|
NM Thyroid Imaging Only
|
Facility
|
OP
|
$1,008.00
|
|
|
Service Code
|
CPT 78013
|
| Hospital Charge Code |
2586975
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$420.71 |
| Max. Negotiated Rate |
$2,396.16 |
| Rate for Payer: Aetna Commercial |
$943.49
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$901.56
|
| 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 |
$555.61
|
| 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 |
$302.40
|
| Rate for Payer: Cash Price |
$302.40
|
| Rate for Payer: Cash Price |
$302.40
|
| Rate for Payer: Cigna Commercial |
$964.45
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$420.71
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$586.66
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$420.71
|
| Rate for Payer: Health EOS Commercial |
$933.00
|
| Rate for Payer: HFN Commercial |
$964.45
|
| 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 |
$838.66
|
| Rate for Payer: NAPHCARE Commercial |
$631.07
|
| Rate for Payer: Preferred Network Access Commercial |
$964.45
|
| Rate for Payer: Quartz Beloit One Network |
$513.68
|
| Rate for Payer: Quartz Commercial |
$681.41
|
| 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 |
$576.58
|
| Rate for Payer: Wellcare Medicare |
$420.71
|
| Rate for Payer: WPS Commercial |
$776.46
|
|
|
NM Thyroid Imaging Only
|
Facility
|
IP
|
$1,008.00
|
|
|
Service Code
|
CPT 78013
|
| Hospital Charge Code |
2586975
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$513.68 |
| Max. Negotiated Rate |
$964.45 |
| Rate for Payer: Aetna Commercial |
$943.49
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$901.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$555.61
|
| Rate for Payer: Cash Price |
$302.40
|
| Rate for Payer: Cigna Commercial |
$964.45
|
| Rate for Payer: Health EOS Commercial |
$933.00
|
| Rate for Payer: HFN Commercial |
$964.45
|
| Rate for Payer: Multiplan Commercial |
$838.66
|
| Rate for Payer: Preferred Network Access Commercial |
$964.45
|
| Rate for Payer: Quartz Beloit One Network |
$513.68
|
| Rate for Payer: Quartz Commercial |
$628.99
|
| Rate for Payer: WEA Trust Commercial |
$576.58
|
| Rate for Payer: WPS Commercial |
$776.46
|
|
|
NM Thyroid Imaging w/ Uptake Multiple
|
Professional
|
Both
|
$2,057.00
|
|
|
Service Code
|
CPT 78014
|
| Hospital Charge Code |
2586977
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$209.12 |
| Max. Negotiated Rate |
$2,032.32 |
| Rate for Payer: Aetna Commercial |
$2,032.32
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,839.78
|
| Rate for Payer: Aetna Managed Medicare |
$209.12
|
| Rate for Payer: Anthem Medicare Advantage |
$209.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$209.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$209.12
|
| Rate for Payer: Cash Price |
$617.10
|
| Rate for Payer: Cash Price |
$617.10
|
| Rate for Payer: Cash Price |
$617.10
|
| Rate for Payer: Cigna Commercial |
$2,032.32
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,069.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$209.12
|
| Rate for Payer: Health EOS Commercial |
$1,946.74
|
| Rate for Payer: HFN Commercial |
$2,032.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$847.06
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$847.06
|
| Rate for Payer: Independent Care Health Plan Medicare |
$209.12
|
| Rate for Payer: Multiplan Commercial |
$1,711.42
|
| Rate for Payer: NAPHCARE Commercial |
$313.68
|
| Rate for Payer: Preferred Network Access Commercial |
$2,032.32
|
| Rate for Payer: Quartz Beloit One Network |
$941.28
|
| Rate for Payer: Quartz Commercial |
$1,219.39
|
| Rate for Payer: Quartz Medicare Advantage |
$209.12
|
| Rate for Payer: The Alliance Commercial |
$794.67
|
| Rate for Payer: United Healthcare Medicare Advantage |
$209.12
|
| Rate for Payer: WEA Trust Commercial |
$1,176.60
|
| Rate for Payer: WPS Commercial |
$1,045.62
|
|
|
NM Thyroid Imaging w/ Uptake Multiple
|
Facility
|
OP
|
$2,057.00
|
|
|
Service Code
|
CPT 78014
|
