|
NM Tumor Localization/Limited
|
Facility
|
IP
|
$2,293.00
|
|
|
Service Code
|
CPT 78800
|
| Hospital Charge Code |
2586993
|
|
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 Localization/Multiple Areas
|
Facility
|
IP
|
$3,899.00
|
|
|
Service Code
|
CPT 78801
|
| Hospital Charge Code |
2586995
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,986.93 |
| Max. Negotiated Rate |
$3,730.56 |
| Rate for Payer: Aetna Commercial |
$3,649.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,487.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,149.13
|
| Rate for Payer: Cash Price |
$1,169.70
|
| Rate for Payer: Cigna Commercial |
$3,730.56
|
| Rate for Payer: Health EOS Commercial |
$3,608.91
|
| Rate for Payer: HFN Commercial |
$3,730.56
|
| Rate for Payer: Multiplan Commercial |
$3,243.97
|
| Rate for Payer: Preferred Network Access Commercial |
$3,730.56
|
| Rate for Payer: Quartz Beloit One Network |
$1,986.93
|
| Rate for Payer: Quartz Commercial |
$2,432.98
|
| Rate for Payer: WEA Trust Commercial |
$2,230.23
|
| Rate for Payer: WPS Commercial |
$3,003.40
|
|
|
NM Tumor Localization/Multiple Areas
|
Facility
|
OP
|
$3,899.00
|
|
|
Service Code
|
CPT 78801
|
| Hospital Charge Code |
2586995
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$420.71 |
| Max. Negotiated Rate |
$3,730.56 |
| Rate for Payer: Aetna Commercial |
$3,649.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,487.27
|
| 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 |
$2,149.13
|
| 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 |
$1,169.70
|
| Rate for Payer: Cash Price |
$1,169.70
|
| Rate for Payer: Cash Price |
$1,169.70
|
| Rate for Payer: Cigna Commercial |
$3,730.56
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$420.71
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,269.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$420.71
|
| Rate for Payer: Health EOS Commercial |
$3,608.91
|
| Rate for Payer: HFN Commercial |
$3,730.56
|
| 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 |
$3,243.97
|
| Rate for Payer: NAPHCARE Commercial |
$631.07
|
| Rate for Payer: Preferred Network Access Commercial |
$3,730.56
|
| Rate for Payer: Quartz Beloit One Network |
$1,986.93
|
| Rate for Payer: Quartz Commercial |
$2,635.72
|
| 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 |
$2,230.23
|
| Rate for Payer: Wellcare Medicare |
$420.71
|
| Rate for Payer: WPS Commercial |
$3,003.40
|
|
|
NM Tumor Localization/Multiple Areas
|
Professional
|
Both
|
$3,899.00
|
|
|
Service Code
|
CPT 78801
|
| Hospital Charge Code |
2586995
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$238.50 |
| Max. Negotiated Rate |
$3,852.21 |
| Rate for Payer: Aetna Commercial |
$3,852.21
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,487.27
|
| Rate for Payer: Aetna Managed Medicare |
$238.50
|
| Rate for Payer: Anthem Medicare Advantage |
$238.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$238.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$238.50
|
| Rate for Payer: Cash Price |
$1,169.70
|
| Rate for Payer: Cash Price |
$1,169.70
|
| Rate for Payer: Cash Price |
$1,169.70
|
| Rate for Payer: Cigna Commercial |
$3,852.21
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,027.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$238.50
|
| Rate for Payer: Health EOS Commercial |
$3,690.01
|
| Rate for Payer: HFN Commercial |
$3,852.21
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,000.73
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,000.73
|
| Rate for Payer: Independent Care Health Plan Medicare |
$238.50
|
| Rate for Payer: Multiplan Commercial |
$3,243.97
|
| Rate for Payer: NAPHCARE Commercial |
$357.75
|
| Rate for Payer: Preferred Network Access Commercial |
$3,852.21
|
| Rate for Payer: Quartz Beloit One Network |
$1,784.18
|
| Rate for Payer: Quartz Commercial |
$2,311.33
|
| Rate for Payer: Quartz Medicare Advantage |
$238.50
|
| Rate for Payer: The Alliance Commercial |
$906.31
|
| Rate for Payer: United Healthcare Medicare Advantage |
$238.50
|
| Rate for Payer: WEA Trust Commercial |
$2,230.23
|
| Rate for Payer: WPS Commercial |
$1,192.52
|
|
|
NM Tumor Localization Spect
|
Facility
|
IP
|
$3,379.00
|
|
|
Service Code
