|
NM Pulmonary Perfusion w/ Ventilation
|
Professional
|
Both
|
$3,212.00
|
|
|
Service Code
|
CPT 78582
|
| Hospital Charge Code |
2586945
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$288.55 |
| Max. Negotiated Rate |
$3,173.46 |
| Rate for Payer: Aetna Commercial |
$3,173.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,872.81
|
| Rate for Payer: Aetna Managed Medicare |
$288.55
|
| Rate for Payer: Anthem Medicare Advantage |
$288.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$288.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$288.55
|
| Rate for Payer: Cash Price |
$963.60
|
| Rate for Payer: Cash Price |
$963.60
|
| Rate for Payer: Cash Price |
$963.60
|
| Rate for Payer: Cigna Commercial |
$3,173.46
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,670.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$288.55
|
| Rate for Payer: Health EOS Commercial |
$3,039.84
|
| Rate for Payer: HFN Commercial |
$3,173.46
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,181.87
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,181.87
|
| Rate for Payer: Independent Care Health Plan Medicare |
$288.55
|
| Rate for Payer: Multiplan Commercial |
$2,672.38
|
| Rate for Payer: NAPHCARE Commercial |
$432.82
|
| Rate for Payer: Preferred Network Access Commercial |
$3,173.46
|
| Rate for Payer: Quartz Beloit One Network |
$1,469.81
|
| Rate for Payer: Quartz Commercial |
$1,904.07
|
| Rate for Payer: Quartz Medicare Advantage |
$288.55
|
| Rate for Payer: The Alliance Commercial |
$1,096.48
|
| Rate for Payer: United Healthcare Medicare Advantage |
$288.55
|
| Rate for Payer: WEA Trust Commercial |
$1,837.26
|
| Rate for Payer: WPS Commercial |
$1,442.74
|
|
|
NM Pulmonary Ventilation Gaseous Single
|
Professional
|
Both
|
$1,412.00
|
|
|
Service Code
|
CPT 78579
|
| Hospital Charge Code |
2586949
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$165.07 |
| Max. Negotiated Rate |
$1,395.06 |
| Rate for Payer: Aetna Commercial |
$1,395.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,262.89
|
| Rate for Payer: Aetna Managed Medicare |
$165.07
|
| Rate for Payer: Anthem Medicare Advantage |
$165.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$165.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$165.07
|
| Rate for Payer: Cash Price |
$423.60
|
| Rate for Payer: Cash Price |
$423.60
|
| Rate for Payer: Cash Price |
$423.60
|
| Rate for Payer: Cigna Commercial |
$1,395.06
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$734.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$165.07
|
| Rate for Payer: Health EOS Commercial |
$1,336.32
|
| Rate for Payer: HFN Commercial |
$1,395.06
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$662.36
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$662.36
|
| Rate for Payer: Independent Care Health Plan Medicare |
$165.07
|
| Rate for Payer: Multiplan Commercial |
$1,174.78
|
| Rate for Payer: NAPHCARE Commercial |
$247.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,395.06
|
| Rate for Payer: Quartz Beloit One Network |
$646.13
|
| Rate for Payer: Quartz Commercial |
$837.03
|
| Rate for Payer: Quartz Medicare Advantage |
$165.07
|
| Rate for Payer: The Alliance Commercial |
$627.26
|
| Rate for Payer: United Healthcare Medicare Advantage |
$165.07
|
| Rate for Payer: WEA Trust Commercial |
$807.66
|
| Rate for Payer: WPS Commercial |
$825.34
|
|
|
NM Pulmonary Ventilation Gaseous Single
|
Facility
|
OP
|
$1,412.00
|
|
|
Service Code
|
CPT 78579
|
| Hospital Charge Code |
2586949
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$420.71 |
| Max. Negotiated Rate |
$2,396.16 |
| Rate for Payer: Aetna Commercial |
$1,321.63
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,262.89
|
| 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 |
$778.29
|
| 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 |
$423.60
|
| Rate for Payer: Cash Price |
$423.60
|
| Rate for Payer: Cash Price |
$423.60
|
| Rate for Payer: Cigna Commercial |
$1,351.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$420.71
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$821.78
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$420.71
|