| Hospital Charge Code |
2586977
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$420.71 |
| Max. Negotiated Rate |
$2,396.16 |
| Rate for Payer: Aetna Commercial |
$1,925.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,839.78
|
| 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 |
$1,133.82
|
| 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 |
$617.10
|
| Rate for Payer: Cash Price |
$617.10
|
| Rate for Payer: Cash Price |
$617.10
|
| Rate for Payer: Cigna Commercial |
$1,968.14
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$420.71
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,197.17
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$420.71
|
| Rate for Payer: Health EOS Commercial |
$1,903.96
|
| Rate for Payer: HFN Commercial |
$1,968.14
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,565.05
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$420.71
|
| Rate for Payer: Independent Care Health Plan Medicare |
$420.71
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$420.71
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$420.71
|
| Rate for Payer: Multiplan Commercial |
$1,711.42
|
| Rate for Payer: NAPHCARE Commercial |
$631.07
|
| Rate for Payer: Preferred Network Access Commercial |
$1,968.14
|
| Rate for Payer: Quartz Beloit One Network |
$1,048.25
|
| Rate for Payer: Quartz Commercial |
$1,390.53
|
| 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 |
$1,176.60
|
| Rate for Payer: Wellcare Medicare |
$420.71
|
| Rate for Payer: WPS Commercial |
$1,584.51
|
|
|
NM Thyroid Imaging w/ Uptake Multiple
|
Professional
|
Both
|
$1,613.00
|
|
| Hospital Charge Code |
631453
|
| Min. Negotiated Rate |
$738.11 |
| Max. Negotiated Rate |
$1,593.64 |
| Rate for Payer: Aetna Commercial |
$1,593.64
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,442.67
|
| Rate for Payer: Cash Price |
$483.90
|
| Rate for Payer: Cigna Commercial |
$1,593.64
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$838.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,006.51
|
| Rate for Payer: Health EOS Commercial |
$1,526.54
|
| Rate for Payer: HFN Commercial |
$1,593.64
|
| Rate for Payer: Multiplan Commercial |
$1,342.02
|
| Rate for Payer: Preferred Network Access Commercial |
$1,593.64
|
| Rate for Payer: Quartz Beloit One Network |
$738.11
|
| Rate for Payer: Quartz Commercial |
$956.19
|
| Rate for Payer: The Alliance Commercial |
$838.76
|
| Rate for Payer: WEA Trust Commercial |
$922.64
|
| Rate for Payer: WPS Commercial |
$1,242.49
|
|
|
NM Thyroid Imaging w/ Uptake Multiple
|
Facility
|
IP
|
$2,057.00
|
|
|
Service Code
|
CPT 78014
|
| Hospital Charge Code |
2586977
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,048.25 |
| Max. Negotiated Rate |
$1,968.14 |
| Rate for Payer: Aetna Commercial |
$1,925.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,839.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,133.82
|
| Rate for Payer: Cash Price |
$617.10
|
| Rate for Payer: Cigna Commercial |
$1,968.14
|
| Rate for Payer: Health EOS Commercial |
$1,903.96
|
| Rate for Payer: HFN Commercial |
$1,968.14
|
| Rate for Payer: Multiplan Commercial |
$1,711.42
|
| Rate for Payer: Preferred Network Access Commercial |
$1,968.14
|
| Rate for Payer: Quartz Beloit One Network |
$1,048.25
|
| Rate for Payer: Quartz Commercial |
$1,283.57
|
| Rate for Payer: WEA Trust Commercial |
$1,176.60
|
| Rate for Payer: WPS Commercial |
$1,584.51
|
|
|
NM Thyroid Imaging w/ Uptake Multiple
|
Facility
|
OP
|
$1,613.00
|
|
| Hospital Charge Code |
631453
|
| Min. Negotiated Rate |
$469.71 |
| Max. Negotiated Rate |
$1,543.32 |
| Rate for Payer: Aetna Commercial |
$1,509.77
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,442.67
|
| Rate for Payer: Aetna Managed Medicare |
$469.71
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,090.39
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$838.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$805.21
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$889.09
|