|
CPT 78803
|
| Hospital Charge Code |
631421
|
| Min. Negotiated Rate |
$1,721.94 |
| Max. Negotiated Rate |
$3,233.03 |
| Rate for Payer: Aetna Commercial |
$3,162.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,022.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,862.50
|
| Rate for Payer: Cash Price |
$1,013.70
|
| Rate for Payer: Cigna Commercial |
$3,233.03
|
| Rate for Payer: Health EOS Commercial |
$3,127.60
|
| Rate for Payer: HFN Commercial |
$3,233.03
|
| Rate for Payer: Multiplan Commercial |
$2,811.33
|
| Rate for Payer: Preferred Network Access Commercial |
$3,233.03
|
| Rate for Payer: Quartz Beloit One Network |
$1,721.94
|
| Rate for Payer: Quartz Commercial |
$2,108.50
|
| Rate for Payer: WEA Trust Commercial |
$1,932.79
|
| Rate for Payer: WPS Commercial |
$2,602.84
|
|
|
NM Tumor Localization Spect
|
Professional
|
Both
|
$3,379.00
|
|
|
Service Code
|
CPT 78803
|
| Hospital Charge Code |
631421
|
| Min. Negotiated Rate |
$333.74 |
| Max. Negotiated Rate |
$3,338.45 |
| Rate for Payer: Aetna Commercial |
$3,338.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,022.18
|
| Rate for Payer: Aetna Managed Medicare |
$333.74
|
| Rate for Payer: Anthem Medicare Advantage |
$333.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$333.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$333.74
|
| Rate for Payer: Cash Price |
$1,013.70
|
| Rate for Payer: Cash Price |
$1,013.70
|
| Rate for Payer: Cash Price |
$1,013.70
|
| Rate for Payer: Cigna Commercial |
$3,338.45
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,757.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$333.74
|
| Rate for Payer: Health EOS Commercial |
$3,197.89
|
| Rate for Payer: HFN Commercial |
$3,338.45
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,373.87
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,373.87
|
| Rate for Payer: Independent Care Health Plan Medicare |
$333.74
|
| Rate for Payer: Multiplan Commercial |
$2,811.33
|
| Rate for Payer: NAPHCARE Commercial |
$500.60
|
| Rate for Payer: Preferred Network Access Commercial |
$3,338.45
|
| Rate for Payer: Quartz Beloit One Network |
$1,546.23
|
| Rate for Payer: Quartz Commercial |
$2,003.07
|
| Rate for Payer: Quartz Medicare Advantage |
$333.74
|
| Rate for Payer: The Alliance Commercial |
$1,268.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$333.74
|
| Rate for Payer: WEA Trust Commercial |
$1,932.79
|
| Rate for Payer: WPS Commercial |
$1,668.68
|
|
|
NM Tumor Localization Spect
|
Facility
|
OP
|
$3,379.00
|
|
|
Service Code
|
CPT 78803
|
| Hospital Charge Code |
631421
|
| Min. Negotiated Rate |
$571.42 |
| Max. Negotiated Rate |
$3,233.03 |
| Rate for Payer: Aetna Commercial |
$3,162.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,022.18
|
| Rate for Payer: Aetna Managed Medicare |
$571.42
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,284.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,757.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,686.80
|
| Rate for Payer: Anthem Medicare Advantage |
$571.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,862.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$571.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$571.42
|
| Rate for Payer: Cash Price |
$1,013.70
|
| Rate for Payer: Cash Price |
$1,013.70
|
| Rate for Payer: Cigna Commercial |
$3,233.03
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$571.42
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,966.58
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$571.42
|
| Rate for Payer: Health EOS Commercial |
$3,127.60
|
| Rate for Payer: HFN Commercial |
$3,233.03
|
| 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 |
$2,811.33
|
| Rate for Payer: NAPHCARE Commercial |
$857.13
|
| Rate for Payer: Preferred Network Access Commercial |
$3,233.03
|
| Rate for Payer: Quartz Beloit One Network |
$1,721.94
|
| Rate for Payer: Quartz Commercial |
$2,284.20
|
| 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 |
$1,932.79
|
| Rate for Payer: Wellcare Medicare |
$571.42
|
| Rate for Payer: WPS Commercial |
$2,602.84
|
|
|
NM Tumor Localization/Whole Body 2+ Days
|
Facility
|
IP
|
$3,518.00
|
|
|
Service Code
|
CPT 78804
|
| Hospital Charge Code |
