|
NM Shunt Evaluation
|
Facility
|
OP
|
$1,920.00
|
|
|
Service Code
|
CPT 78645
|
| Hospital Charge Code |
2586963
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$571.42 |
| Max. Negotiated Rate |
$2,396.16 |
| Rate for Payer: Aetna Commercial |
$1,797.12
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,717.25
|
| 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 |
$1,058.30
|
| 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 |
$576.00
|
| Rate for Payer: Cash Price |
$576.00
|
| Rate for Payer: Cash Price |
$576.00
|
| Rate for Payer: Cigna Commercial |
$1,837.06
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$571.42
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,117.44
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$571.42
|
| Rate for Payer: Health EOS Commercial |
$1,777.15
|
| Rate for Payer: HFN Commercial |
$1,837.06
|
| 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 |
$1,597.44
|
| Rate for Payer: NAPHCARE Commercial |
$857.13
|
| Rate for Payer: Preferred Network Access Commercial |
$1,837.06
|
| Rate for Payer: Quartz Beloit One Network |
$978.43
|
| Rate for Payer: Quartz Commercial |
$1,297.92
|
| Rate for Payer: Quartz Medicare Advantage |
$571.42
|
| Rate for Payer: The Alliance Commercial |
$2,285.67
|
| Rate for Payer: United Healthcare Medicare Advantage |
$571.42
|
| Rate for Payer: United Healthcare PPO |
$2,396.16
|
| Rate for Payer: WEA Trust Commercial |
$1,098.24
|
| Rate for Payer: Wellcare Medicare |
$571.42
|
| Rate for Payer: WPS Commercial |
$1,478.98
|
|
|
NM Shunt Evaluation
|
Facility
|
IP
|
$1,846.00
|
|
|
Service Code
|
CPT 78645
|
| Hospital Charge Code |
631547
|
| Min. Negotiated Rate |
$940.72 |
| Max. Negotiated Rate |
$1,766.25 |
| Rate for Payer: Aetna Commercial |
$1,727.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,651.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,017.52
|
| Rate for Payer: Cash Price |
$553.80
|
| Rate for Payer: Cigna Commercial |
$1,766.25
|
| Rate for Payer: Health EOS Commercial |
$1,708.66
|
| Rate for Payer: HFN Commercial |
$1,766.25
|
| Rate for Payer: Multiplan Commercial |
$1,535.87
|
| Rate for Payer: Preferred Network Access Commercial |
$1,766.25
|
| Rate for Payer: Quartz Beloit One Network |
$940.72
|
| Rate for Payer: Quartz Commercial |
$1,151.90
|
| Rate for Payer: WEA Trust Commercial |
$1,055.91
|
| Rate for Payer: WPS Commercial |
$1,421.97
|
|
|
NM Shunt Evaluation
|
Facility
|
IP
|
$1,920.00
|
|
|
Service Code
|
CPT 78645
|
| Hospital Charge Code |
2586963
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$978.43 |
| Max. Negotiated Rate |
$1,837.06 |
| Rate for Payer: Aetna Commercial |
$1,797.12
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,717.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,058.30
|
| Rate for Payer: Cash Price |
$576.00
|
| Rate for Payer: Cigna Commercial |
$1,837.06
|
| Rate for Payer: Health EOS Commercial |
$1,777.15
|
| Rate for Payer: HFN Commercial |
$1,837.06
|
| Rate for Payer: Multiplan Commercial |
$1,597.44
|
| Rate for Payer: Preferred Network Access Commercial |
$1,837.06
|
| Rate for Payer: Quartz Beloit One Network |
$978.43
|
| Rate for Payer: Quartz Commercial |
$1,198.08
|
| Rate for Payer: WEA Trust Commercial |
$1,098.24
|
| Rate for Payer: WPS Commercial |
$1,478.98
|
|
|
NM SPECT/CT Multiple
|
Facility
|
OP
|
$12,401.00
|
|
|
Service Code
|
CPT 78832 TC
|
| Hospital Charge Code |
5577506
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$2,396.16 |
| Max. Negotiated Rate |
$11,865.28 |
| Rate for Payer: Aetna Commercial |
$11,607.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$11,091.45
|
| Rate for Payer: Aetna Managed Medicare |
$3,611.17
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,030.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,824.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,583.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,835.43