| Rate for Payer: Cash Price |
$483.90
|
| Rate for Payer: Cigna Commercial |
$1,543.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$938.77
|
| Rate for Payer: Health EOS Commercial |
$1,492.99
|
| Rate for Payer: HFN Commercial |
$1,543.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,258.14
|
| Rate for Payer: Multiplan Commercial |
$1,342.02
|
| Rate for Payer: NAPHCARE Commercial |
$1,006.51
|
| Rate for Payer: Preferred Network Access Commercial |
$1,543.32
|
| Rate for Payer: Quartz Beloit One Network |
$821.98
|
| Rate for Payer: Quartz Commercial |
$1,090.39
|
| Rate for Payer: Quartz Medicare Advantage |
$1,006.51
|
| Rate for Payer: The Alliance Commercial |
$838.76
|
| Rate for Payer: WEA Trust Commercial |
$922.64
|
| Rate for Payer: WPS Commercial |
$1,242.49
|
|
|
NM Thyroid Imaging w/ Uptake Multiple
|
Facility
|
IP
|
$1,613.00
|
|
| Hospital Charge Code |
631453
|
| Min. Negotiated Rate |
$821.98 |
| Max. Negotiated Rate |
$1,543.32 |
| Rate for Payer: Aetna Commercial |
$1,509.77
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,442.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$889.09
|
| Rate for Payer: Cash Price |
$483.90
|
| Rate for Payer: Cigna Commercial |
$1,543.32
|
| Rate for Payer: Health EOS Commercial |
$1,492.99
|
| Rate for Payer: HFN Commercial |
$1,543.32
|
| Rate for Payer: Multiplan Commercial |
$1,342.02
|
| Rate for Payer: Preferred Network Access Commercial |
$1,543.32
|
| Rate for Payer: Quartz Beloit One Network |
$821.98
|
| Rate for Payer: Quartz Commercial |
$1,006.51
|
| Rate for Payer: WEA Trust Commercial |
$922.64
|
| Rate for Payer: WPS Commercial |
$1,242.49
|
|
|
NM Thyroid Uptake Multiple Determinate
|
Facility
|
OP
|
$857.00
|
|
| Hospital Charge Code |
631435
|
| Min. Negotiated Rate |
$249.56 |
| Max. Negotiated Rate |
$819.98 |
| Rate for Payer: Aetna Commercial |
$802.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$766.50
|
| Rate for Payer: Aetna Managed Medicare |
$249.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$579.33
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$445.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$427.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$472.38
|
| Rate for Payer: Cash Price |
$257.10
|
| Rate for Payer: Cigna Commercial |
$819.98
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$498.77
|
| Rate for Payer: Health EOS Commercial |
$793.24
|
| Rate for Payer: HFN Commercial |
$819.98
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$668.46
|
| Rate for Payer: Multiplan Commercial |
$713.02
|
| Rate for Payer: NAPHCARE Commercial |
$534.77
|
| Rate for Payer: Preferred Network Access Commercial |
$819.98
|
| Rate for Payer: Quartz Beloit One Network |
$436.73
|
| Rate for Payer: Quartz Commercial |
$579.33
|
| Rate for Payer: Quartz Medicare Advantage |
$534.77
|
| Rate for Payer: The Alliance Commercial |
$445.64
|
| Rate for Payer: WEA Trust Commercial |
$490.20
|
| Rate for Payer: WPS Commercial |
$660.15
|
|
|
NM Thyroid Uptake Multiple Determinate
|
Facility
|
IP
|
$891.00
|
|
|
Service Code
|
CPT 78012
|
| Hospital Charge Code |
2586983
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$454.05 |
| Max. Negotiated Rate |
$852.51 |
| Rate for Payer: Aetna Commercial |
$833.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$796.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$491.12
|
| Rate for Payer: Cash Price |
$267.30
|
| Rate for Payer: Cigna Commercial |
$852.51
|
| Rate for Payer: Health EOS Commercial |
$824.71
|
| Rate for Payer: HFN Commercial |
$852.51
|
| Rate for Payer: Multiplan Commercial |
$741.31
|
| Rate for Payer: Preferred Network Access Commercial |
$852.51
|
| Rate for Payer: Quartz Beloit One Network |
$454.05
|
| Rate for Payer: Quartz Commercial |
$555.98
|
| Rate for Payer: WEA Trust Commercial |
$509.65
|
| Rate for Payer: WPS Commercial |
$686.34
|
|
|
NM Thyroid Uptake Multiple Determinate
|
Professional
|
Both
|
$857.00
|
|
| Hospital Charge Code |
631435
|
