| Rate for Payer: Health EOS Commercial |
$2,538.00
|
| Rate for Payer: HFN Commercial |
$2,623.55
|
| 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 |
$2,281.34
|
| Rate for Payer: NAPHCARE Commercial |
$857.13
|
| 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 |
$1,853.59
|
| Rate for Payer: Quartz Medicare Advantage |
$571.42
|
| Rate for Payer: The Alliance Commercial |
$2,285.67
|
| Rate for Payer: United Healthcare Medicare Advantage |
$571.42
|
| Rate for Payer: WEA Trust Commercial |
$1,568.42
|
| Rate for Payer: Wellcare Medicare |
$571.42
|
| Rate for Payer: WPS Commercial |
$2,112.16
|
|
|
NM Kidney Imaging w/ Flow w/ Pharm
|
Professional
|
Both
|
$2,812.00
|
|
|
Service Code
|
CPT 78708
|
| Hospital Charge Code |
2586887
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$170.96 |
| Max. Negotiated Rate |
$2,778.26 |
| Rate for Payer: Aetna Commercial |
$2,778.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,515.05
|
| Rate for Payer: Aetna Managed Medicare |
$170.96
|
| Rate for Payer: Anthem Medicare Advantage |
$170.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$170.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$170.96
|
| 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 |
$2,778.26
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,462.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$170.96
|
| Rate for Payer: Health EOS Commercial |
$2,661.28
|
| Rate for Payer: HFN Commercial |
$2,778.26
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$627.01
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$627.01
|
| Rate for Payer: Independent Care Health Plan Medicare |
$170.96
|
| Rate for Payer: Multiplan Commercial |
$2,339.58
|
| Rate for Payer: NAPHCARE Commercial |
$256.43
|
| Rate for Payer: Preferred Network Access Commercial |
$2,778.26
|
| Rate for Payer: Quartz Beloit One Network |
$1,286.77
|
| Rate for Payer: Quartz Commercial |
$1,666.95
|
| Rate for Payer: Quartz Medicare Advantage |
$170.96
|
| Rate for Payer: The Alliance Commercial |
$649.63
|
| Rate for Payer: United Healthcare Medicare Advantage |
$170.96
|
| Rate for Payer: WEA Trust Commercial |
$1,608.46
|
| Rate for Payer: WPS Commercial |
$854.78
|
|
|
NM Kidney Imaging w/ Flow w/ Pharm
|
Professional
|
Both
|
$2,742.00
|
|
|
Service Code
|
CPT 78708
|
| Hospital Charge Code |
631440
|
| Min. Negotiated Rate |
$170.96 |
| Max. Negotiated Rate |
$2,709.10 |
| Rate for Payer: Aetna Commercial |
$2,709.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,452.44
|
| Rate for Payer: Aetna Managed Medicare |
$170.96
|
| Rate for Payer: Anthem Medicare Advantage |
$170.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$170.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$170.96
|
| Rate for Payer: Cash Price |
$822.60
|
| Rate for Payer: Cash Price |
$822.60
|
| Rate for Payer: Cash Price |
$822.60
|
| Rate for Payer: Cigna Commercial |
$2,709.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,425.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$170.96
|
| Rate for Payer: Health EOS Commercial |
$2,595.03
|
| Rate for Payer: HFN Commercial |
$2,709.10
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$627.01
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$627.01
|
| Rate for Payer: Independent Care Health Plan Medicare |
$170.96
|
| Rate for Payer: Multiplan Commercial |
$2,281.34
|
| Rate for Payer: NAPHCARE Commercial |
$256.43
|
| Rate for Payer: Preferred Network Access Commercial |
$2,709.10
|
| Rate for Payer: Quartz Beloit One Network |
$1,254.74
|
| Rate for Payer: Quartz Commercial |
$1,625.46
|
| Rate for Payer: Quartz Medicare Advantage |
$170.96
|
| Rate for Payer: The Alliance Commercial |
$649.63
|
| Rate for Payer: United Healthcare Medicare Advantage |
$170.96
|
| Rate for Payer: WEA Trust Commercial |
$1,568.42
|
| Rate for Payer: WPS Commercial |
$854.78
|
|
|
NM Kidney Imaging w/ Flow w/ + w/o Pharm
|
Facility
|
OP
|
$3,527.00
|
|
|
Service Code
|
CPT 78709
|
| Hospital Charge Code |
2586885
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$571.42 |
| Max. Negotiated Rate |
$3,374.63 |
| Rate for Payer: Aetna Commercial |
$3,301.27
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,154.55
|
| 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 |