661631
|
| Min. Negotiated Rate |
$1,792.77 |
| Max. Negotiated Rate |
$3,366.02 |
| Rate for Payer: Aetna Commercial |
$3,292.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,146.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,939.12
|
| Rate for Payer: Cash Price |
$1,055.40
|
| Rate for Payer: Cigna Commercial |
$3,366.02
|
| Rate for Payer: Health EOS Commercial |
$3,256.26
|
| Rate for Payer: HFN Commercial |
$3,366.02
|
| Rate for Payer: Multiplan Commercial |
$2,926.98
|
| Rate for Payer: Preferred Network Access Commercial |
$3,366.02
|
| Rate for Payer: Quartz Beloit One Network |
$1,792.77
|
| Rate for Payer: Quartz Commercial |
$2,195.23
|
| Rate for Payer: WEA Trust Commercial |
$2,012.30
|
| Rate for Payer: WPS Commercial |
$2,709.92
|
|
|
NM Tumor Localization/Whole Body 2+ Days
|
Professional
|
Both
|
$3,518.00
|
|
|
Service Code
|
CPT 78804
|
| Hospital Charge Code |
661631
|
| Min. Negotiated Rate |
$557.56 |
| Max. Negotiated Rate |
$3,475.78 |
| Rate for Payer: Aetna Commercial |
$3,475.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,146.50
|
| Rate for Payer: Aetna Managed Medicare |
$557.56
|
| Rate for Payer: Anthem Medicare Advantage |
$557.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$557.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$557.56
|
| Rate for Payer: Cash Price |
$1,055.40
|
| Rate for Payer: Cash Price |
$1,055.40
|
| Rate for Payer: Cash Price |
$1,055.40
|
| Rate for Payer: Cigna Commercial |
$3,475.78
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,829.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$557.56
|
| Rate for Payer: Health EOS Commercial |
$3,329.44
|
| Rate for Payer: HFN Commercial |
$3,475.78
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,340.17
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$2,340.17
|
| Rate for Payer: Independent Care Health Plan Medicare |
$557.56
|
| Rate for Payer: Multiplan Commercial |
$2,926.98
|
| Rate for Payer: NAPHCARE Commercial |
$836.35
|
| Rate for Payer: Preferred Network Access Commercial |
$3,475.78
|
| Rate for Payer: Quartz Beloit One Network |
$1,609.84
|
| Rate for Payer: Quartz Commercial |
$2,085.47
|
| Rate for Payer: Quartz Medicare Advantage |
$557.56
|
| Rate for Payer: The Alliance Commercial |
$2,118.75
|
| Rate for Payer: United Healthcare Medicare Advantage |
$557.56
|
| Rate for Payer: WEA Trust Commercial |
$2,012.30
|
| Rate for Payer: WPS Commercial |
$2,787.82
|
|
|
NM Tumor Localization/Whole Body 2+ Days
|
Facility
|
OP
|
$3,659.00
|
|
|
Service Code
|
CPT 78804
|
| Hospital Charge Code |
2586999
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$571.42 |
| Max. Negotiated Rate |
$5,473.65 |
| Rate for Payer: Aetna Commercial |
$3,424.82
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,272.61
|
| Rate for Payer: Aetna Managed Medicare |
$571.42
|
| 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: Anthem Medicare Advantage |
$571.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,016.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$571.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$571.42
|
| Rate for Payer: Cash Price |
$1,097.70
|
| Rate for Payer: Cash Price |
$1,097.70
|
| Rate for Payer: Cash Price |
$1,097.70
|
| Rate for Payer: Cigna Commercial |
$3,500.93
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$571.42
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,129.54
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$571.42
|
| Rate for Payer: Health EOS Commercial |
$3,386.77
|
| Rate for Payer: HFN Commercial |
$3,500.93
|
| 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 |
$3,044.29
|
| Rate for Payer: NAPHCARE Commercial |
$857.13
|
| Rate for Payer: Preferred Network Access Commercial |
$3,500.93
|
| Rate for Payer: Quartz Beloit One Network |
$1,864.63
|
| Rate for Payer: Quartz Commercial |
$2,473.48
|
| Rate for Payer: Quartz Medicare Advantage |
$571.42
|
| Rate for Payer: The Alliance Commercial |
$2,285.67
|
| Rate for Payer: United Healthcare Medicare Advantage |
$571.42
|
| Rate for Payer: United Healthcare PPO |
$2,396.16
|
| Rate for Payer: WEA Trust Commercial |
$2,092.95
|
| Rate for Payer: Wellcare Medicare |
$571.42
|