| Rate for Payer: Health EOS Commercial |
$1,306.95
|
| Rate for Payer: HFN Commercial |
$1,351.00
|
| 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 |
$1,174.78
|
| Rate for Payer: NAPHCARE Commercial |
$631.07
|
| Rate for Payer: Preferred Network Access Commercial |
$1,351.00
|
| Rate for Payer: Quartz Beloit One Network |
$719.56
|
| Rate for Payer: Quartz Commercial |
$954.51
|
| 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 |
$807.66
|
| Rate for Payer: Wellcare Medicare |
$420.71
|
| Rate for Payer: WPS Commercial |
$1,087.66
|
|
|
NM Pulmonary Ventilation Gaseous Single
|
Facility
|
IP
|
$1,412.00
|
|
|
Service Code
|
CPT 78579
|
| Hospital Charge Code |
2586949
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$719.56 |
| Max. Negotiated Rate |
$1,351.00 |
| Rate for Payer: Aetna Commercial |
$1,321.63
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,262.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$778.29
|
| Rate for Payer: Cash Price |
$423.60
|
| Rate for Payer: Cigna Commercial |
$1,351.00
|
| Rate for Payer: Health EOS Commercial |
$1,306.95
|
| Rate for Payer: HFN Commercial |
$1,351.00
|
| Rate for Payer: Multiplan Commercial |
$1,174.78
|
| Rate for Payer: Preferred Network Access Commercial |
$1,351.00
|
| Rate for Payer: Quartz Beloit One Network |
$719.56
|
| Rate for Payer: Quartz Commercial |
$881.09
|
| Rate for Payer: WEA Trust Commercial |
$807.66
|
| Rate for Payer: WPS Commercial |
$1,087.66
|
|
|
NM Quantitative Pulmonary Perfusion
|
Professional
|
Both
|
$3,031.00
|
|
|
Service Code
|
CPT 78597
|
| Hospital Charge Code |
2942805
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$179.08 |
| Max. Negotiated Rate |
$2,994.63 |
| Rate for Payer: Aetna Commercial |
$2,994.63
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,710.93
|
| Rate for Payer: Aetna Managed Medicare |
$179.08
|
| Rate for Payer: Anthem Medicare Advantage |
$179.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$179.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$179.08
|
| Rate for Payer: Cash Price |
$909.30
|
| Rate for Payer: Cash Price |
$909.30
|
| Rate for Payer: Cash Price |
$909.30
|
| Rate for Payer: Cigna Commercial |
$2,994.63
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,576.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$179.08
|
| Rate for Payer: Health EOS Commercial |
$2,868.54
|
| Rate for Payer: HFN Commercial |
$2,994.63
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$716.94
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$716.94
|
| Rate for Payer: Independent Care Health Plan Medicare |
$179.08
|
| Rate for Payer: Multiplan Commercial |
$2,521.79
|
| Rate for Payer: NAPHCARE Commercial |
$268.62
|
| Rate for Payer: Preferred Network Access Commercial |
$2,994.63
|
| Rate for Payer: Quartz Beloit One Network |
$1,386.99
|
| Rate for Payer: Quartz Commercial |
$1,796.78
|
| Rate for Payer: Quartz Medicare Advantage |
$179.08
|
| Rate for Payer: The Alliance Commercial |
$680.49
|
| Rate for Payer: United Healthcare Medicare Advantage |
$179.08
|
| Rate for Payer: WEA Trust Commercial |
$1,733.73
|
| Rate for Payer: WPS Commercial |
$895.39
|
|
|
NM Quantitative Pulmonary Perfusion
|
Facility
|
OP
|
$3,031.00
|
|
|
Service Code
|
CPT 78597
|
| Hospital Charge Code |
2942805
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$420.71 |
| Max. Negotiated Rate |
$2,900.06 |
| Rate for Payer: Aetna Commercial |
$2,837.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,710.93
|
| 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 |
$1,670.69
|
| 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 |
$909.30
|
| Rate for Payer: Cash Price |
$909.30
|
| Rate for Payer: Cash Price |
$909.30
|
| Rate for Payer: Cigna Commercial |
$2,900.06
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$420.71
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,764.04
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$420.71
|
| Rate for Payer: Health EOS Commercial |
$2,805.49
|
| Rate for Payer: HFN Commercial |
$2,900.06
|
| 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 |
$2,521.79
|
| Rate for Payer: NAPHCARE Commercial |
$631.07
|
| Rate for Payer: Preferred Network Access Commercial |