$1,944.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$571.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$571.42
|
| Rate for Payer: Cash Price |
$1,058.10
|
| Rate for Payer: Cash Price |
$1,058.10
|
| Rate for Payer: Cash Price |
$1,058.10
|
| Rate for Payer: Cigna Commercial |
$3,374.63
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$571.42
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,052.71
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$571.42
|
| Rate for Payer: Health EOS Commercial |
$3,264.59
|
| Rate for Payer: HFN Commercial |
$3,374.63
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,125.67
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$571.42
|
| Rate for Payer: Independent Care Health Plan Medicare |
$571.42
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$571.42
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$571.42
|
| Rate for Payer: Multiplan Commercial |
$2,934.46
|
| Rate for Payer: NAPHCARE Commercial |
$857.13
|
| Rate for Payer: Preferred Network Access Commercial |
$3,374.63
|
| Rate for Payer: Quartz Beloit One Network |
$1,797.36
|
| Rate for Payer: Quartz Commercial |
$2,384.25
|
| Rate for Payer: Quartz Medicare Advantage |
$571.42
|
| Rate for Payer: The Alliance Commercial |
$2,285.67
|
| Rate for Payer: United Healthcare Medicare Advantage |
$571.42
|
| Rate for Payer: United Healthcare PPO |
$2,396.16
|
| Rate for Payer: WEA Trust Commercial |
$2,017.44
|
| Rate for Payer: Wellcare Medicare |
$571.42
|
| Rate for Payer: WPS Commercial |
$2,716.85
|
|
|
NM Kidney Imaging w/ Flow w/ + w/o Pharm
|
Facility
|
OP
|
$3,267.00
|
|
|
Service Code
|
CPT 78709
|
| Hospital Charge Code |
631445
|
| Min. Negotiated Rate |
$571.42 |
| Max. Negotiated Rate |
$3,125.87 |
| Rate for Payer: Aetna Commercial |
$3,057.91
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,922.00
|
| Rate for Payer: Aetna Managed Medicare |
$571.42
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,208.49
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,698.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,630.89
|
| Rate for Payer: Anthem Medicare Advantage |
$571.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,800.77
|
| 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 |
$980.10
|
| Rate for Payer: Cash Price |
$980.10
|
| Rate for Payer: Cigna Commercial |
$3,125.87
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$571.42
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,901.39
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$571.42
|
| Rate for Payer: Health EOS Commercial |
$3,023.94
|
| Rate for Payer: HFN Commercial |
$3,125.87
|
| 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 |
$2,718.14
|
| Rate for Payer: NAPHCARE Commercial |
$857.13
|
| Rate for Payer: Preferred Network Access Commercial |
$3,125.87
|
| Rate for Payer: Quartz Beloit One Network |
$1,664.86
|
| Rate for Payer: Quartz Commercial |
$2,208.49
|
| 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 |
$1,868.72
|
| Rate for Payer: Wellcare Medicare |
$571.42
|
| Rate for Payer: WPS Commercial |
$2,516.57
|
|
|
NM Kidney Imaging w/ Flow w/ + w/o Pharm
|
Professional
|
Both
|
$3,527.00
|
|
|
Service Code
|
CPT 78709
|
| Hospital Charge Code |
2586885
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$324.19 |
| Max. Negotiated Rate |
$3,484.68 |
| Rate for Payer: Aetna Commercial |
$3,484.68
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,154.55
|
| Rate for Payer: Aetna Managed Medicare |
$324.19
|
| Rate for Payer: Anthem Medicare Advantage |
$324.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$324.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$324.19
|
| Rate for Payer: Cash Price |
$1,058.10
|
| Rate for Payer: Cash Price |
$1,058.10
|
| Rate for Payer: Cash Price |
$1,058.10
|
| Rate for Payer: Cigna Commercial |
$3,484.68
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,834.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$324.19
|
| Rate for Payer: Health EOS Commercial |
$3,337.95
|
| Rate for Payer: HFN Commercial |
$3,484.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,306.66
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,306.66
|