| Min. Negotiated Rate |
$392.16 |
| Max. Negotiated Rate |
$846.72 |
| Rate for Payer: Aetna Commercial |
$846.72
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$766.50
|
| Rate for Payer: Cash Price |
$257.10
|
| Rate for Payer: Cigna Commercial |
$846.72
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$445.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$534.77
|
| Rate for Payer: Health EOS Commercial |
$811.06
|
| Rate for Payer: HFN Commercial |
$846.72
|
| Rate for Payer: Multiplan Commercial |
$713.02
|
| Rate for Payer: Preferred Network Access Commercial |
$846.72
|
| Rate for Payer: Quartz Beloit One Network |
$392.16
|
| Rate for Payer: Quartz Commercial |
$508.03
|
| Rate for Payer: The Alliance Commercial |
$445.64
|
| Rate for Payer: WEA Trust Commercial |
$490.20
|
| Rate for Payer: WPS Commercial |
$660.15
|
|
|
NM Thyroid Uptake Multiple Determinate
|
Facility
|
IP
|
$857.00
|
|
| Hospital Charge Code |
631435
|
| Min. Negotiated Rate |
$436.73 |
| Max. Negotiated Rate |
$819.98 |
| Rate for Payer: Aetna Commercial |
$802.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$766.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$472.38
|
| Rate for Payer: Cash Price |
$257.10
|
| Rate for Payer: Cigna Commercial |
$819.98
|
| Rate for Payer: Health EOS Commercial |
$793.24
|
| Rate for Payer: HFN Commercial |
$819.98
|
| Rate for Payer: Multiplan Commercial |
$713.02
|
| Rate for Payer: Preferred Network Access Commercial |
$819.98
|
| Rate for Payer: Quartz Beloit One Network |
$436.73
|
| Rate for Payer: Quartz Commercial |
$534.77
|
| Rate for Payer: WEA Trust Commercial |
$490.20
|
| Rate for Payer: WPS Commercial |
$660.15
|
|
|
NM Thyroid Uptake Multiple Determinate
|
Facility
|
OP
|
$891.00
|
|
|
Service Code
|
CPT 78012
|
| Hospital Charge Code |
2586983
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$420.71 |
| Max. Negotiated Rate |
$2,396.16 |
| Rate for Payer: Aetna Commercial |
$833.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$796.91
|
| 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 |
$491.12
|
| 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 |
$267.30
|
| Rate for Payer: Cash Price |
$267.30
|
| Rate for Payer: Cash Price |
$267.30
|
| Rate for Payer: Cigna Commercial |
$852.51
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$420.71
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$518.56
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$420.71
|
| Rate for Payer: Health EOS Commercial |
$824.71
|
| Rate for Payer: HFN Commercial |
$852.51
|
| 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 |
$741.31
|
| Rate for Payer: NAPHCARE Commercial |
$631.07
|
| Rate for Payer: Preferred Network Access Commercial |
$852.51
|
| Rate for Payer: Quartz Beloit One Network |
$454.05
|
| Rate for Payer: Quartz Commercial |
$602.32
|
| 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 |
$509.65
|
| Rate for Payer: Wellcare Medicare |
$420.71
|
| Rate for Payer: WPS Commercial |
$686.34
|
|
|
NM Thyroid Uptake Multiple Determinate
|
Professional
|
Both
|
$891.00
|
|
|
Service Code
|
CPT 78012
|
| Hospital Charge Code |
2586983
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$79.24 |
| Max. Negotiated Rate |
$880.31 |
| Rate for Payer: Aetna Commercial |
$880.31
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$796.91
|
| Rate for Payer: Aetna Managed Medicare |
$79.24
|
| Rate for Payer: Anthem Medicare Advantage |
$79.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$79.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$79.24
|
| Rate for Payer: Cash Price |
$267.30
|
| Rate for Payer: Cash Price |
$267.30
|
| Rate for Payer: Cash Price |
$267.30
|
| Rate for Payer: Cigna Commercial |
$880.31
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$463.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$79.24
|
| Rate for Payer: Health EOS Commercial |
$843.24
|
| Rate for Payer: HFN Commercial |
$880.31
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$286.86