$2,900.06
|
| Rate for Payer: Quartz Beloit One Network |
$1,544.60
|
| Rate for Payer: Quartz Commercial |
$2,048.96
|
| 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 |
$1,733.73
|
| Rate for Payer: Wellcare Medicare |
$420.71
|
| Rate for Payer: WPS Commercial |
$2,334.78
|
|
|
NM Quantitative Pulmonary Perfusion
|
Facility
|
IP
|
$3,031.00
|
|
|
Service Code
|
CPT 78597
|
| Hospital Charge Code |
2942805
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,544.60 |
| Max. Negotiated Rate |
$2,900.06 |
| Rate for Payer: Aetna Commercial |
$2,837.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,710.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,670.69
|
| Rate for Payer: Cash Price |
$909.30
|
| Rate for Payer: Cigna Commercial |
$2,900.06
|
| Rate for Payer: Health EOS Commercial |
$2,805.49
|
| Rate for Payer: HFN Commercial |
$2,900.06
|
| Rate for Payer: Multiplan Commercial |
$2,521.79
|
| Rate for Payer: Preferred Network Access Commercial |
$2,900.06
|
| Rate for Payer: Quartz Beloit One Network |
$1,544.60
|
| Rate for Payer: Quartz Commercial |
$1,891.34
|
| Rate for Payer: WEA Trust Commercial |
$1,733.73
|
| Rate for Payer: WPS Commercial |
$2,334.78
|
|
|
NM Quantitative Pulmonary Perf/Vent
|
Professional
|
Both
|
$3,152.00
|
|
|
Service Code
|
CPT 78598
|
| Hospital Charge Code |
2942802
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$263.08 |
| Max. Negotiated Rate |
$3,114.18 |
| Rate for Payer: Aetna Commercial |
$3,114.18
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,819.15
|
| Rate for Payer: Aetna Managed Medicare |
$263.08
|
| Rate for Payer: Anthem Medicare Advantage |
$263.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$263.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$263.08
|
| Rate for Payer: Cash Price |
$945.60
|
| Rate for Payer: Cash Price |
$945.60
|
| Rate for Payer: Cash Price |
$945.60
|
| Rate for Payer: Cigna Commercial |
$3,114.18
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,639.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$263.08
|
| Rate for Payer: Health EOS Commercial |
$2,983.05
|
| Rate for Payer: HFN Commercial |
$3,114.18
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,078.49
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,078.49
|
| Rate for Payer: Independent Care Health Plan Medicare |
$263.08
|
| Rate for Payer: Multiplan Commercial |
$2,622.46
|
| Rate for Payer: NAPHCARE Commercial |
$394.62
|
| Rate for Payer: Preferred Network Access Commercial |
$3,114.18
|
| Rate for Payer: Quartz Beloit One Network |
$1,442.36
|
| Rate for Payer: Quartz Commercial |
$1,868.51
|
| Rate for Payer: Quartz Medicare Advantage |
$263.08
|
| Rate for Payer: The Alliance Commercial |
$999.70
|
| Rate for Payer: United Healthcare Medicare Advantage |
$263.08
|
| Rate for Payer: WEA Trust Commercial |
$1,802.94
|
| Rate for Payer: WPS Commercial |
$1,315.39
|
|
|
NM Quantitative Pulmonary Perf/Vent
|
Facility
|
IP
|
$3,152.00
|
|
|
Service Code
|
CPT 78598
|
| Hospital Charge Code |
2942802
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,606.26 |
| Max. Negotiated Rate |
$3,015.83 |
| Rate for Payer: Aetna Commercial |
$2,950.27
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,819.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,737.38
|
| Rate for Payer: Cash Price |
$945.60
|
| Rate for Payer: Cigna Commercial |
$3,015.83
|
| Rate for Payer: Health EOS Commercial |
$2,917.49
|
| Rate for Payer: HFN Commercial |
$3,015.83
|
| Rate for Payer: Multiplan Commercial |
$2,622.46
|
| Rate for Payer: Preferred Network Access Commercial |
$3,015.83
|
| Rate for Payer: Quartz Beloit One Network |
$1,606.26
|
| Rate for Payer: Quartz Commercial |
$1,966.85
|
| Rate for Payer: WEA Trust Commercial |
$1,802.94
|
| Rate for Payer: WPS Commercial |
$2,427.99
|
|
|
NM Quantitative Pulmonary Perf/Vent
|
Facility
|
OP
|
$3,152.00
|
|
|
Service Code
|
CPT 78598
|
| Hospital Charge Code |
2942802
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$571.42 |
| Max. Negotiated Rate |
$3,015.83 |
| Rate for Payer: Aetna Commercial |
$2,950.27
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,819.15
|