| Rate for Payer: Independent Care Health Plan Medicare |
$324.19
|
| Rate for Payer: Multiplan Commercial |
$2,934.46
|
| Rate for Payer: NAPHCARE Commercial |
$486.28
|
| Rate for Payer: Preferred Network Access Commercial |
$3,484.68
|
| Rate for Payer: Quartz Beloit One Network |
$1,613.96
|
| Rate for Payer: Quartz Commercial |
$2,090.81
|
| Rate for Payer: Quartz Medicare Advantage |
$324.19
|
| Rate for Payer: The Alliance Commercial |
$1,231.92
|
| Rate for Payer: United Healthcare Medicare Advantage |
$324.19
|
| Rate for Payer: WEA Trust Commercial |
$2,017.44
|
| Rate for Payer: WPS Commercial |
$1,620.94
|
|
|
NM Kidney Imaging w/ Flow w/ + w/o Pharm
|
Facility
|
IP
|
$3,527.00
|
|
|
Service Code
|
CPT 78709
|
| Hospital Charge Code |
2586885
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,797.36 |
| Max. Negotiated Rate |
$3,374.63 |
| Rate for Payer: Aetna Commercial |
$3,301.27
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,154.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,944.08
|
| Rate for Payer: Cash Price |
$1,058.10
|
| Rate for Payer: Cigna Commercial |
$3,374.63
|
| Rate for Payer: Health EOS Commercial |
$3,264.59
|
| Rate for Payer: HFN Commercial |
$3,374.63
|
| Rate for Payer: Multiplan Commercial |
$2,934.46
|
| Rate for Payer: Preferred Network Access Commercial |
$3,374.63
|
| Rate for Payer: Quartz Beloit One Network |
$1,797.36
|
| Rate for Payer: Quartz Commercial |
$2,200.85
|
| Rate for Payer: WEA Trust Commercial |
$2,017.44
|
| Rate for Payer: WPS Commercial |
$2,716.85
|
|
|
NM Kidney Imaging w/ Flow w/ + w/o Pharm
|
Facility
|
IP
|
$3,267.00
|
|
|
Service Code
|
CPT 78709
|
| Hospital Charge Code |
631445
|
| Min. Negotiated Rate |
$1,664.86 |
| Max. Negotiated Rate |
$3,125.87 |
| Rate for Payer: Aetna Commercial |
$3,057.91
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,922.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,800.77
|
| Rate for Payer: Cash Price |
$980.10
|
| Rate for Payer: Cigna Commercial |
$3,125.87
|
| Rate for Payer: Health EOS Commercial |
$3,023.94
|
| Rate for Payer: HFN Commercial |
$3,125.87
|
| Rate for Payer: Multiplan Commercial |
$2,718.14
|
| Rate for Payer: Preferred Network Access Commercial |
$3,125.87
|
| Rate for Payer: Quartz Beloit One Network |
$1,664.86
|
| Rate for Payer: Quartz Commercial |
$2,038.61
|
| Rate for Payer: WEA Trust Commercial |
$1,868.72
|
| Rate for Payer: WPS Commercial |
$2,516.57
|
|
|
NM Kidney Imaging w/ Flow w/ + w/o Pharm
|
Professional
|
Both
|
$3,267.00
|
|
|
Service Code
|
CPT 78709
|
| Hospital Charge Code |
631445
|
| Min. Negotiated Rate |
$324.19 |
| Max. Negotiated Rate |
$3,227.80 |
| Rate for Payer: Aetna Commercial |
$3,227.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,922.00
|
| Rate for Payer: Aetna Managed Medicare |
$324.19
|
| Rate for Payer: Anthem Medicare Advantage |
$324.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$324.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$324.19
|
| Rate for Payer: Cash Price |
$980.10
|
| Rate for Payer: Cash Price |
$980.10
|
| Rate for Payer: Cash Price |
$980.10
|
| Rate for Payer: Cigna Commercial |
$3,227.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,698.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$324.19
|
| Rate for Payer: Health EOS Commercial |
$3,091.89
|
| Rate for Payer: HFN Commercial |
$3,227.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,306.66
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,306.66
|
| Rate for Payer: Independent Care Health Plan Medicare |
$324.19
|
| Rate for Payer: Multiplan Commercial |
$2,718.14
|
| Rate for Payer: NAPHCARE Commercial |
$486.28
|
| Rate for Payer: Preferred Network Access Commercial |
$3,227.80
|
| Rate for Payer: Quartz Beloit One Network |
$1,494.98
|
| Rate for Payer: Quartz Commercial |
$1,936.68
|
| Rate for Payer: Quartz Medicare Advantage |
$324.19
|
| Rate for Payer: The Alliance Commercial |
$1,231.92
|
| Rate for Payer: United Healthcare Medicare Advantage |
$324.19
|
| Rate for Payer: WEA Trust Commercial |
$1,868.72
|
| Rate for Payer: WPS Commercial |
$1,620.94
|
|
|
NM Liver Imaging w/ Vascular Flow
|
Professional
|
Both
|
$2,936.00
|
|
|
Service Code
|
CPT 78216
|
| Hospital Charge Code |
2586901