|
| Rate for Payer: Cash Price |
$3,720.30
|
| Rate for Payer: Cash Price |
$3,720.30
|
| Rate for Payer: Cash Price |
$3,720.30
|
| Rate for Payer: Cigna Commercial |
$11,865.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$7,217.38
|
| Rate for Payer: Health EOS Commercial |
$11,478.37
|
| Rate for Payer: HFN Commercial |
$11,865.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$9,672.78
|
| Rate for Payer: Multiplan Commercial |
$10,317.63
|
| Rate for Payer: NAPHCARE Commercial |
$7,738.22
|
| Rate for Payer: Preferred Network Access Commercial |
$11,865.28
|
| Rate for Payer: Quartz Beloit One Network |
$6,319.55
|
| Rate for Payer: Quartz Commercial |
$8,383.08
|
| Rate for Payer: Quartz Medicare Advantage |
$7,738.22
|
| Rate for Payer: The Alliance Commercial |
$2,769.94
|
| Rate for Payer: United Healthcare PPO |
$2,396.16
|
| Rate for Payer: WEA Trust Commercial |
$7,093.37
|
| Rate for Payer: WPS Commercial |
$9,552.49
|
|
|
NM SPECT/CT Multiple
|
Professional
|
Both
|
$12,401.00
|
|
|
Service Code
|
CPT 78832 TC
|
| Hospital Charge Code |
5577506
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$692.48 |
| Max. Negotiated Rate |
$12,252.19 |
| Rate for Payer: Aetna Commercial |
$12,252.19
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$11,091.45
|
| Rate for Payer: Aetna Managed Medicare |
$692.48
|
| Rate for Payer: Anthem Medicare Advantage |
$692.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$692.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$692.48
|
| Rate for Payer: Cash Price |
$3,720.30
|
| Rate for Payer: Cash Price |
$3,720.30
|
| Rate for Payer: Cash Price |
$3,720.30
|
| Rate for Payer: Cigna Commercial |
$12,252.19
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$6,448.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$692.48
|
| Rate for Payer: Health EOS Commercial |
$11,736.31
|
| Rate for Payer: HFN Commercial |
$12,252.19
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,925.18
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$2,925.18
|
| Rate for Payer: Independent Care Health Plan Medicare |
$692.48
|
| Rate for Payer: Multiplan Commercial |
$10,317.63
|
| Rate for Payer: NAPHCARE Commercial |
$1,038.73
|
| Rate for Payer: Preferred Network Access Commercial |
$12,252.19
|
| Rate for Payer: Quartz Beloit One Network |
$5,674.70
|
| Rate for Payer: Quartz Commercial |
$7,351.31
|
| Rate for Payer: Quartz Medicare Advantage |
$692.48
|
| Rate for Payer: The Alliance Commercial |
$2,631.44
|
| Rate for Payer: United Healthcare Medicare Advantage |
$692.48
|
| Rate for Payer: WEA Trust Commercial |
$7,093.37
|
| Rate for Payer: WPS Commercial |
$3,462.42
|
|
|
NM SPECT/CT Multiple
|
Facility
|
IP
|
$12,401.00
|
|
|
Service Code
|
CPT 78832 TC
|
| Hospital Charge Code |
5577506
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$6,319.55 |
| Max. Negotiated Rate |
$11,865.28 |
| Rate for Payer: Aetna Commercial |
$11,607.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$11,091.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,835.43
|
| Rate for Payer: Cash Price |
$3,720.30
|
| Rate for Payer: Cigna Commercial |
$11,865.28
|
| Rate for Payer: Health EOS Commercial |
$11,478.37
|
| Rate for Payer: HFN Commercial |
$11,865.28
|
| Rate for Payer: Multiplan Commercial |
$10,317.63
|
| Rate for Payer: Preferred Network Access Commercial |
$11,865.28
|
| Rate for Payer: Quartz Beloit One Network |
$6,319.55
|
| Rate for Payer: Quartz Commercial |
$7,738.22
|
| Rate for Payer: WEA Trust Commercial |
$7,093.37
|
| Rate for Payer: WPS Commercial |
$9,552.49
|
|
|
NM SPECT/CT Single
|
Professional
|
Both
|
$10,997.00
|
|
|
Service Code
|
CPT 78830 TC
|
| Hospital Charge Code |
5577509
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$353.06 |
| Max. Negotiated Rate |
$10,865.04 |
| Rate for Payer: Aetna Commercial |
$10,865.04