| 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 |
$1,737.38
|
| 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 |
$945.60
|
| Rate for Payer: Cash Price |
$945.60
|
| Rate for Payer: Cash Price |
$945.60
|
| Rate for Payer: Cigna Commercial |
$3,015.83
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$571.42
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,834.46
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$571.42
|
| Rate for Payer: Health EOS Commercial |
$2,917.49
|
| Rate for Payer: HFN Commercial |
$3,015.83
|
| 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 |
$2,622.46
|
| Rate for Payer: NAPHCARE Commercial |
$857.13
|
| Rate for Payer: Preferred Network Access Commercial |
$3,015.83
|
| Rate for Payer: Quartz Beloit One Network |
$1,606.26
|
| Rate for Payer: Quartz Commercial |
$2,130.75
|
| 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 |
$1,802.94
|
| Rate for Payer: Wellcare Medicare |
$571.42
|
| Rate for Payer: WPS Commercial |
$2,427.99
|
|
|
NM Radionuclide IV Therapy
|
Professional
|
Both
|
$2,113.00
|
|
|
Service Code
|
CPT 79101
|
| Hospital Charge Code |
2580818
|
| Min. Negotiated Rate |
$143.19 |
| Max. Negotiated Rate |
$2,087.64 |
| Rate for Payer: Aetna Commercial |
$2,087.64
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,889.87
|
| Rate for Payer: Aetna Managed Medicare |
$143.19
|
| Rate for Payer: Anthem Medicare Advantage |
$143.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$143.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$143.19
|
| Rate for Payer: Cash Price |
$633.90
|
| Rate for Payer: Cash Price |
$633.90
|
| Rate for Payer: Cash Price |
$633.90
|
| Rate for Payer: Cigna Commercial |
$2,087.64
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,098.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$143.19
|
| Rate for Payer: Health EOS Commercial |
$1,999.74
|
| Rate for Payer: HFN Commercial |
$2,087.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$529.24
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$529.24
|
| Rate for Payer: Independent Care Health Plan Medicare |
$143.19
|
| Rate for Payer: Multiplan Commercial |
$1,758.02
|
| Rate for Payer: NAPHCARE Commercial |
$214.78
|
| Rate for Payer: Preferred Network Access Commercial |
$2,087.64
|
| Rate for Payer: Quartz Beloit One Network |
$966.91
|
| Rate for Payer: Quartz Commercial |
$1,252.59
|
| Rate for Payer: Quartz Medicare Advantage |
$143.19
|
| Rate for Payer: The Alliance Commercial |
$544.11
|
| Rate for Payer: United Healthcare Medicare Advantage |
$143.19
|
| Rate for Payer: WEA Trust Commercial |
$1,208.64
|
| Rate for Payer: WPS Commercial |
$715.94
|
|
|
NM Radionuclide IV Therapy
|
Facility
|
IP
|
$2,113.00
|
|
|
Service Code
|
CPT 79101
|
| Hospital Charge Code |
2580818
|
| Min. Negotiated Rate |
$1,076.78 |
| Max. Negotiated Rate |
$2,021.72 |
| Rate for Payer: Aetna Commercial |
$1,977.77
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,889.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,164.69
|
| Rate for Payer: Cash Price |
$633.90
|
| Rate for Payer: Cigna Commercial |
$2,021.72
|
| Rate for Payer: Health EOS Commercial |
$1,955.79
|
| Rate for Payer: HFN Commercial |
$2,021.72
|
| Rate for Payer: Multiplan Commercial |
$1,758.02
|
| Rate for Payer: Preferred Network Access Commercial |
$2,021.72
|
| Rate for Payer: Quartz Beloit One Network |
$1,076.78
|
| Rate for Payer: Quartz Commercial |
$1,318.51
|
| Rate for Payer: WEA Trust Commercial |
$1,208.64
|
| Rate for Payer: WPS Commercial |
$1,627.64
|
|
|
NM Radionuclide IV Therapy
|
Facility
|
OP
|
$2,198.00
|
|
|
Service Code
|
CPT 79101
|
| Hospital Charge Code |
2586951
|
|
Hospital Revenue Code
|
342
|
| Min. Negotiated Rate |
$245.56 |
| Max. Negotiated Rate |
$2,396.16 |
| Rate for Payer: Aetna Commercial |
$2,057.33
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,965.89
|
| 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 |
$1,211.54
|
| 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 |
$659.40
|
| Rate for Payer: Cash Price |
$659.40
|
| Rate for Payer: Cash Price |
$659.40
|
| Rate for Payer: Cigna Commercial |
$2,103.05