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$130.69 |
| Max. Negotiated Rate |
$2,900.77 |
| Rate for Payer: Aetna Commercial |
$2,900.77
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,625.96
|
| Rate for Payer: Aetna Managed Medicare |
$130.69
|
| Rate for Payer: Anthem Medicare Advantage |
$130.69
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$130.69
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$130.69
|
| Rate for Payer: Cash Price |
$880.80
|
| Rate for Payer: Cash Price |
$880.80
|
| Rate for Payer: Cash Price |
$880.80
|
| Rate for Payer: Cigna Commercial |
$2,900.77
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,526.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$130.69
|
| Rate for Payer: Health EOS Commercial |
$2,778.63
|
| Rate for Payer: HFN Commercial |
$2,900.77
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$457.80
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$457.80
|
| Rate for Payer: Independent Care Health Plan Medicare |
$130.69
|
| Rate for Payer: Multiplan Commercial |
$2,442.75
|
| Rate for Payer: NAPHCARE Commercial |
$196.03
|
| Rate for Payer: Preferred Network Access Commercial |
$2,900.77
|
| Rate for Payer: Quartz Beloit One Network |
$1,343.51
|
| Rate for Payer: Quartz Commercial |
$1,740.46
|
| Rate for Payer: Quartz Medicare Advantage |
$130.69
|
| Rate for Payer: The Alliance Commercial |
$496.61
|
| Rate for Payer: United Healthcare Medicare Advantage |
$130.69
|
| Rate for Payer: WEA Trust Commercial |
$1,679.39
|
| Rate for Payer: WPS Commercial |
$653.43
|
|
|
NM Liver Imaging w/ Vascular Flow
|
Facility
|
OP
|
$2,936.00
|
|
|
Service Code
|
CPT 78216
|
| Hospital Charge Code |
2586901
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$420.71 |
| Max. Negotiated Rate |
$2,809.16 |
| Rate for Payer: Aetna Commercial |
$2,748.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,625.96
|
| 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 |
$1,618.32
|
| 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 |
$880.80
|
| Rate for Payer: Cash Price |
$880.80
|
| Rate for Payer: Cash Price |
$880.80
|
| Rate for Payer: Cigna Commercial |
$2,809.16
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$420.71
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,708.75
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$420.71
|
| Rate for Payer: Health EOS Commercial |
$2,717.56
|
| Rate for Payer: HFN Commercial |
$2,809.16
|
| 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 |
$2,442.75
|
| Rate for Payer: NAPHCARE Commercial |
$631.07
|
| Rate for Payer: Preferred Network Access Commercial |
$2,809.16
|
| Rate for Payer: Quartz Beloit One Network |
$1,496.19
|
| Rate for Payer: Quartz Commercial |
$1,984.74
|
| 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 |
$1,679.39
|
| Rate for Payer: Wellcare Medicare |
$420.71
|
| Rate for Payer: WPS Commercial |
$2,261.60
|
|
|
NM Liver Imaging w/ Vascular Flow
|
Facility
|
IP
|
$2,936.00
|
|
|
Service Code
|
CPT 78216
|
| Hospital Charge Code |
2586901
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,496.19 |
| Max. Negotiated Rate |
$2,809.16 |
| Rate for Payer: Aetna Commercial |
$2,748.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,625.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,618.32
|
| Rate for Payer: Cash Price |
$880.80
|
| Rate for Payer: Cigna Commercial |
$2,809.16
|
| Rate for Payer: Health EOS Commercial |
$2,717.56
|
| Rate for Payer: HFN Commercial |
$2,809.16
|
| Rate for Payer: Multiplan Commercial |
$2,442.75
|
| Rate for Payer: Preferred Network Access Commercial |
$2,809.16
|
| Rate for Payer: Quartz Beloit One Network |
$1,496.19
|
| Rate for Payer: Quartz Commercial |
$1,832.06
|
| Rate for Payer: WEA Trust Commercial |
$1,679.39
|
| Rate for Payer: WPS Commercial |
$2,261.60
|
|
|
NM Liver/Spleen Imaging
|
Professional
|
Both
|
$2,418.00
|
|
|
Service Code
|
CPT 78215
|
| Hospital Charge Code |
631331
|
| Min. Negotiated Rate |
$176.82 |
| Max. Negotiated Rate |
$2,388.98 |
| Rate for Payer: Aetna Commercial |
$2,388.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,162.66
|
| Rate for Payer: Aetna Managed Medicare |
$176.82
|
| Rate for Payer: Anthem Medicare Advantage |