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$286.86
|
| Rate for Payer: Independent Care Health Plan Medicare |
$79.24
|
| Rate for Payer: Multiplan Commercial |
$741.31
|
| Rate for Payer: NAPHCARE Commercial |
$118.86
|
| Rate for Payer: Preferred Network Access Commercial |
$880.31
|
| Rate for Payer: Quartz Beloit One Network |
$407.72
|
| Rate for Payer: Quartz Commercial |
$528.18
|
| Rate for Payer: Quartz Medicare Advantage |
$79.24
|
| Rate for Payer: The Alliance Commercial |
$301.10
|
| Rate for Payer: United Healthcare Medicare Advantage |
$79.24
|
| Rate for Payer: WEA Trust Commercial |
$509.65
|
| Rate for Payer: WPS Commercial |
$396.19
|
|
|
NM Tumor Limited Scan - Oncoscint
|
Professional
|
Both
|
$2,293.00
|
|
|
Service Code
|
CPT 78800
|
| Hospital Charge Code |
2586989
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$229.60 |
| Max. Negotiated Rate |
$2,265.48 |
| Rate for Payer: Aetna Commercial |
$2,265.48
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,050.86
|
| Rate for Payer: Aetna Managed Medicare |
$229.60
|
| Rate for Payer: Anthem Medicare Advantage |
$229.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$229.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$229.60
|
| Rate for Payer: Cash Price |
$687.90
|
| Rate for Payer: Cash Price |
$687.90
|
| Rate for Payer: Cash Price |
$687.90
|
| Rate for Payer: Cigna Commercial |
$2,265.48
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,192.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$229.60
|
| Rate for Payer: Health EOS Commercial |
$2,170.10
|
| Rate for Payer: HFN Commercial |
$2,265.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$905.94
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$905.94
|
| Rate for Payer: Independent Care Health Plan Medicare |
$229.60
|
| Rate for Payer: Multiplan Commercial |
$1,907.78
|
| Rate for Payer: NAPHCARE Commercial |
$344.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,265.48
|
| Rate for Payer: Quartz Beloit One Network |
$1,049.28
|
| Rate for Payer: Quartz Commercial |
$1,359.29
|
| Rate for Payer: Quartz Medicare Advantage |
$229.60
|
| Rate for Payer: The Alliance Commercial |
$872.48
|
| Rate for Payer: United Healthcare Medicare Advantage |
$229.60
|
| Rate for Payer: WEA Trust Commercial |
$1,311.60
|
| Rate for Payer: WPS Commercial |
$1,148.00
|
|
|
NM Tumor Limited Scan - Oncoscint
|
Facility
|
IP
|
$2,205.00
|
|
|
Service Code
|
CPT 78800
|
| Hospital Charge Code |
675705
|
| Min. Negotiated Rate |
$1,123.67 |
| Max. Negotiated Rate |
$2,109.74 |
| Rate for Payer: Aetna Commercial |
$2,063.88
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,972.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,215.40
|
| Rate for Payer: Cash Price |
$661.50
|
| Rate for Payer: Cigna Commercial |
$2,109.74
|
| Rate for Payer: Health EOS Commercial |
$2,040.95
|
| Rate for Payer: HFN Commercial |
$2,109.74
|
| Rate for Payer: Multiplan Commercial |
$1,834.56
|
| Rate for Payer: Preferred Network Access Commercial |
$2,109.74
|
| Rate for Payer: Quartz Beloit One Network |
$1,123.67
|
| Rate for Payer: Quartz Commercial |
$1,375.92
|
| Rate for Payer: WEA Trust Commercial |
$1,261.26
|
| Rate for Payer: WPS Commercial |
$1,698.51
|
|
|
NM Tumor Limited Scan - Oncoscint
|
Facility
|
OP
|
$2,293.00
|
|
|
Service Code
|
CPT 78800
|
| Hospital Charge Code |
2586989
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$420.71 |
| Max. Negotiated Rate |
$2,396.16 |
| Rate for Payer: Aetna Commercial |
$2,146.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,050.86
|
| 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 |
$1,263.90
|
| 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 |
$687.90
|
| Rate for Payer: Cash Price |
$687.90
|
| Rate for Payer: Cash Price |
$687.90
|
| Rate for Payer: Cigna Commercial |
$2,193.94
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$420.71
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,334.53
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$420.71