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$245.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,279.24
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$245.56
|
| Rate for Payer: Health EOS Commercial |
$2,034.47
|
| Rate for Payer: HFN Commercial |
$2,103.05
|
| 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 |
$1,828.74
|
| Rate for Payer: NAPHCARE Commercial |
$368.35
|
| Rate for Payer: Preferred Network Access Commercial |
$2,103.05
|
| Rate for Payer: Quartz Beloit One Network |
$1,120.10
|
| Rate for Payer: Quartz Commercial |
$1,485.85
|
| 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 |
$1,257.26
|
| Rate for Payer: Wellcare Medicare |
$245.56
|
| Rate for Payer: WPS Commercial |
$1,693.12
|
|
|
NM Radionuclide IV Therapy
|
Facility
|
OP
|
$2,113.00
|
|
|
Service Code
|
CPT 79101
|
| Hospital Charge Code |
2580818
|
| Min. Negotiated Rate |
$245.56 |
| Max. Negotiated Rate |
$2,021.72 |
| Rate for Payer: Aetna Commercial |
$1,977.77
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,889.87
|
| Rate for Payer: Aetna Managed Medicare |
$245.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,428.39
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,098.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,054.81
|
| Rate for Payer: Anthem Medicare Advantage |
$245.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,164.69
|
| 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 |
$633.90
|
| Rate for Payer: Cash Price |
$633.90
|
| Rate for Payer: Cigna Commercial |
$2,021.72
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$245.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,229.77
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$245.56
|
| Rate for Payer: Health EOS Commercial |
$1,955.79
|
| Rate for Payer: HFN Commercial |
$2,021.72
|
| 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 |
$1,758.02
|
| Rate for Payer: NAPHCARE Commercial |
$368.35
|
| Rate for Payer: Preferred Network Access Commercial |
$2,021.72
|
| Rate for Payer: Quartz Beloit One Network |
$1,076.78
|
| Rate for Payer: Quartz Commercial |
$1,428.39
|
| 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: WEA Trust Commercial |
$1,208.64
|
| Rate for Payer: Wellcare Medicare |
$245.56
|
| Rate for Payer: WPS Commercial |
$1,627.64
|
|
|
NM Radionuclide IV Therapy
|
Facility
|
IP
|
$2,198.00
|
|
|
Service Code
|
CPT 79101
|
| Hospital Charge Code |
2586951
|
|
Hospital Revenue Code
|
342
|
| Min. Negotiated Rate |
$1,120.10 |
| Max. Negotiated Rate |
$2,103.05 |
| Rate for Payer: Aetna Commercial |
$2,057.33
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,965.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,211.54
|
| Rate for Payer: Cash Price |
$659.40
|
| Rate for Payer: Cigna Commercial |
$2,103.05
|
| Rate for Payer: Health EOS Commercial |
$2,034.47
|
| Rate for Payer: HFN Commercial |
$2,103.05
|
| Rate for Payer: Multiplan Commercial |
$1,828.74
|
| Rate for Payer: Preferred Network Access Commercial |
$2,103.05
|
| Rate for Payer: Quartz Beloit One Network |
$1,120.10
|
| Rate for Payer: Quartz Commercial |
$1,371.55
|
| Rate for Payer: WEA Trust Commercial |
$1,257.26
|
| Rate for Payer: WPS Commercial |
$1,693.12
|
|
|
NM Radionuclide IV Therapy
|
Professional
|
Both
|
$2,198.00
|
|
|
Service Code
|
CPT 79101
|
| Hospital Charge Code |
2586951
|
|
Hospital Revenue Code
|
342
|
| Min. Negotiated Rate |
$143.19 |
| Max. Negotiated Rate |
$2,171.62 |
| Rate for Payer: Aetna Commercial |
$2,171.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,965.89
|
| Rate for Payer: Aetna Managed Medicare |
$143.19
|
| Rate for Payer: Anthem Medicare Advantage |
$143.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$143.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$143.19
|
| Rate for Payer: Cash Price |
$659.40
|
| Rate for Payer: Cash Price |
$659.40
|
| Rate for Payer: Cash Price |
$659.40
|
| Rate for Payer: Cigna Commercial |
$2,171.62
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,142.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$143.19
|
| Rate for Payer: Health EOS Commercial |
$2,080.19
|
| Rate for Payer: HFN Commercial |
$2,171.62
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$529.24