$176.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$176.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$176.82
|
| Rate for Payer: Cash Price |
$725.40
|
| Rate for Payer: Cash Price |
$725.40
|
| Rate for Payer: Cash Price |
$725.40
|
| Rate for Payer: Cigna Commercial |
$2,388.98
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,257.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$176.82
|
| Rate for Payer: Health EOS Commercial |
$2,288.40
|
| Rate for Payer: HFN Commercial |
$2,388.98
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$693.74
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$693.74
|
| Rate for Payer: Independent Care Health Plan Medicare |
$176.82
|
| Rate for Payer: Multiplan Commercial |
$2,011.78
|
| Rate for Payer: NAPHCARE Commercial |
$265.23
|
| Rate for Payer: Preferred Network Access Commercial |
$2,388.98
|
| Rate for Payer: Quartz Beloit One Network |
$1,106.48
|
| Rate for Payer: Quartz Commercial |
$1,433.39
|
| Rate for Payer: Quartz Medicare Advantage |
$176.82
|
| Rate for Payer: The Alliance Commercial |
$671.92
|
| Rate for Payer: United Healthcare Medicare Advantage |
$176.82
|
| Rate for Payer: WEA Trust Commercial |
$1,383.10
|
| Rate for Payer: WPS Commercial |
$884.10
|
|
|
NM Liver/Spleen Imaging
|
Facility
|
OP
|
$2,418.00
|
|
|
Service Code
|
CPT 78215
|
| Hospital Charge Code |
631331
|
| Min. Negotiated Rate |
$420.71 |
| Max. Negotiated Rate |
$2,313.54 |
| Rate for Payer: Aetna Commercial |
$2,263.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,162.66
|
| Rate for Payer: Aetna Managed Medicare |
$420.71
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,634.57
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,257.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,207.07
|
| Rate for Payer: Anthem Medicare Advantage |
$420.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,332.80
|
| 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 |
$725.40
|
| Rate for Payer: Cash Price |
$725.40
|
| Rate for Payer: Cigna Commercial |
$2,313.54
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$420.71
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,407.28
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$420.71
|
| Rate for Payer: Health EOS Commercial |
$2,238.10
|
| Rate for Payer: HFN Commercial |
$2,313.54
|
| 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 |
$2,011.78
|
| Rate for Payer: NAPHCARE Commercial |
$631.07
|
| Rate for Payer: Preferred Network Access Commercial |
$2,313.54
|
| Rate for Payer: Quartz Beloit One Network |
$1,232.21
|
| Rate for Payer: Quartz Commercial |
$1,634.57
|
| 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: WEA Trust Commercial |
$1,383.10
|
| Rate for Payer: Wellcare Medicare |
$420.71
|
| Rate for Payer: WPS Commercial |
$1,862.59
|
|
|
NM Liver/Spleen Imaging
|
Facility
|
IP
|
$2,418.00
|
|
|
Service Code
|
CPT 78215
|
| Hospital Charge Code |
631331
|
| Min. Negotiated Rate |
$1,232.21 |
| Max. Negotiated Rate |
$2,313.54 |
| Rate for Payer: Aetna Commercial |
$2,263.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,162.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,332.80
|
| Rate for Payer: Cash Price |
$725.40
|
| Rate for Payer: Cigna Commercial |
$2,313.54
|
| Rate for Payer: Health EOS Commercial |
$2,238.10
|
| Rate for Payer: HFN Commercial |
$2,313.54
|
| Rate for Payer: Multiplan Commercial |
$2,011.78
|
| Rate for Payer: Preferred Network Access Commercial |
$2,313.54
|
| Rate for Payer: Quartz Beloit One Network |
$1,232.21
|
| Rate for Payer: Quartz Commercial |
$1,508.83
|
| Rate for Payer: WEA Trust Commercial |
$1,383.10
|
| Rate for Payer: WPS Commercial |
$1,862.59
|
|
|
NM Liver/Spleen Imaging
|
Professional
|
Both
|
$2,612.00
|
|
|
Service Code
|
CPT 78215
|
| Hospital Charge Code |
2586903
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$176.82 |
| Max. Negotiated Rate |
$2,580.66 |
| Rate for Payer: Aetna Commercial |
$2,580.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,336.17
|
| Rate for Payer: Aetna Managed Medicare |
$176.82
|
| Rate for Payer: Anthem Medicare Advantage |
$176.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$176.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$176.82
|
| Rate for Payer: Cash Price |
$783.60
|