| Rate for Payer: WPS Commercial |
$2,818.53
|
|
|
NM Tumor Localization/Whole Body 2+ Days
|
Professional
|
Both
|
$3,659.00
|
|
|
Service Code
|
CPT 78804
|
| Hospital Charge Code |
2586999
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$557.56 |
| Max. Negotiated Rate |
$3,615.09 |
| Rate for Payer: Aetna Commercial |
$3,615.09
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,272.61
|
| Rate for Payer: Aetna Managed Medicare |
$557.56
|
| Rate for Payer: Anthem Medicare Advantage |
$557.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$557.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$557.56
|
| Rate for Payer: Cash Price |
$1,097.70
|
| Rate for Payer: Cash Price |
$1,097.70
|
| Rate for Payer: Cash Price |
$1,097.70
|
| Rate for Payer: Cigna Commercial |
$3,615.09
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,902.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$557.56
|
| Rate for Payer: Health EOS Commercial |
$3,462.88
|
| Rate for Payer: HFN Commercial |
$3,615.09
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,340.17
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$2,340.17
|
| Rate for Payer: Independent Care Health Plan Medicare |
$557.56
|
| Rate for Payer: Multiplan Commercial |
$3,044.29
|
| Rate for Payer: NAPHCARE Commercial |
$836.35
|
| Rate for Payer: Preferred Network Access Commercial |
$3,615.09
|
| Rate for Payer: Quartz Beloit One Network |
$1,674.36
|
| Rate for Payer: Quartz Commercial |
$2,169.06
|
| Rate for Payer: Quartz Medicare Advantage |
$557.56
|
| Rate for Payer: The Alliance Commercial |
$2,118.75
|
| Rate for Payer: United Healthcare Medicare Advantage |
$557.56
|
| Rate for Payer: WEA Trust Commercial |
$2,092.95
|
| Rate for Payer: WPS Commercial |
$2,787.82
|
|
|
NM Tumor Localization/Whole Body 2+ Days
|
Facility
|
OP
|
$3,518.00
|
|
|
Service Code
|
CPT 78804
|
| Hospital Charge Code |
661631
|
| Min. Negotiated Rate |
$571.42 |
| Max. Negotiated Rate |
$3,366.02 |
| Rate for Payer: Aetna Commercial |
$3,292.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,146.50
|
| Rate for Payer: Aetna Managed Medicare |
$571.42
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,378.17
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,829.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,756.19
|
| Rate for Payer: Anthem Medicare Advantage |
$571.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,939.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$571.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$571.42
|
| Rate for Payer: Cash Price |
$1,055.40
|
| Rate for Payer: Cash Price |
$1,055.40
|
| Rate for Payer: Cigna Commercial |
$3,366.02
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$571.42
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,047.48
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$571.42
|
| Rate for Payer: Health EOS Commercial |
$3,256.26
|
| Rate for Payer: HFN Commercial |
$3,366.02
|
| 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 |
$2,926.98
|
| Rate for Payer: NAPHCARE Commercial |
$857.13
|
| Rate for Payer: Preferred Network Access Commercial |
$3,366.02
|
| Rate for Payer: Quartz Beloit One Network |
$1,792.77
|
| Rate for Payer: Quartz Commercial |
$2,378.17
|
| 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 |
$2,012.30
|
| Rate for Payer: Wellcare Medicare |
$571.42
|
| Rate for Payer: WPS Commercial |
$2,709.92
|
|
|
NM Tumor Localization/Whole Body 2+ Days
|
Facility
|
IP
|
$3,659.00
|
|
|
Service Code
|
CPT 78804
|
| Hospital Charge Code |
2586999
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,864.63 |
| Max. Negotiated Rate |
$3,500.93 |
| Rate for Payer: Aetna Commercial |
$3,424.82
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,272.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,016.84
|
| Rate for Payer: Cash Price |
$1,097.70
|
| Rate for Payer: Cigna Commercial |
$3,500.93
|
| Rate for Payer: Health EOS Commercial |
$3,386.77
|
| Rate for Payer: HFN Commercial |
$3,500.93
|
| Rate for Payer: Multiplan Commercial |
$3,044.29
|
| Rate for Payer: Preferred Network Access Commercial |
$3,500.93
|
| Rate for Payer: Quartz Beloit One Network |
$1,864.63
|
| Rate for Payer: Quartz Commercial |
$2,283.22