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$529.24
|
| Rate for Payer: Independent Care Health Plan Medicare |
$143.19
|
| Rate for Payer: Multiplan Commercial |
$1,828.74
|
| Rate for Payer: NAPHCARE Commercial |
$214.78
|
| Rate for Payer: Preferred Network Access Commercial |
$2,171.62
|
| Rate for Payer: Quartz Beloit One Network |
$1,005.80
|
| Rate for Payer: Quartz Commercial |
$1,302.97
|
| Rate for Payer: Quartz Medicare Advantage |
$143.19
|
| Rate for Payer: The Alliance Commercial |
$544.11
|
| Rate for Payer: United Healthcare Medicare Advantage |
$143.19
|
| Rate for Payer: WEA Trust Commercial |
$1,257.26
|
| Rate for Payer: WPS Commercial |
$715.94
|
|
|
NM Radionuclide Thyroid Oral Ablation
|
Facility
|
OP
|
$2,304.00
|
|
|
Service Code
|
CPT 79005
|
| Hospital Charge Code |
2580815
|
| Min. Negotiated Rate |
$245.56 |
| Max. Negotiated Rate |
$2,204.47 |
| Rate for Payer: Aetna Commercial |
$2,156.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,060.70
|
| Rate for Payer: Aetna Managed Medicare |
$245.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,557.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,198.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,150.16
|
| Rate for Payer: Anthem Medicare Advantage |
$245.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,269.96
|
| 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 |
$691.20
|
| Rate for Payer: Cash Price |
$691.20
|
| Rate for Payer: Cigna Commercial |
$2,204.47
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$245.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,340.93
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$245.56
|
| Rate for Payer: Health EOS Commercial |
$2,132.58
|
| Rate for Payer: HFN Commercial |
$2,204.47
|
| 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 |
$1,916.93
|
| Rate for Payer: NAPHCARE Commercial |
$368.35
|
| Rate for Payer: Preferred Network Access Commercial |
$2,204.47
|
| Rate for Payer: Quartz Beloit One Network |
$1,174.12
|
| Rate for Payer: Quartz Commercial |
$1,557.50
|
| 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: WEA Trust Commercial |
$1,317.89
|
| Rate for Payer: Wellcare Medicare |
$245.56
|
| Rate for Payer: WPS Commercial |
$1,774.77
|
|
|
NM Radionuclide Thyroid Oral Ablation
|
Facility
|
IP
|
$2,488.00
|
|
|
Service Code
|
CPT 79005
|
| Hospital Charge Code |
2586954
|
|
Hospital Revenue Code
|
342
|
| Min. Negotiated Rate |
$1,267.88 |
| Max. Negotiated Rate |
$2,380.52 |
| Rate for Payer: Aetna Commercial |
$2,328.77
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,225.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,371.39
|
| Rate for Payer: Cash Price |
$746.40
|
| Rate for Payer: Cigna Commercial |
$2,380.52
|
| Rate for Payer: Health EOS Commercial |
$2,302.89
|
| Rate for Payer: HFN Commercial |
$2,380.52
|
| Rate for Payer: Multiplan Commercial |
$2,070.02
|
| Rate for Payer: Preferred Network Access Commercial |
$2,380.52
|
| Rate for Payer: Quartz Beloit One Network |
$1,267.88
|
| Rate for Payer: Quartz Commercial |
$1,552.51
|
| Rate for Payer: WEA Trust Commercial |
$1,423.14
|
| Rate for Payer: WPS Commercial |
$1,916.51
|
|
|
NM Radionuclide Thyroid Oral Ablation
|
Professional
|
Both
|
$2,488.00
|
|
|
Service Code
|
CPT 79005
|
| Hospital Charge Code |
2586954
|
|
Hospital Revenue Code
|
342
|
| Min. Negotiated Rate |
$132.32 |
| Max. Negotiated Rate |
$2,458.14 |
| Rate for Payer: Aetna Commercial |
$2,458.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,225.27
|
| 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 |
$746.40
|
| Rate for Payer: Cash Price |
$746.40
|
| Rate for Payer: Cash Price |
$746.40
|
| Rate for Payer: Cigna Commercial |
$2,458.14
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,293.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$132.32
|
| Rate for Payer: Health EOS Commercial |
$2,354.64
|
| Rate for Payer: HFN Commercial |
$2,458.14
|
| 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 |
$2,070.02
|
| Rate for Payer: NAPHCARE Commercial |
$198.48
|
| Rate for Payer: Preferred Network Access Commercial |
$2,458.14
|
| Rate for Payer: Quartz Beloit One Network |
$1,138.51
|
| Rate for Payer: Quartz Commercial |