| Rate for Payer: Cash Price |
$783.60
|
| Rate for Payer: Cash Price |
$783.60
|
| Rate for Payer: Cigna Commercial |
$2,580.66
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,358.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$176.82
|
| Rate for Payer: Health EOS Commercial |
$2,472.00
|
| Rate for Payer: HFN Commercial |
$2,580.66
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$693.74
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$693.74
|
| Rate for Payer: Independent Care Health Plan Medicare |
$176.82
|
| Rate for Payer: Multiplan Commercial |
$2,173.18
|
| Rate for Payer: NAPHCARE Commercial |
$265.23
|
| Rate for Payer: Preferred Network Access Commercial |
$2,580.66
|
| Rate for Payer: Quartz Beloit One Network |
$1,195.25
|
| Rate for Payer: Quartz Commercial |
$1,548.39
|
| Rate for Payer: Quartz Medicare Advantage |
$176.82
|
| Rate for Payer: The Alliance Commercial |
$671.92
|
| Rate for Payer: United Healthcare Medicare Advantage |
$176.82
|
| Rate for Payer: WEA Trust Commercial |
$1,494.06
|
| Rate for Payer: WPS Commercial |
$884.10
|
|
|
NM Liver/Spleen Imaging
|
Facility
|
OP
|
$2,612.00
|
|
|
Service Code
|
CPT 78215
|
| Hospital Charge Code |
2586903
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$420.71 |
| Max. Negotiated Rate |
$2,499.16 |
| Rate for Payer: Aetna Commercial |
$2,444.83
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,336.17
|
| 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 |
$1,439.73
|
| 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 |
$783.60
|
| Rate for Payer: Cash Price |
$783.60
|
| Rate for Payer: Cash Price |
$783.60
|
| Rate for Payer: Cigna Commercial |
$2,499.16
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$420.71
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,520.18
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$420.71
|
| Rate for Payer: Health EOS Commercial |
$2,417.67
|
| Rate for Payer: HFN Commercial |
$2,499.16
|
| 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 |
$2,173.18
|
| Rate for Payer: NAPHCARE Commercial |
$631.07
|
| Rate for Payer: Preferred Network Access Commercial |
$2,499.16
|
| Rate for Payer: Quartz Beloit One Network |
$1,331.08
|
| Rate for Payer: Quartz Commercial |
$1,765.71
|
| 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 |
$1,494.06
|
| Rate for Payer: Wellcare Medicare |
$420.71
|
| Rate for Payer: WPS Commercial |
$2,012.02
|
|
|
NM Liver/Spleen Imaging
|
Facility
|
IP
|
$2,612.00
|
|
|
Service Code
|
CPT 78215
|
| Hospital Charge Code |
2586903
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,331.08 |
| Max. Negotiated Rate |
$2,499.16 |
| Rate for Payer: Aetna Commercial |
$2,444.83
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,336.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,439.73
|
| Rate for Payer: Cash Price |
$783.60
|
| Rate for Payer: Cigna Commercial |
$2,499.16
|
| Rate for Payer: Health EOS Commercial |
$2,417.67
|
| Rate for Payer: HFN Commercial |
$2,499.16
|
| Rate for Payer: Multiplan Commercial |
$2,173.18
|
| Rate for Payer: Preferred Network Access Commercial |
$2,499.16
|
| Rate for Payer: Quartz Beloit One Network |
$1,331.08
|
| Rate for Payer: Quartz Commercial |
$1,629.89
|
| Rate for Payer: WEA Trust Commercial |
$1,494.06
|
| Rate for Payer: WPS Commercial |
$2,012.02
|
|
|
NM Liver/Spleen Imaging w/ Vascular Flow
|
Facility
|
OP
|
$2,936.00
|
|
|
Service Code
|
CPT 78216
|
| Hospital Charge Code |
2586905
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$420.71 |
| Max. Negotiated Rate |
$2,809.16 |
| Rate for Payer: Aetna Commercial |
$2,748.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,625.96
|
| 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 |
$1,618.32
|
| 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 |
$880.80
|
| Rate for Payer: Cash Price |
$880.80
|
| Rate for Payer: Cash Price |
$880.80
|
| Rate for Payer: Cigna Commercial |
$2,809.16
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$420.71
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,708.75
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$420.71
|
| Rate for Payer: Health EOS Commercial |
$2,717.56
|
| Rate for Payer: HFN Commercial |
$2,809.16
|
| 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 |