|
| Rate for Payer: WEA Trust Commercial |
$2,092.95
|
| Rate for Payer: WPS Commercial |
$2,818.53
|
|
|
NM Tumor Whole Body Scan - Oncoscint
|
Professional
|
Both
|
$3,659.00
|
|
|
Service Code
|
CPT 78804
|
| Hospital Charge Code |
2587001
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$557.56 |
| Max. Negotiated Rate |
$3,615.09 |
| Rate for Payer: Aetna Commercial |
$3,615.09
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,272.61
|
| Rate for Payer: Aetna Managed Medicare |
$557.56
|
| Rate for Payer: Anthem Medicare Advantage |
$557.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$557.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$557.56
|
| Rate for Payer: Cash Price |
$1,097.70
|
| Rate for Payer: Cash Price |
$1,097.70
|
| Rate for Payer: Cash Price |
$1,097.70
|
| Rate for Payer: Cigna Commercial |
$3,615.09
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,902.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$557.56
|
| Rate for Payer: Health EOS Commercial |
$3,462.88
|
| Rate for Payer: HFN Commercial |
$3,615.09
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,340.17
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$2,340.17
|
| Rate for Payer: Independent Care Health Plan Medicare |
$557.56
|
| Rate for Payer: Multiplan Commercial |
$3,044.29
|
| Rate for Payer: NAPHCARE Commercial |
$836.35
|
| Rate for Payer: Preferred Network Access Commercial |
$3,615.09
|
| Rate for Payer: Quartz Beloit One Network |
$1,674.36
|
| Rate for Payer: Quartz Commercial |
$2,169.06
|
| Rate for Payer: Quartz Medicare Advantage |
$557.56
|
| Rate for Payer: The Alliance Commercial |
$2,118.75
|
| Rate for Payer: United Healthcare Medicare Advantage |
$557.56
|
| Rate for Payer: WEA Trust Commercial |
$2,092.95
|
| Rate for Payer: WPS Commercial |
$2,787.82
|
|
|
NM Tumor Whole Body Scan - Oncoscint
|
Facility
|
IP
|
$3,659.00
|
|
|
Service Code
|
CPT 78804
|
| Hospital Charge Code |
2587001
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,864.63 |
| Max. Negotiated Rate |
$3,500.93 |
| Rate for Payer: Aetna Commercial |
$3,424.82
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,272.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,016.84
|
| Rate for Payer: Cash Price |
$1,097.70
|
| Rate for Payer: Cigna Commercial |
$3,500.93
|
| Rate for Payer: Health EOS Commercial |
$3,386.77
|
| Rate for Payer: HFN Commercial |
$3,500.93
|
| Rate for Payer: Multiplan Commercial |
$3,044.29
|
| Rate for Payer: Preferred Network Access Commercial |
$3,500.93
|
| Rate for Payer: Quartz Beloit One Network |
$1,864.63
|
| Rate for Payer: Quartz Commercial |
$2,283.22
|
| Rate for Payer: WEA Trust Commercial |
$2,092.95
|
| Rate for Payer: WPS Commercial |
$2,818.53
|
|
|
NM Tumor Whole Body Scan - Oncoscint
|
Facility
|
OP
|
$3,518.00
|
|
|
Service Code
|
CPT 78804
|
| Hospital Charge Code |
675711
|
| Min. Negotiated Rate |
$571.42 |
| Max. Negotiated Rate |
$3,366.02 |
| Rate for Payer: Aetna Commercial |
$3,292.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,146.50
|
| Rate for Payer: Aetna Managed Medicare |
$571.42
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,378.17
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,829.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,756.19
|
| Rate for Payer: Anthem Medicare Advantage |
$571.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,939.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$571.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$571.42
|
| Rate for Payer: Cash Price |
$1,055.40
|
| Rate for Payer: Cash Price |
$1,055.40
|
| Rate for Payer: Cigna Commercial |
$3,366.02
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$571.42
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,047.48
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$571.42
|
| Rate for Payer: Health EOS Commercial |
$3,256.26
|
| Rate for Payer: HFN Commercial |
$3,366.02
|
| 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 |
$2,926.98
|
| Rate for Payer: NAPHCARE Commercial |
$857.13
|
| Rate for Payer: Preferred Network Access Commercial |
$3,366.02
|
| Rate for Payer: Quartz Beloit One Network |
$1,792.77
|
| Rate for Payer: Quartz Commercial |
$2,378.17
|