$1,474.89
|
| 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 |
$1,423.14
|
| Rate for Payer: WPS Commercial |
$661.60
|
|
|
NM Radionuclide Thyroid Oral Ablation
|
Facility
|
OP
|
$2,488.00
|
|
|
Service Code
|
CPT 79005
|
| Hospital Charge Code |
2586954
|
|
Hospital Revenue Code
|
342
|
| Min. Negotiated Rate |
$245.56 |
| Max. Negotiated Rate |
$2,396.16 |
| Rate for Payer: Aetna Commercial |
$2,328.77
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,225.27
|
| 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 |
$1,371.39
|
| 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 |
$746.40
|
| Rate for Payer: Cash Price |
$746.40
|
| Rate for Payer: Cash Price |
$746.40
|
| Rate for Payer: Cigna Commercial |
$2,380.52
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$245.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,448.02
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$245.56
|
| Rate for Payer: Health EOS Commercial |
$2,302.89
|
| Rate for Payer: HFN Commercial |
$2,380.52
|
| 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 |
$2,070.02
|
| Rate for Payer: NAPHCARE Commercial |
$368.35
|
| Rate for Payer: Preferred Network Access Commercial |
$2,380.52
|
| Rate for Payer: Quartz Beloit One Network |
$1,267.88
|
| Rate for Payer: Quartz Commercial |
$1,681.89
|
| 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 |
$1,423.14
|
| Rate for Payer: Wellcare Medicare |
$245.56
|
| Rate for Payer: WPS Commercial |
$1,916.51
|
|
|
NM Radionuclide Thyroid Oral Ablation
|
Facility
|
IP
|
$2,304.00
|
|
|
Service Code
|
CPT 79005
|
| Hospital Charge Code |
2580815
|
| Min. Negotiated Rate |
$1,174.12 |
| Max. Negotiated Rate |
$2,204.47 |
| Rate for Payer: Aetna Commercial |
$2,156.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,060.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,269.96
|
| Rate for Payer: Cash Price |
$691.20
|
| Rate for Payer: Cigna Commercial |
$2,204.47
|
| Rate for Payer: Health EOS Commercial |
$2,132.58
|
| Rate for Payer: HFN Commercial |
$2,204.47
|
| Rate for Payer: Multiplan Commercial |
$1,916.93
|
| Rate for Payer: Preferred Network Access Commercial |
$2,204.47
|
| Rate for Payer: Quartz Beloit One Network |
$1,174.12
|
| Rate for Payer: Quartz Commercial |
$1,437.70
|
| Rate for Payer: WEA Trust Commercial |
$1,317.89
|
| Rate for Payer: WPS Commercial |
$1,774.77
|
|
|
NM Radionuclide Thyroid Oral Ablation
|
Professional
|
Both
|
$2,304.00
|
|
|
Service Code
|
CPT 79005
|
| Hospital Charge Code |
2580815
|
| Min. Negotiated Rate |
$132.32 |
| Max. Negotiated Rate |
$2,276.35 |
| Rate for Payer: Aetna Commercial |
$2,276.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,060.70
|
| 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 |
$691.20
|
| Rate for Payer: Cash Price |
$691.20
|
| Rate for Payer: Cash Price |
$691.20
|
| Rate for Payer: Cigna Commercial |
$2,276.35
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,198.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$132.32
|
| Rate for Payer: Health EOS Commercial |
$2,180.51
|
| Rate for Payer: HFN Commercial |
$2,276.35
|
| 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 |
$1,916.93
|
| Rate for Payer: NAPHCARE Commercial |
$198.48
|
| Rate for Payer: Preferred Network Access Commercial |
$2,276.35
|
| Rate for Payer: Quartz Beloit One Network |
$1,054.31
|
| Rate for Payer: Quartz Commercial |
$1,365.81
|
| 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 |
$1,317.89
|
| Rate for Payer: WPS Commercial |
$661.60
|
|
|
NM Shunt Evaluation
|
Professional
|
Both
|
$1,920.00
|
|
|
Service Code
|
CPT 78645
|
| Hospital Charge Code |
2586963
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$283.20 |
| Max. Negotiated Rate |
$1,896.96 |
| Rate for Payer: Aetna Commercial |
$1,896.96
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,717.25
|
| Rate for Payer: Aetna Managed Medicare |
$283.20
|
| Rate for Payer: Anthem Medicare Advantage |
$283.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$283.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$283.20
|
| Rate for Payer: Cash Price |
$576.00
|
| Rate for Payer: Cash Price |
$576.00
|
| Rate for Payer: Cash Price |