|
| Rate for Payer: Health EOS Commercial |
$2,122.40
|
| Rate for Payer: HFN Commercial |
$2,193.94
|
| 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 |
$1,907.78
|
| Rate for Payer: NAPHCARE Commercial |
$631.07
|
| Rate for Payer: Preferred Network Access Commercial |
$2,193.94
|
| Rate for Payer: Quartz Beloit One Network |
$1,168.51
|
| Rate for Payer: Quartz Commercial |
$1,550.07
|
| 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 |
$1,311.60
|
| Rate for Payer: Wellcare Medicare |
$420.71
|
| Rate for Payer: WPS Commercial |
$1,766.30
|
|
|
NM Tumor Limited Scan - Oncoscint
|
Facility
|
OP
|
$2,205.00
|
|
|
Service Code
|
CPT 78800
|
| Hospital Charge Code |
675705
|
| Min. Negotiated Rate |
$420.71 |
| Max. Negotiated Rate |
$2,109.74 |
| Rate for Payer: Aetna Commercial |
$2,063.88
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,972.15
|
| Rate for Payer: Aetna Managed Medicare |
$420.71
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,490.58
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,146.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,100.74
|
| Rate for Payer: Anthem Medicare Advantage |
$420.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,215.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$420.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$420.71
|
| Rate for Payer: Cash Price |
$661.50
|
| Rate for Payer: Cash Price |
$661.50
|
| Rate for Payer: Cigna Commercial |
$2,109.74
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$420.71
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,283.31
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$420.71
|
| Rate for Payer: Health EOS Commercial |
$2,040.95
|
| Rate for Payer: HFN Commercial |
$2,109.74
|
| 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 |
$1,834.56
|
| Rate for Payer: NAPHCARE Commercial |
$631.07
|
| Rate for Payer: Preferred Network Access Commercial |
$2,109.74
|
| Rate for Payer: Quartz Beloit One Network |
$1,123.67
|
| Rate for Payer: Quartz Commercial |
$1,490.58
|
| 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 |
$1,261.26
|
| Rate for Payer: Wellcare Medicare |
$420.71
|
| Rate for Payer: WPS Commercial |
$1,698.51
|
|
|
NM Tumor Limited Scan - Oncoscint
|
Facility
|
IP
|
$2,293.00
|
|
|
Service Code
|
CPT 78800
|
| Hospital Charge Code |
2586989
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,168.51 |
| Max. Negotiated Rate |
$2,193.94 |
| Rate for Payer: Aetna Commercial |
$2,146.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,050.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,263.90
|
| Rate for Payer: Cash Price |
$687.90
|
| Rate for Payer: Cigna Commercial |
$2,193.94
|
| Rate for Payer: Health EOS Commercial |
$2,122.40
|
| Rate for Payer: HFN Commercial |
$2,193.94
|
| Rate for Payer: Multiplan Commercial |
$1,907.78
|
| Rate for Payer: Preferred Network Access Commercial |
$2,193.94
|
| Rate for Payer: Quartz Beloit One Network |
$1,168.51
|
| Rate for Payer: Quartz Commercial |
$1,430.83
|
| Rate for Payer: WEA Trust Commercial |
$1,311.60
|
| Rate for Payer: WPS Commercial |
$1,766.30
|
|
|
NM Tumor Limited Scan - Oncoscint
|
Professional
|
Both
|
$2,205.00
|
|
|
Service Code
|
CPT 78800
|
| Hospital Charge Code |
675705
|
| Min. Negotiated Rate |
$229.60 |
| Max. Negotiated Rate |
$2,178.54 |
| Rate for Payer: Aetna Commercial |
$2,178.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,972.15
|
| Rate for Payer: Aetna Managed Medicare |
$229.60
|
| Rate for Payer: Anthem Medicare Advantage |
$229.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$229.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$229.60
|
| Rate for Payer: Cash Price |
$661.50
|
| Rate for Payer: Cash Price |
$661.50
|
| Rate for Payer: Cash Price |
$661.50
|
| Rate for Payer: Cigna Commercial |
$2,178.54
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,146.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$229.60
|
| Rate for Payer: Health EOS Commercial |