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,835.72
|
| Rate for Payer: Aetna Managed Medicare |
$353.06
|
| Rate for Payer: Anthem Medicare Advantage |
$353.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$353.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$353.06
|
| Rate for Payer: Cash Price |
$3,299.10
|
| Rate for Payer: Cash Price |
$3,299.10
|
| Rate for Payer: Cash Price |
$3,299.10
|
| Rate for Payer: Cigna Commercial |
$10,865.04
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$5,718.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$353.06
|
| Rate for Payer: Health EOS Commercial |
$10,407.56
|
| Rate for Payer: HFN Commercial |
$10,865.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,498.18
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,498.18
|
| Rate for Payer: Independent Care Health Plan Medicare |
$353.06
|
| Rate for Payer: Multiplan Commercial |
$9,149.50
|
| Rate for Payer: NAPHCARE Commercial |
$529.59
|
| Rate for Payer: Preferred Network Access Commercial |
$10,865.04
|
| Rate for Payer: Quartz Beloit One Network |
$5,032.23
|
| Rate for Payer: Quartz Commercial |
$6,519.02
|
| Rate for Payer: Quartz Medicare Advantage |
$353.06
|
| Rate for Payer: The Alliance Commercial |
$1,341.62
|
| Rate for Payer: United Healthcare Medicare Advantage |
$353.06
|
| Rate for Payer: WEA Trust Commercial |
$6,290.28
|
| Rate for Payer: WPS Commercial |
$1,765.30
|
|
|
NM SPECT/CT Single
|
Facility
|
OP
|
$10,997.00
|
|
|
Service Code
|
CPT 78830 TC
|
| Hospital Charge Code |
5577509
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,412.24 |
| Max. Negotiated Rate |
$10,521.93 |
| Rate for Payer: Aetna Commercial |
$10,293.19
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,835.72
|
| Rate for Payer: Aetna Managed Medicare |
$3,202.33
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,473.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,378.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,159.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,061.55
|
| Rate for Payer: Cash Price |
$3,299.10
|
| Rate for Payer: Cash Price |
$3,299.10
|
| Rate for Payer: Cash Price |
$3,299.10
|
| Rate for Payer: Cigna Commercial |
$10,521.93
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,400.25
|
| Rate for Payer: Health EOS Commercial |
$10,178.82
|
| Rate for Payer: HFN Commercial |
$10,521.93
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$8,577.66
|
| Rate for Payer: Multiplan Commercial |
$9,149.50
|
| Rate for Payer: NAPHCARE Commercial |
$6,862.13
|
| Rate for Payer: Preferred Network Access Commercial |
$10,521.93
|
| Rate for Payer: Quartz Beloit One Network |
$5,604.07
|
| Rate for Payer: Quartz Commercial |
$7,433.97
|
| Rate for Payer: Quartz Medicare Advantage |
$6,862.13
|
| Rate for Payer: The Alliance Commercial |
$1,412.24
|
| Rate for Payer: United Healthcare PPO |
$2,396.16
|
| Rate for Payer: WEA Trust Commercial |
$6,290.28
|
| Rate for Payer: WPS Commercial |
$8,470.99
|
|
|
NM SPECT/CT Single
|
Facility
|
IP
|
$10,997.00
|
|
|
Service Code
|
CPT 78830 TC
|
| Hospital Charge Code |
5577509
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$5,604.07 |
| Max. Negotiated Rate |
$10,521.93 |
| Rate for Payer: Aetna Commercial |
$10,293.19
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,835.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,061.55
|
| Rate for Payer: Cash Price |
$3,299.10
|
| Rate for Payer: Cigna Commercial |
$10,521.93
|
| Rate for Payer: Health EOS Commercial |
$10,178.82
|
| Rate for Payer: HFN Commercial |
$10,521.93
|
| Rate for Payer: Multiplan Commercial |
$9,149.50
|
| Rate for Payer: Preferred Network Access Commercial |
$10,521.93
|
| Rate for Payer: Quartz Beloit One Network |
$5,604.07
|
| Rate for Payer: Quartz Commercial |
$6,862.13
|
| Rate for Payer: WEA Trust Commercial |
$6,290.28
|
| Rate for Payer: WPS Commercial |