$2,442.75
|
| Rate for Payer: NAPHCARE Commercial |
$631.07
|
| Rate for Payer: Preferred Network Access Commercial |
$2,809.16
|
| Rate for Payer: Quartz Beloit One Network |
$1,496.19
|
| Rate for Payer: Quartz Commercial |
$1,984.74
|
| 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 |
$1,679.39
|
| Rate for Payer: Wellcare Medicare |
$420.71
|
| Rate for Payer: WPS Commercial |
$2,261.60
|
|
|
NM Liver/Spleen Imaging w/ Vascular Flow
|
Professional
|
Both
|
$2,936.00
|
|
|
Service Code
|
CPT 78216
|
| Hospital Charge Code |
2586905
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$130.69 |
| Max. Negotiated Rate |
$2,900.77 |
| Rate for Payer: Aetna Commercial |
$2,900.77
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,625.96
|
| Rate for Payer: Aetna Managed Medicare |
$130.69
|
| Rate for Payer: Anthem Medicare Advantage |
$130.69
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$130.69
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$130.69
|
| Rate for Payer: Cash Price |
$880.80
|
| Rate for Payer: Cash Price |
$880.80
|
| Rate for Payer: Cash Price |
$880.80
|
| Rate for Payer: Cigna Commercial |
$2,900.77
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,526.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$130.69
|
| Rate for Payer: Health EOS Commercial |
$2,778.63
|
| Rate for Payer: HFN Commercial |
$2,900.77
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$457.80
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$457.80
|
| Rate for Payer: Independent Care Health Plan Medicare |
$130.69
|
| Rate for Payer: Multiplan Commercial |
$2,442.75
|
| Rate for Payer: NAPHCARE Commercial |
$196.03
|
| Rate for Payer: Preferred Network Access Commercial |
$2,900.77
|
| Rate for Payer: Quartz Beloit One Network |
$1,343.51
|
| Rate for Payer: Quartz Commercial |
$1,740.46
|
| Rate for Payer: Quartz Medicare Advantage |
$130.69
|
| Rate for Payer: The Alliance Commercial |
$496.61
|
| Rate for Payer: United Healthcare Medicare Advantage |
$130.69
|
| Rate for Payer: WEA Trust Commercial |
$1,679.39
|
| Rate for Payer: WPS Commercial |
$653.43
|
|
|
NM Liver/Spleen Imaging w/ Vascular Flow
|
Facility
|
IP
|
$2,936.00
|
|
|
Service Code
|
CPT 78216
|
| Hospital Charge Code |
2586905
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,496.19 |
| Max. Negotiated Rate |
$2,809.16 |
| Rate for Payer: Aetna Commercial |
$2,748.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,625.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,618.32
|
| Rate for Payer: Cash Price |
$880.80
|
| Rate for Payer: Cigna Commercial |
$2,809.16
|
| Rate for Payer: Health EOS Commercial |
$2,717.56
|
| Rate for Payer: HFN Commercial |
$2,809.16
|
| Rate for Payer: Multiplan Commercial |
$2,442.75
|
| Rate for Payer: Preferred Network Access Commercial |
$2,809.16
|
| Rate for Payer: Quartz Beloit One Network |
$1,496.19
|
| Rate for Payer: Quartz Commercial |
$1,832.06
|
| Rate for Payer: WEA Trust Commercial |
$1,679.39
|
| Rate for Payer: WPS Commercial |
$2,261.60
|
|
|
NM Lymphoscintigraphy
|
Professional
|
Both
|
$2,156.00
|
|
|
Service Code
|
CPT 78195
|
| Hospital Charge Code |
2586909
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$309.71 |
| Max. Negotiated Rate |
$2,130.13 |
| Rate for Payer: Aetna Commercial |
$2,130.13
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,928.33
|
| Rate for Payer: Aetna Managed Medicare |
$309.71
|
| Rate for Payer: Anthem Medicare Advantage |
$309.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$309.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$309.71
|
| Rate for Payer: Cash Price |
$646.80
|
| Rate for Payer: Cash Price |
$646.80
|
| Rate for Payer: Cash Price |
$646.80
|
| Rate for Payer: Cigna Commercial |
$2,130.13
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,121.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$309.71
|
| Rate for Payer: Health EOS Commercial |
$2,040.44
|
| Rate for Payer: HFN Commercial |
$2,130.13
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,258.02
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,258.02
|
| Rate for Payer: Independent Care Health Plan Medicare |
$309.71
|
| Rate for Payer: Multiplan Commercial |
$1,793.79
|
| Rate for Payer: NAPHCARE Commercial |