| 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 |
$2,012.30
|
| Rate for Payer: Wellcare Medicare |
$571.42
|
| Rate for Payer: WPS Commercial |
$2,709.92
|
|
|
NM Tumor Whole Body Scan - Oncoscint
|
Professional
|
Both
|
$3,518.00
|
|
|
Service Code
|
CPT 78804
|
| Hospital Charge Code |
675711
|
| Min. Negotiated Rate |
$557.56 |
| Max. Negotiated Rate |
$3,475.78 |
| Rate for Payer: Aetna Commercial |
$3,475.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,146.50
|
| Rate for Payer: Aetna Managed Medicare |
$557.56
|
| Rate for Payer: Anthem Medicare Advantage |
$557.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$557.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$557.56
|
| Rate for Payer: Cash Price |
$1,055.40
|
| Rate for Payer: Cash Price |
$1,055.40
|
| Rate for Payer: Cash Price |
$1,055.40
|
| Rate for Payer: Cigna Commercial |
$3,475.78
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,829.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$557.56
|
| Rate for Payer: Health EOS Commercial |
$3,329.44
|
| Rate for Payer: HFN Commercial |
$3,475.78
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,340.17
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$2,340.17
|
| Rate for Payer: Independent Care Health Plan Medicare |
$557.56
|
| Rate for Payer: Multiplan Commercial |
$2,926.98
|
| Rate for Payer: NAPHCARE Commercial |
$836.35
|
| Rate for Payer: Preferred Network Access Commercial |
$3,475.78
|
| Rate for Payer: Quartz Beloit One Network |
$1,609.84
|
| Rate for Payer: Quartz Commercial |
$2,085.47
|
| Rate for Payer: Quartz Medicare Advantage |
$557.56
|
| Rate for Payer: The Alliance Commercial |
$2,118.75
|
| Rate for Payer: United Healthcare Medicare Advantage |
$557.56
|
| Rate for Payer: WEA Trust Commercial |
$2,012.30
|
| Rate for Payer: WPS Commercial |
$2,787.82
|
|
|
NM Tumor Whole Body Scan - Oncoscint
|
Facility
|
OP
|
$3,659.00
|
|
|
Service Code
|
CPT 78804
|
| Hospital Charge Code |
2587001
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$571.42 |
| Max. Negotiated Rate |
$5,473.65 |
| Rate for Payer: Aetna Commercial |
$3,424.82
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,272.61
|
| Rate for Payer: Aetna Managed Medicare |
$571.42
|
| 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: Anthem Medicare Advantage |
$571.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,016.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$571.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$571.42
|
| Rate for Payer: Cash Price |
$1,097.70
|
| Rate for Payer: Cash Price |
$1,097.70
|
| Rate for Payer: Cash Price |
$1,097.70
|
| Rate for Payer: Cigna Commercial |
$3,500.93
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$571.42
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,129.54
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$571.42
|
| Rate for Payer: Health EOS Commercial |
$3,386.77
|
| Rate for Payer: HFN Commercial |
$3,500.93
|
| 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 |
$3,044.29
|
| Rate for Payer: NAPHCARE Commercial |
$857.13
|
| Rate for Payer: Preferred Network Access Commercial |
$3,500.93
|
| Rate for Payer: Quartz Beloit One Network |
$1,864.63
|
| Rate for Payer: Quartz Commercial |
$2,473.48
|
| Rate for Payer: Quartz Medicare Advantage |
$571.42
|
| Rate for Payer: The Alliance Commercial |
$2,285.67
|
| Rate for Payer: United Healthcare Medicare Advantage |
$571.42
|
| Rate for Payer: United Healthcare PPO |
$2,396.16
|
| Rate for Payer: WEA Trust Commercial |
$2,092.95
|
| Rate for Payer: Wellcare Medicare |
$571.42
|
| Rate for Payer: WPS Commercial |
$2,818.53
|
|
|
NM Tumor Whole Body Scan - Oncoscint
|
Facility
|
IP
|
$3,518.00
|
|
|
Service Code
|
CPT 78804
|
| Hospital Charge Code |
675711
|
| Min. Negotiated Rate |
$1,792.77 |
| Max. Negotiated Rate |
$3,366.02 |
| Rate for Payer: Aetna Commercial |
$3,292.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,146.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,939.12
|
| Rate for Payer: Cash Price |
$1,055.40
|
| Rate for Payer: Cigna Commercial |
$3,366.02
|
| Rate for Payer: Health EOS Commercial |
$3,256.26
|
| Rate for Payer: HFN Commercial |
$3,366.02
|