$8,470.99
|
|
|
NM Testicular Imaging w/ Vascular Flow
|
Professional
|
Both
|
$1,914.00
|
|
|
Service Code
|
CPT 78761
|
| Hospital Charge Code |
631527
|
| Min. Negotiated Rate |
$188.55 |
| Max. Negotiated Rate |
$1,891.03 |
| Rate for Payer: Aetna Commercial |
$1,891.03
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,711.88
|
| Rate for Payer: Aetna Managed Medicare |
$188.55
|
| Rate for Payer: Anthem Medicare Advantage |
$188.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$188.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$188.55
|
| Rate for Payer: Cash Price |
$574.20
|
| Rate for Payer: Cash Price |
$574.20
|
| Rate for Payer: Cash Price |
$574.20
|
| Rate for Payer: Cigna Commercial |
$1,891.03
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$995.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$188.55
|
| Rate for Payer: Health EOS Commercial |
$1,811.41
|
| Rate for Payer: HFN Commercial |
$1,891.03
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$750.43
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$750.43
|
| Rate for Payer: Independent Care Health Plan Medicare |
$188.55
|
| Rate for Payer: Multiplan Commercial |
$1,592.45
|
| Rate for Payer: NAPHCARE Commercial |
$282.83
|
| Rate for Payer: Preferred Network Access Commercial |
$1,891.03
|
| Rate for Payer: Quartz Beloit One Network |
$875.85
|
| Rate for Payer: Quartz Commercial |
$1,134.62
|
| Rate for Payer: Quartz Medicare Advantage |
$188.55
|
| Rate for Payer: The Alliance Commercial |
$716.50
|
| Rate for Payer: United Healthcare Medicare Advantage |
$188.55
|
| Rate for Payer: WEA Trust Commercial |
$1,094.81
|
| Rate for Payer: WPS Commercial |
$942.76
|
|
|
NM Testicular Imaging w/ Vascular Flow
|
Facility
|
IP
|
$2,065.00
|
|
|
Service Code
|
CPT 78761
|
| Hospital Charge Code |
2586967
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,052.32 |
| Max. Negotiated Rate |
$1,975.79 |
| Rate for Payer: Aetna Commercial |
$1,932.84
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,846.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,138.23
|
| Rate for Payer: Cash Price |
$619.50
|
| Rate for Payer: Cigna Commercial |
$1,975.79
|
| Rate for Payer: Health EOS Commercial |
$1,911.36
|
| Rate for Payer: HFN Commercial |
$1,975.79
|
| Rate for Payer: Multiplan Commercial |
$1,718.08
|
| Rate for Payer: Preferred Network Access Commercial |
$1,975.79
|
| Rate for Payer: Quartz Beloit One Network |
$1,052.32
|
| Rate for Payer: Quartz Commercial |
$1,288.56
|
| Rate for Payer: WEA Trust Commercial |
$1,181.18
|
| Rate for Payer: WPS Commercial |
$1,590.67
|
|
|
NM Testicular Imaging w/ Vascular Flow
|
Facility
|
OP
|
$1,914.00
|
|
|
Service Code
|
CPT 78761
|
| Hospital Charge Code |
631527
|
| Min. Negotiated Rate |
$420.71 |
| Max. Negotiated Rate |
$1,831.32 |
| Rate for Payer: Aetna Commercial |
$1,791.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,711.88
|
| Rate for Payer: Aetna Managed Medicare |
$420.71
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,293.86
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$995.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$955.47
|
| Rate for Payer: Anthem Medicare Advantage |
$420.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,055.00
|
| 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 |
$574.20
|
| Rate for Payer: Cash Price |
$574.20
|
| Rate for Payer: Cigna Commercial |
$1,831.32
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$420.71
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,113.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$420.71
|
| Rate for Payer: Health EOS Commercial |
$1,771.60
|
| Rate for Payer: HFN Commercial |
$1,831.32
|
| 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 |
$1,592.45
|
| Rate for Payer: NAPHCARE Commercial |
$631.07
|
| Rate for Payer: Preferred Network Access Commercial |
$1,831.32
|