$576.00
|
| Rate for Payer: Cigna Commercial |
$1,896.96
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$998.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$283.20
|
| Rate for Payer: Health EOS Commercial |
$1,817.09
|
| Rate for Payer: HFN Commercial |
$1,896.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,147.21
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,147.21
|
| Rate for Payer: Independent Care Health Plan Medicare |
$283.20
|
| Rate for Payer: Multiplan Commercial |
$1,597.44
|
| Rate for Payer: NAPHCARE Commercial |
$424.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,896.96
|
| Rate for Payer: Quartz Beloit One Network |
$878.59
|
| Rate for Payer: Quartz Commercial |
$1,138.18
|
| Rate for Payer: Quartz Medicare Advantage |
$283.20
|
| Rate for Payer: The Alliance Commercial |
$1,076.17
|
| Rate for Payer: United Healthcare Medicare Advantage |
$283.20
|
| Rate for Payer: WEA Trust Commercial |
$1,098.24
|
| Rate for Payer: WPS Commercial |
$1,416.01
|
|
|
NM Shunt Evaluation
|
Professional
|
Both
|
$1,846.00
|
|
|
Service Code
|
CPT 78645
|
| Hospital Charge Code |
631547
|
| Min. Negotiated Rate |
$283.20 |
| Max. Negotiated Rate |
$1,823.85 |
| Rate for Payer: Aetna Commercial |
$1,823.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,651.06
|
| Rate for Payer: Aetna Managed Medicare |
$283.20
|
| Rate for Payer: Anthem Medicare Advantage |
$283.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$283.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$283.20
|
| Rate for Payer: Cash Price |
$553.80
|
| Rate for Payer: Cash Price |
$553.80
|
| Rate for Payer: Cash Price |
$553.80
|
| Rate for Payer: Cigna Commercial |
$1,823.85
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$959.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$283.20
|
| Rate for Payer: Health EOS Commercial |
$1,747.05
|
| Rate for Payer: HFN Commercial |
$1,823.85
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,147.21
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,147.21
|
| Rate for Payer: Independent Care Health Plan Medicare |
$283.20
|
| Rate for Payer: Multiplan Commercial |
$1,535.87
|
| Rate for Payer: NAPHCARE Commercial |
$424.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,823.85
|
| Rate for Payer: Quartz Beloit One Network |
$844.73
|
| Rate for Payer: Quartz Commercial |
$1,094.31
|
| Rate for Payer: Quartz Medicare Advantage |
$283.20
|
| Rate for Payer: The Alliance Commercial |
$1,076.17
|
| Rate for Payer: United Healthcare Medicare Advantage |
$283.20
|
| Rate for Payer: WEA Trust Commercial |
$1,055.91
|
| Rate for Payer: WPS Commercial |
$1,416.01
|
|
|
NM Shunt Evaluation
|
Facility
|
OP
|
$1,846.00
|
|
|
Service Code
|
CPT 78645
|
| Hospital Charge Code |
631547
|
| Min. Negotiated Rate |
$571.42 |
| Max. Negotiated Rate |
$2,285.67 |
| Rate for Payer: Aetna Commercial |
$1,727.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,651.06
|
| Rate for Payer: Aetna Managed Medicare |
$571.42
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,247.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$959.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$921.52
|
| Rate for Payer: Anthem Medicare Advantage |
$571.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,017.52
|
| 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 |
$553.80
|
| Rate for Payer: Cash Price |
$553.80
|
| Rate for Payer: Cigna Commercial |
$1,766.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$571.42
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,074.37
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$571.42
|
| Rate for Payer: Health EOS Commercial |
$1,708.66
|
| Rate for Payer: HFN Commercial |
$1,766.25
|
| 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 |
$1,535.87
|
| Rate for Payer: NAPHCARE Commercial |
$857.13
|
| Rate for Payer: Preferred Network Access Commercial |
$1,766.25
|
| Rate for Payer: Quartz Beloit One Network |
$940.72
|
| Rate for Payer: Quartz Commercial |
$1,247.90
|
| 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 |
$1,055.91
|
| Rate for Payer: Wellcare Medicare |
$571.42
|
| Rate for Payer: WPS Commercial |
$1,421.97
|
|