$2,086.81
|
| Rate for Payer: HFN Commercial |
$2,178.54
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$905.94
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$905.94
|
| Rate for Payer: Independent Care Health Plan Medicare |
$229.60
|
| Rate for Payer: Multiplan Commercial |
$1,834.56
|
| Rate for Payer: NAPHCARE Commercial |
$344.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,178.54
|
| Rate for Payer: Quartz Beloit One Network |
$1,009.01
|
| Rate for Payer: Quartz Commercial |
$1,307.12
|
| Rate for Payer: Quartz Medicare Advantage |
$229.60
|
| Rate for Payer: The Alliance Commercial |
$872.48
|
| Rate for Payer: United Healthcare Medicare Advantage |
$229.60
|
| Rate for Payer: WEA Trust Commercial |
$1,261.26
|
| Rate for Payer: WPS Commercial |
$1,148.00
|
|
|
NM Tumor Localization/Limited
|
Professional
|
Both
|
$2,293.00
|
|
|
Service Code
|
CPT 78800
|
| Hospital Charge Code |
2586993
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$229.60 |
| Max. Negotiated Rate |
$2,265.48 |
| Rate for Payer: Aetna Commercial |
$2,265.48
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,050.86
|
| Rate for Payer: Aetna Managed Medicare |
$229.60
|
| Rate for Payer: Anthem Medicare Advantage |
$229.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$229.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$229.60
|
| Rate for Payer: Cash Price |
$687.90
|
| Rate for Payer: Cash Price |
$687.90
|
| Rate for Payer: Cash Price |
$687.90
|
| Rate for Payer: Cigna Commercial |
$2,265.48
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,192.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$229.60
|
| Rate for Payer: Health EOS Commercial |
$2,170.10
|
| Rate for Payer: HFN Commercial |
$2,265.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$905.94
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$905.94
|
| Rate for Payer: Independent Care Health Plan Medicare |
$229.60
|
| Rate for Payer: Multiplan Commercial |
$1,907.78
|
| Rate for Payer: NAPHCARE Commercial |
$344.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,265.48
|
| Rate for Payer: Quartz Beloit One Network |
$1,049.28
|
| Rate for Payer: Quartz Commercial |
$1,359.29
|
| Rate for Payer: Quartz Medicare Advantage |
$229.60
|
| Rate for Payer: The Alliance Commercial |
$872.48
|
| Rate for Payer: United Healthcare Medicare Advantage |
$229.60
|
| Rate for Payer: WEA Trust Commercial |
$1,311.60
|
| Rate for Payer: WPS Commercial |
$1,148.00
|
|
|
NM Tumor Localization/Limited
|
Facility
|
OP
|
$2,293.00
|
|
|
Service Code
|
CPT 78800
|
| Hospital Charge Code |
2586993
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$420.71 |
| Max. Negotiated Rate |
$2,396.16 |
| Rate for Payer: Aetna Commercial |
$2,146.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,050.86
|
| 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 |
$1,263.90
|
| 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 |
$687.90
|
| Rate for Payer: Cash Price |
$687.90
|
| Rate for Payer: Cash Price |
$687.90
|
| Rate for Payer: Cigna Commercial |
$2,193.94
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$420.71
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,334.53
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$420.71
|
| Rate for Payer: Health EOS Commercial |
$2,122.40
|
| Rate for Payer: HFN Commercial |
$2,193.94
|
| 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 |
$1,907.78
|
| Rate for Payer: NAPHCARE Commercial |
$631.07
|
| Rate for Payer: Preferred Network Access Commercial |
$2,193.94
|
| Rate for Payer: Quartz Beloit One Network |
$1,168.51
|
| Rate for Payer: Quartz Commercial |
$1,550.07
|
| 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 |
$1,311.60
|
| Rate for Payer: Wellcare Medicare |
$420.71
|
| Rate for Payer: WPS Commercial |
$1,766.30
|
|
|
NM Tumor Localization/Limited
|
Professional
|
Both
|
$2,205.00
|
|
|
Service Code
|
CPT 78800
|
| Hospital Charge Code |
631415
|
| Min. Negotiated Rate |
$229.60 |