| Rate for Payer: Quartz Beloit One Network |
$975.37
|
| Rate for Payer: Quartz Commercial |
$1,293.86
|
| Rate for Payer: Quartz Medicare Advantage |
$420.71
|
| Rate for Payer: The Alliance Commercial |
$1,682.84
|
| Rate for Payer: United Healthcare Medicare Advantage |
$420.71
|
| Rate for Payer: WEA Trust Commercial |
$1,094.81
|
| Rate for Payer: Wellcare Medicare |
$420.71
|
| Rate for Payer: WPS Commercial |
$1,474.35
|
|
|
NM Testicular Imaging w/ Vascular Flow
|
Facility
|
IP
|
$1,914.00
|
|
|
Service Code
|
CPT 78761
|
| Hospital Charge Code |
631527
|
| Min. Negotiated Rate |
$975.37 |
| Max. Negotiated Rate |
$1,831.32 |
| Rate for Payer: Aetna Commercial |
$1,791.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,711.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,055.00
|
| Rate for Payer: Cash Price |
$574.20
|
| Rate for Payer: Cigna Commercial |
$1,831.32
|
| Rate for Payer: Health EOS Commercial |
$1,771.60
|
| Rate for Payer: HFN Commercial |
$1,831.32
|
| Rate for Payer: Multiplan Commercial |
$1,592.45
|
| Rate for Payer: Preferred Network Access Commercial |
$1,831.32
|
| Rate for Payer: Quartz Beloit One Network |
$975.37
|
| Rate for Payer: Quartz Commercial |
$1,194.34
|
| Rate for Payer: WEA Trust Commercial |
$1,094.81
|
| Rate for Payer: WPS Commercial |
$1,474.35
|
|
|
NM Testicular Imaging w/ Vascular Flow
|
Facility
|
OP
|
$2,065.00
|
|
|
Service Code
|
CPT 78761
|
| Hospital Charge Code |
2586967
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$420.71 |
| Max. Negotiated Rate |
$2,396.16 |
| Rate for Payer: Aetna Commercial |
$1,932.84
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,846.94
|
| 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 |
$1,138.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$420.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$420.71
|
| Rate for Payer: Cash Price |
$619.50
|
| Rate for Payer: Cash Price |
$619.50
|
| Rate for Payer: Cash Price |
$619.50
|
| Rate for Payer: Cigna Commercial |
$1,975.79
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$420.71
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,201.83
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$420.71
|
| Rate for Payer: Health EOS Commercial |
$1,911.36
|
| Rate for Payer: HFN Commercial |
$1,975.79
|
| 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 |
$1,718.08
|
| Rate for Payer: NAPHCARE Commercial |
$631.07
|
| Rate for Payer: Preferred Network Access Commercial |
$1,975.79
|
| Rate for Payer: Quartz Beloit One Network |
$1,052.32
|
| Rate for Payer: Quartz Commercial |
$1,395.94
|
| 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 |
$1,181.18
|
| Rate for Payer: Wellcare Medicare |
$420.71
|
| Rate for Payer: WPS Commercial |
$1,590.67
|
|
|
NM Testicular Imaging w/ Vascular Flow
|
Professional
|
Both
|
$2,065.00
|
|
|
Service Code
|
CPT 78761
|
| Hospital Charge Code |
2586967
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$188.55 |
| Max. Negotiated Rate |
$2,040.22 |
| Rate for Payer: Aetna Commercial |
$2,040.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,846.94
|
| Rate for Payer: Aetna Managed Medicare |
$188.55
|
| Rate for Payer: Anthem Medicare Advantage |
$188.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$188.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$188.55
|
| Rate for Payer: Cash Price |
$619.50
|
| Rate for Payer: Cash Price |
$619.50
|
| Rate for Payer: Cash Price |
$619.50
|
| Rate for Payer: Cigna Commercial |
$2,040.22
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,073.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$188.55
|
| Rate for Payer: Health EOS Commercial |
$1,954.32
|
| Rate for Payer: HFN Commercial |
$2,040.22
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$750.43
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$750.43
|
| Rate for Payer: Independent Care Health Plan Medicare |
$188.55
|