| Rate for Payer: Multiplan Commercial |
$2,926.98
|
| Rate for Payer: Preferred Network Access Commercial |
$3,366.02
|
| Rate for Payer: Quartz Beloit One Network |
$1,792.77
|
| Rate for Payer: Quartz Commercial |
$2,195.23
|
| Rate for Payer: WEA Trust Commercial |
$2,012.30
|
| Rate for Payer: WPS Commercial |
$2,709.92
|
|
|
NM Ureteral Reflux Study
|
Facility
|
OP
|
$1,433.00
|
|
|
Service Code
|
CPT 78740
|
| Hospital Charge Code |
631395
|
| Min. Negotiated Rate |
$420.71 |
| Max. Negotiated Rate |
$1,682.84 |
| Rate for Payer: Aetna Commercial |
$1,341.29
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,281.68
|
| Rate for Payer: Aetna Managed Medicare |
$420.71
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$968.71
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$745.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$715.35
|
| Rate for Payer: Anthem Medicare Advantage |
$420.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$789.87
|
| 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 |
$429.90
|
| Rate for Payer: Cash Price |
$429.90
|
| Rate for Payer: Cigna Commercial |
$1,371.09
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$420.71
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$834.01
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$420.71
|
| Rate for Payer: Health EOS Commercial |
$1,326.38
|
| Rate for Payer: HFN Commercial |
$1,371.09
|
| 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 |
$1,192.26
|
| Rate for Payer: NAPHCARE Commercial |
$631.07
|
| Rate for Payer: Preferred Network Access Commercial |
$1,371.09
|
| Rate for Payer: Quartz Beloit One Network |
$730.26
|
| Rate for Payer: Quartz Commercial |
$968.71
|
| Rate for Payer: Quartz Medicare Advantage |
$420.71
|
| Rate for Payer: The Alliance Commercial |
$1,682.84
|
| Rate for Payer: United Healthcare Medicare Advantage |
$420.71
|
| Rate for Payer: WEA Trust Commercial |
$819.68
|
| Rate for Payer: Wellcare Medicare |
$420.71
|
| Rate for Payer: WPS Commercial |
$1,103.84
|
|
|
NM Ureteral Reflux Study
|
Facility
|
IP
|
$1,490.00
|
|
|
Service Code
|
CPT 78740
|
| Hospital Charge Code |
2587003
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$759.30 |
| Max. Negotiated Rate |
$1,425.63 |
| Rate for Payer: Aetna Commercial |
$1,394.64
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,332.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$821.29
|
| Rate for Payer: Cash Price |
$447.00
|
| Rate for Payer: Cigna Commercial |
$1,425.63
|
| Rate for Payer: Health EOS Commercial |
$1,379.14
|
| Rate for Payer: HFN Commercial |
$1,425.63
|
| Rate for Payer: Multiplan Commercial |
$1,239.68
|
| Rate for Payer: Preferred Network Access Commercial |
$1,425.63
|
| Rate for Payer: Quartz Beloit One Network |
$759.30
|
| Rate for Payer: Quartz Commercial |
$929.76
|
| Rate for Payer: WEA Trust Commercial |
$852.28
|
| Rate for Payer: WPS Commercial |
$1,147.75
|
|
|
NM Ureteral Reflux Study
|
Facility
|
OP
|
$1,490.00
|
|
|
Service Code
|
CPT 78740
|
| Hospital Charge Code |
2587003
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$420.71 |
| Max. Negotiated Rate |
$2,396.16 |
| Rate for Payer: Aetna Commercial |
$1,394.64
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,332.66
|
| 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 |
$821.29
|
| 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 |
$447.00
|
| Rate for Payer: Cash Price |
$447.00
|
| Rate for Payer: Cash Price |
$447.00
|
| Rate for Payer: Cigna Commercial |
$1,425.63
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$420.71
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$867.18
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$420.71
|
| Rate for Payer: Health EOS Commercial |
$1,379.14
|
| Rate for Payer: HFN Commercial |
$1,425.63
|
| 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 |
$1,239.68
|
| Rate for Payer: NAPHCARE Commercial |
$631.07
|
| Rate for Payer: Preferred Network Access Commercial |
$1,425.63
|
| Rate for Payer: Quartz Beloit One Network |
$759.30
|
| Rate for Payer: Quartz Commercial |
$1,007.24
|
| 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 |
$852.28
|
| Rate for Payer: Wellcare Medicare |
$420.71
|
| Rate for Payer: WPS Commercial |