| Max. Negotiated Rate |
$2,178.54 |
| Rate for Payer: Aetna Commercial |
$2,178.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,972.15
|
| Rate for Payer: Aetna Managed Medicare |
$229.60
|
| Rate for Payer: Anthem Medicare Advantage |
$229.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$229.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$229.60
|
| Rate for Payer: Cash Price |
$661.50
|
| Rate for Payer: Cash Price |
$661.50
|
| Rate for Payer: Cash Price |
$661.50
|
| Rate for Payer: Cigna Commercial |
$2,178.54
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,146.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$229.60
|
| Rate for Payer: Health EOS Commercial |
$2,086.81
|
| Rate for Payer: HFN Commercial |
$2,178.54
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$905.94
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$905.94
|
| Rate for Payer: Independent Care Health Plan Medicare |
$229.60
|
| Rate for Payer: Multiplan Commercial |
$1,834.56
|
| Rate for Payer: NAPHCARE Commercial |
$344.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,178.54
|
| Rate for Payer: Quartz Beloit One Network |
$1,009.01
|
| Rate for Payer: Quartz Commercial |
$1,307.12
|
| Rate for Payer: Quartz Medicare Advantage |
$229.60
|
| Rate for Payer: The Alliance Commercial |
$872.48
|
| Rate for Payer: United Healthcare Medicare Advantage |
$229.60
|
| Rate for Payer: WEA Trust Commercial |
$1,261.26
|
| Rate for Payer: WPS Commercial |
$1,148.00
|
|
|
NM Tumor Localization/Limited
|
Facility
|
IP
|
$2,205.00
|
|
|
Service Code
|
CPT 78800
|
| Hospital Charge Code |
631415
|
| Min. Negotiated Rate |
$1,123.67 |
| Max. Negotiated Rate |
$2,109.74 |
| Rate for Payer: Aetna Commercial |
$2,063.88
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,972.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,215.40
|
| Rate for Payer: Cash Price |
$661.50
|
| Rate for Payer: Cigna Commercial |
$2,109.74
|
| Rate for Payer: Health EOS Commercial |
$2,040.95
|
| Rate for Payer: HFN Commercial |
$2,109.74
|
| Rate for Payer: Multiplan Commercial |
$1,834.56
|
| Rate for Payer: Preferred Network Access Commercial |
$2,109.74
|
| Rate for Payer: Quartz Beloit One Network |
$1,123.67
|
| Rate for Payer: Quartz Commercial |
$1,375.92
|
| Rate for Payer: WEA Trust Commercial |
$1,261.26
|
| Rate for Payer: WPS Commercial |
$1,698.51
|
|
|
NM Tumor Localization/Limited
|
Facility
|
OP
|
$2,205.00
|
|
|
Service Code
|
CPT 78800
|
| Hospital Charge Code |
631415
|
| Min. Negotiated Rate |
$420.71 |
| Max. Negotiated Rate |
$2,109.74 |
| Rate for Payer: Aetna Commercial |
$2,063.88
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,972.15
|
| Rate for Payer: Aetna Managed Medicare |
$420.71
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,490.58
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,146.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,100.74
|
| Rate for Payer: Anthem Medicare Advantage |
$420.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,215.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$420.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$420.71
|
| Rate for Payer: Cash Price |
$661.50
|
| Rate for Payer: Cash Price |
$661.50
|
| Rate for Payer: Cigna Commercial |
$2,109.74
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$420.71
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,283.31
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$420.71
|
| Rate for Payer: Health EOS Commercial |
$2,040.95
|
| Rate for Payer: HFN Commercial |
$2,109.74
|
| 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 |
$1,834.56
|
| Rate for Payer: NAPHCARE Commercial |
$631.07
|
| Rate for Payer: Preferred Network Access Commercial |
$2,109.74
|
| Rate for Payer: Quartz Beloit One Network |
$1,123.67
|
| Rate for Payer: Quartz Commercial |
$1,490.58
|
| 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 |
$1,261.26
|
| Rate for Payer: Wellcare Medicare |
$420.71
|
| Rate for Payer: WPS Commercial |
$1,698.51
|
|