| Rate for Payer: Multiplan Commercial |
$1,718.08
|
| Rate for Payer: NAPHCARE Commercial |
$282.83
|
| Rate for Payer: Preferred Network Access Commercial |
$2,040.22
|
| Rate for Payer: Quartz Beloit One Network |
$944.94
|
| Rate for Payer: Quartz Commercial |
$1,224.13
|
| Rate for Payer: Quartz Medicare Advantage |
$188.55
|
| Rate for Payer: The Alliance Commercial |
$716.50
|
| Rate for Payer: United Healthcare Medicare Advantage |
$188.55
|
| Rate for Payer: WEA Trust Commercial |
$1,181.18
|
| Rate for Payer: WPS Commercial |
$942.76
|
|
|
NM Thyroid CA Mets Imaging Whole Body
|
Facility
|
IP
|
$2,593.00
|
|
|
Service Code
|
CPT 78018
|
| Hospital Charge Code |
2586973
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,321.39 |
| Max. Negotiated Rate |
$2,480.98 |
| Rate for Payer: Aetna Commercial |
$2,427.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,319.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,429.26
|
| Rate for Payer: Cash Price |
$777.90
|
| Rate for Payer: Cigna Commercial |
$2,480.98
|
| Rate for Payer: Health EOS Commercial |
$2,400.08
|
| Rate for Payer: HFN Commercial |
$2,480.98
|
| Rate for Payer: Multiplan Commercial |
$2,157.38
|
| Rate for Payer: Preferred Network Access Commercial |
$2,480.98
|
| Rate for Payer: Quartz Beloit One Network |
$1,321.39
|
| Rate for Payer: Quartz Commercial |
$1,618.03
|
| Rate for Payer: WEA Trust Commercial |
$1,483.20
|
| Rate for Payer: WPS Commercial |
$1,997.39
|
|
|
NM Thyroid CA Mets Imaging Whole Body
|
Professional
|
Both
|
$2,304.00
|
|
|
Service Code
|
CPT 78018
|
| Hospital Charge Code |
631467
|
| Min. Negotiated Rate |
$273.74 |
| 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 |
$273.74
|
| Rate for Payer: Anthem Medicare Advantage |
$273.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$273.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$273.74
|
| 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 |
$273.74
|
| 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 |
$1,112.74
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,112.74
|
| Rate for Payer: Independent Care Health Plan Medicare |
$273.74
|
| Rate for Payer: Multiplan Commercial |
$1,916.93
|
| Rate for Payer: NAPHCARE Commercial |
$410.61
|
| 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 |
$273.74
|
| Rate for Payer: The Alliance Commercial |
$1,040.21
|
| Rate for Payer: United Healthcare Medicare Advantage |
$273.74
|
| Rate for Payer: WEA Trust Commercial |
$1,317.89
|
| Rate for Payer: WPS Commercial |
$1,368.69
|
|
|
NM Thyroid CA Mets Imaging Whole Body
|
Facility
|
OP
|
$2,304.00
|
|
|
Service Code
|
CPT 78018
|
| Hospital Charge Code |
631467
|
| Min. Negotiated Rate |
$571.42 |
| Max. Negotiated Rate |
$2,285.67 |
| Rate for Payer: Aetna Commercial |
$2,156.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,060.70
|
| Rate for Payer: Aetna Managed Medicare |
$571.42
|
| 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 |
$571.42
|
| 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 |
$571.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$571.42
|
| 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 |
$571.42
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,340.93
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$571.42
|
| 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 |
$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 |
$1,916.93
|
| Rate for Payer: NAPHCARE Commercial |
$857.13
|
| 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 |
$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 |
$1,317.89
|
| Rate for Payer: Wellcare Medicare |
$571.42
|
| Rate for Payer: WPS Commercial |
$1,774.77
|
|
|
NM Thyroid CA Mets Imaging Whole Body
|
Facility
|
IP
|
$2,304.00
|
|
|
Service Code
|
CPT 78018
|
| Hospital Charge Code |
631467
|
| 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 Thyroid CA Mets Imaging Whole Body