$1,147.75
|
|
|
NM Ureteral Reflux Study
|
Professional
|
Both
|
$1,433.00
|
|
|
Service Code
|
CPT 78740
|
| Hospital Charge Code |
631395
|
| Min. Negotiated Rate |
$219.43 |
| Max. Negotiated Rate |
$1,415.80 |
| Rate for Payer: Aetna Commercial |
$1,415.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,281.68
|
| Rate for Payer: Aetna Managed Medicare |
$219.43
|
| Rate for Payer: Anthem Medicare Advantage |
$219.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$219.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$219.43
|
| Rate for Payer: Cash Price |
$429.90
|
| Rate for Payer: Cash Price |
$429.90
|
| Rate for Payer: Cash Price |
$429.90
|
| Rate for Payer: Cigna Commercial |
$1,415.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$745.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$219.43
|
| Rate for Payer: Health EOS Commercial |
$1,356.19
|
| Rate for Payer: HFN Commercial |
$1,415.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$782.40
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$782.40
|
| Rate for Payer: Independent Care Health Plan Medicare |
$219.43
|
| Rate for Payer: Multiplan Commercial |
$1,192.26
|
| Rate for Payer: NAPHCARE Commercial |
$329.14
|
| Rate for Payer: Preferred Network Access Commercial |
$1,415.80
|
| Rate for Payer: Quartz Beloit One Network |
$655.74
|
| Rate for Payer: Quartz Commercial |
$849.48
|
| Rate for Payer: Quartz Medicare Advantage |
$219.43
|
| Rate for Payer: The Alliance Commercial |
$833.83
|
| Rate for Payer: United Healthcare Medicare Advantage |
$219.43
|
| Rate for Payer: WEA Trust Commercial |
$819.68
|
| Rate for Payer: WPS Commercial |
$1,097.15
|
|
|
NM Ureteral Reflux Study
|
Professional
|
Both
|
$1,490.00
|
|
|
Service Code
|
CPT 78740
|
| Hospital Charge Code |
2587003
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$219.43 |
| Max. Negotiated Rate |
$1,472.12 |
| Rate for Payer: Aetna Commercial |
$1,472.12
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,332.66
|
| Rate for Payer: Aetna Managed Medicare |
$219.43
|
| Rate for Payer: Anthem Medicare Advantage |
$219.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$219.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$219.43
|
| Rate for Payer: Cash Price |
$447.00
|
| Rate for Payer: Cash Price |
$447.00
|
| Rate for Payer: Cash Price |
$447.00
|
| Rate for Payer: Cigna Commercial |
$1,472.12
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$774.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$219.43
|
| Rate for Payer: Health EOS Commercial |
$1,410.14
|
| Rate for Payer: HFN Commercial |
$1,472.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$782.40
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$782.40
|
| Rate for Payer: Independent Care Health Plan Medicare |
$219.43
|
| Rate for Payer: Multiplan Commercial |
$1,239.68
|
| Rate for Payer: NAPHCARE Commercial |
$329.14
|
| Rate for Payer: Preferred Network Access Commercial |
$1,472.12
|
| Rate for Payer: Quartz Beloit One Network |
$681.82
|
| Rate for Payer: Quartz Commercial |
$883.27
|
| Rate for Payer: Quartz Medicare Advantage |
$219.43
|
| Rate for Payer: The Alliance Commercial |
$833.83
|
| Rate for Payer: United Healthcare Medicare Advantage |
$219.43
|
| Rate for Payer: WEA Trust Commercial |
$852.28
|
| Rate for Payer: WPS Commercial |
$1,097.15
|
|
|
NM Ureteral Reflux Study
|
Facility
|
IP
|
$1,433.00
|
|
|
Service Code
|
CPT 78740
|
| Hospital Charge Code |
631395
|
| Min. Negotiated Rate |
$730.26 |
| Max. Negotiated Rate |
$1,371.09 |
| Rate for Payer: Aetna Commercial |
$1,341.29
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,281.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$789.87
|
| Rate for Payer: Cash Price |
$429.90
|
| Rate for Payer: Cigna Commercial |
$1,371.09
|
| Rate for Payer: Health EOS Commercial |
$1,326.38
|
| Rate for Payer: HFN Commercial |
$1,371.09
|
| Rate for Payer: Multiplan Commercial |
$1,192.26
|
| Rate for Payer: Preferred Network Access Commercial |
$1,371.09
|
| Rate for Payer: Quartz Beloit One Network |
$730.26
|
| Rate for Payer: Quartz Commercial |
$894.19
|
| Rate for Payer: WEA Trust Commercial |
$819.68
|
| Rate for Payer: WPS Commercial |
$1,103.84
|
|