$464.57
|
| Rate for Payer: Preferred Network Access Commercial |
$2,130.13
|
| Rate for Payer: Quartz Beloit One Network |
$986.59
|
| Rate for Payer: Quartz Commercial |
$1,278.08
|
| Rate for Payer: Quartz Medicare Advantage |
$309.71
|
| Rate for Payer: The Alliance Commercial |
$1,176.91
|
| Rate for Payer: United Healthcare Medicare Advantage |
$309.71
|
| Rate for Payer: WEA Trust Commercial |
$1,233.23
|
| Rate for Payer: WPS Commercial |
$1,548.56
|
|
|
NM Lymphoscintigraphy
|
Facility
|
OP
|
$2,156.00
|
|
|
Service Code
|
CPT 78195
|
| Hospital Charge Code |
2586909
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$571.42 |
| Max. Negotiated Rate |
$2,396.16 |
| Rate for Payer: Aetna Commercial |
$2,018.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,928.33
|
| 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 |
$1,188.39
|
| 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 |
$646.80
|
| Rate for Payer: Cash Price |
$646.80
|
| Rate for Payer: Cash Price |
$646.80
|
| Rate for Payer: Cigna Commercial |
$2,062.86
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$571.42
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,254.79
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$571.42
|
| Rate for Payer: Health EOS Commercial |
$1,995.59
|
| Rate for Payer: HFN Commercial |
$2,062.86
|
| 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 |
$1,793.79
|
| Rate for Payer: NAPHCARE Commercial |
$857.13
|
| Rate for Payer: Preferred Network Access Commercial |
$2,062.86
|
| Rate for Payer: Quartz Beloit One Network |
$1,098.70
|
| Rate for Payer: Quartz Commercial |
$1,457.46
|
| 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 |
$1,233.23
|
| Rate for Payer: Wellcare Medicare |
$571.42
|
| Rate for Payer: WPS Commercial |
$1,660.77
|
|
|
NM Lymphoscintigraphy
|
Facility
|
IP
|
$2,156.00
|
|
|
Service Code
|
CPT 78195
|
| Hospital Charge Code |
2586909
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,098.70 |
| Max. Negotiated Rate |
$2,062.86 |
| Rate for Payer: Aetna Commercial |
$2,018.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,928.33
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,188.39
|
| Rate for Payer: Cash Price |
$646.80
|
| Rate for Payer: Cigna Commercial |
$2,062.86
|
| Rate for Payer: Health EOS Commercial |
$1,995.59
|
| Rate for Payer: HFN Commercial |
$2,062.86
|
| Rate for Payer: Multiplan Commercial |
$1,793.79
|
| Rate for Payer: Preferred Network Access Commercial |
$2,062.86
|
| Rate for Payer: Quartz Beloit One Network |
$1,098.70
|
| Rate for Payer: Quartz Commercial |
$1,345.34
|
| Rate for Payer: WEA Trust Commercial |
$1,233.23
|
| Rate for Payer: WPS Commercial |
$1,660.77
|
|
|
NM Lymphoscintigraphy
|
Facility
|
OP
|
$1,658.00
|
|
|
Service Code
|
CPT 78195
|
| Hospital Charge Code |
631350
|
| Min. Negotiated Rate |
$571.42 |
| Max. Negotiated Rate |
$2,285.67 |
| Rate for Payer: Aetna Commercial |
$1,551.89
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,482.92
|
| Rate for Payer: Aetna Managed Medicare |
$571.42
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,120.81
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$862.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$827.67
|
| Rate for Payer: Anthem Medicare Advantage |
$571.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$913.89
|
| 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 |
$497.40
|
| Rate for Payer: Cash Price |
$497.40
|
| Rate for Payer: Cigna Commercial |
$1,586.37
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$571.42
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$964.96
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$571.42
|
| Rate for Payer: Health EOS Commercial |
$1,534.64
|
| Rate for Payer: HFN Commercial |
$1,586.37
|
| 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 |
$1,379.46
|
| Rate for Payer: NAPHCARE Commercial |
$857.13
|
| Rate for Payer: Preferred Network Access Commercial |
$1,586.37
|
| Rate for Payer: Quartz Beloit One Network |
$844.92
|
| Rate for Payer: Quartz Commercial |
$1,120.81
|
| 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 |
$948.38
|
| Rate for Payer: Wellcare Medicare |
$571.42
|
| Rate for Payer: WPS Commercial |
$1,277.16
|
|