|
Facility
|
OP
|
$2,593.00
|
|
|
Service Code
|
CPT 78018
|
| Hospital Charge Code |
2586973
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$571.42 |
| Max. Negotiated Rate |
$2,480.98 |
| Rate for Payer: Aetna Commercial |
$2,427.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,319.18
|
| 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 |
$1,429.26
|
| 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 |
$777.90
|
| Rate for Payer: Cash Price |
$777.90
|
| Rate for Payer: Cash Price |
$777.90
|
| Rate for Payer: Cigna Commercial |
$2,480.98
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$571.42
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,509.13
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$571.42
|
| Rate for Payer: Health EOS Commercial |
$2,400.08
|
| Rate for Payer: HFN Commercial |
$2,480.98
|
| 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 |
$2,157.38
|
| Rate for Payer: NAPHCARE Commercial |
$857.13
|
| Rate for Payer: Preferred Network Access Commercial |
$2,480.98
|
| Rate for Payer: Quartz Beloit One Network |
$1,321.39
|
| Rate for Payer: Quartz Commercial |
$1,752.87
|
| 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 |
$1,483.20
|
| Rate for Payer: Wellcare Medicare |
$571.42
|
| Rate for Payer: WPS Commercial |
$1,997.39
|
|
|
NM Thyroid CA Mets Imaging Whole Body
|
Professional
|
Both
|
$2,593.00
|
|
|
Service Code
|
CPT 78018
|
| Hospital Charge Code |
2586973
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$273.74 |
| Max. Negotiated Rate |
$2,561.88 |
| Rate for Payer: Aetna Commercial |
$2,561.88
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,319.18
|
| Rate for Payer: Aetna Managed Medicare |
$273.74
|
| Rate for Payer: Anthem Medicare Advantage |
$273.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$273.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$273.74
|
| Rate for Payer: Cash Price |
$777.90
|
| Rate for Payer: Cash Price |
$777.90
|
| Rate for Payer: Cash Price |
$777.90
|
| Rate for Payer: Cigna Commercial |
$2,561.88
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,348.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$273.74
|
| Rate for Payer: Health EOS Commercial |
$2,454.02
|
| Rate for Payer: HFN Commercial |
$2,561.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,112.74
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,112.74
|
| Rate for Payer: Independent Care Health Plan Medicare |
$273.74
|
| Rate for Payer: Multiplan Commercial |
$2,157.38
|
| Rate for Payer: NAPHCARE Commercial |
$410.61
|
| Rate for Payer: Preferred Network Access Commercial |
$2,561.88
|
| Rate for Payer: Quartz Beloit One Network |
$1,186.56
|
| Rate for Payer: Quartz Commercial |
$1,537.13
|
| Rate for Payer: Quartz Medicare Advantage |
$273.74
|
| Rate for Payer: The Alliance Commercial |
$1,040.21
|
| Rate for Payer: United Healthcare Medicare Advantage |
$273.74
|
| Rate for Payer: WEA Trust Commercial |
$1,483.20
|
| Rate for Payer: WPS Commercial |
$1,368.69
|
|
|
NM Thyroid Imaging Only
|
Facility
|
OP
|
$969.00
|
|
| Hospital Charge Code |
631461
|
| Min. Negotiated Rate |
$282.17 |
| Max. Negotiated Rate |
$927.14 |
| Rate for Payer: Aetna Commercial |
$906.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$866.67
|
| Rate for Payer: Aetna Managed Medicare |
$282.17
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$655.04
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$503.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$483.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$534.11
|
| Rate for Payer: Cash Price |
$290.70
|
| Rate for Payer: Cigna Commercial |
$927.14
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$563.96
|
| Rate for Payer: Health EOS Commercial |
$896.91
|
| Rate for Payer: HFN Commercial |
$927.14
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$755.82
|
| Rate for Payer: Multiplan Commercial |
$806.21
|
| Rate for Payer: NAPHCARE Commercial |
$604.66
|
| Rate for Payer: Preferred Network Access Commercial |
$927.14
|
| Rate for Payer: Quartz Beloit One Network |
$493.80
|
| Rate for Payer: Quartz Commercial |
$655.04
|
| Rate for Payer: Quartz Medicare Advantage |
$604.66
|
| Rate for Payer: The Alliance Commercial |
$503.88
|
| Rate for Payer: WEA Trust Commercial |
$554.27
|
| Rate for Payer: WPS Commercial |
$746.42
|
|
|
NM Thyroid Imaging Only
|
Professional
|
Both
|
$969.00
|
|
| Hospital Charge Code |
631461
|
| Min. Negotiated Rate |
$443.41 |
| Max. Negotiated Rate |
$957.37 |
| Rate for Payer: Aetna Commercial |
$957.37
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$866.67
|
| Rate for Payer: Cash Price |
$290.70
|
| Rate for Payer: Cigna Commercial |
$957.37
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$503.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$604.66
|
| Rate for Payer: Health EOS Commercial |
$917.06
|
| Rate for Payer: HFN Commercial |
$957.37
|
| Rate for Payer: Multiplan Commercial |
$806.21
|
| Rate for Payer: Preferred Network Access Commercial |
$957.37
|
| Rate for Payer: Quartz Beloit One Network |
$443.41
|
| Rate for Payer: Quartz Commercial |
$574.42
|
| Rate for Payer: The Alliance Commercial |
$503.88
|
| Rate for Payer: WEA Trust Commercial |
$554.27
|
| Rate for Payer: WPS Commercial |
$746.42
|
|
|
NM Thyroid Imaging Only
|
Professional
|
Both
|
$1,008.00
|
|
|
Service Code
|
CPT 78013
|
| Hospital Charge Code |
2586975
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$164.79 |
| Max. Negotiated Rate |
$995.90 |
| Rate for Payer: Aetna Commercial |
$995.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$901.56
|
| Rate for Payer: Aetna Managed Medicare |
$164.79
|
| Rate for Payer: Anthem Medicare Advantage |
$164.79
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$164.79
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$164.79
|
| Rate for Payer: Cash Price |
$302.40
|
| Rate for Payer: Cash Price |
$302.40
|
| Rate for Payer: Cash Price |
$302.40
|
| Rate for Payer: Cigna Commercial |
$995.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$524.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$164.79
|
| Rate for Payer: Health EOS Commercial |
$953.97
|
| Rate for Payer: HFN Commercial |
$995.90
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$692.46
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$692.46
|
| Rate for Payer: Independent Care Health Plan Medicare |
$164.79
|
| Rate for Payer: Multiplan Commercial |
$838.66
|
| Rate for Payer: NAPHCARE Commercial |
$247.18
|
| Rate for Payer: Preferred Network Access Commercial |
$995.90
|
| Rate for Payer: Quartz Beloit One Network |
$461.26
|
| Rate for Payer: Quartz Commercial |
$597.54
|
| Rate for Payer: Quartz Medicare Advantage |
$164.79
|
| Rate for Payer: The Alliance Commercial |
$626.19
|
| Rate for Payer: United Healthcare Medicare Advantage |
$164.79
|
| Rate for Payer: WEA Trust Commercial |
$576.58
|
| Rate for Payer: WPS Commercial |
$823.94
|
|
|
NM Thyroid Imaging Only
|
Facility
|
IP
|
$969.00
|
|
| Hospital Charge Code |
631461
|
| Min. Negotiated Rate |
$493.80 |
| Max. Negotiated Rate |
$927.14 |
| Rate for Payer: Aetna Commercial |
$906.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$866.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$534.11
|
| Rate for Payer: Cash Price |
$290.70
|
| Rate for Payer: Cigna Commercial |
$927.14
|
| Rate for Payer: Health EOS Commercial |
$896.91
|
| Rate for Payer: HFN Commercial |
$927.14
|
| Rate for Payer: Multiplan Commercial |
$806.21
|
| Rate for Payer: Preferred Network Access Commercial |
$927.14
|
| Rate for Payer: Quartz Beloit One Network |
$493.80
|
| Rate for Payer: Quartz Commercial |
$604.66
|
| Rate for Payer: WEA Trust Commercial |
$554.27
|
| Rate for Payer: WPS Commercial |
$746.42
|
|
