|
NM Liver/Spleen Imaging
|
Facility
|
OP
|
$2,418.00
|
|
|
Service Code
|
CPT 78215
|
| Hospital Charge Code |
631331
|
| Min. Negotiated Rate |
$420.71 |
| Max. Negotiated Rate |
$2,313.54 |
| Rate for Payer: Aetna Commercial |
$2,263.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,162.66
|
| Rate for Payer: Aetna Managed Medicare |
$420.71
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,634.57
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,257.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,207.07
|
| Rate for Payer: Anthem Medicare Advantage |
$420.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,332.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$420.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$420.71
|
| Rate for Payer: Cash Price |
$725.40
|
| Rate for Payer: Cash Price |
$725.40
|
| Rate for Payer: Cigna Commercial |
$2,313.54
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$420.71
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,407.28
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$420.71
|
| Rate for Payer: Health EOS Commercial |
$2,238.10
|
| Rate for Payer: HFN Commercial |
$2,313.54
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,565.05
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$420.71
|
| Rate for Payer: Independent Care Health Plan Medicare |
$420.71
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$420.71
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$420.71
|
| Rate for Payer: Multiplan Commercial |
$2,011.78
|
| Rate for Payer: NAPHCARE Commercial |
$631.07
|
| Rate for Payer: Preferred Network Access Commercial |
$2,313.54
|
| Rate for Payer: Quartz Beloit One Network |
$1,232.21
|
| Rate for Payer: Quartz Commercial |
$1,634.57
|
| Rate for Payer: Quartz Medicare Advantage |
$420.71
|
| Rate for Payer: The Alliance Commercial |
$1,682.84
|
| Rate for Payer: United Healthcare Medicare Advantage |
$420.71
|
| Rate for Payer: WEA Trust Commercial |
$1,383.10
|
| Rate for Payer: Wellcare Medicare |
$420.71
|
| Rate for Payer: WPS Commercial |
$1,862.59
|
|
|
NM Liver/Spleen Imaging w/ Vascular Flow
|
Professional
|
Both
|
$2,936.00
|
|
|
Service Code
|
CPT 78216
|
| Hospital Charge Code |
2586905
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$130.69 |
| Max. Negotiated Rate |
$2,900.77 |
| Rate for Payer: Aetna Commercial |
$2,900.77
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,625.96
|
| Rate for Payer: Aetna Managed Medicare |
$130.69
|
| Rate for Payer: Anthem Medicare Advantage |
$130.69
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$130.69
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$130.69
|
| Rate for Payer: Cash Price |
$880.80
|
| Rate for Payer: Cash Price |
$880.80
|
| Rate for Payer: Cash Price |
$880.80
|
| Rate for Payer: Cigna Commercial |
$2,900.77
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,526.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$130.69
|
| Rate for Payer: Health EOS Commercial |
$2,778.63
|
| Rate for Payer: HFN Commercial |
$2,900.77
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$457.80
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$457.80
|
| Rate for Payer: Independent Care Health Plan Medicare |
$130.69
|
| Rate for Payer: Multiplan Commercial |
$2,442.75
|
| Rate for Payer: NAPHCARE Commercial |
$196.03
|
| Rate for Payer: Preferred Network Access Commercial |
$2,900.77
|
| Rate for Payer: Quartz Beloit One Network |
$1,343.51
|
| Rate for Payer: Quartz Commercial |
$1,740.46
|
| Rate for Payer: Quartz Medicare Advantage |
$130.69
|
| Rate for Payer: The Alliance Commercial |
$496.61
|
| Rate for Payer: United Healthcare Medicare Advantage |
$130.69
|
| Rate for Payer: WEA Trust Commercial |
$1,679.39
|
| Rate for Payer: WPS Commercial |
$653.43
|
|
|
NM Liver/Spleen Imaging w/ Vascular Flow
|
Facility
|
IP
|
$2,936.00
|
|
|
Service Code
|
CPT 78216
|
| Hospital Charge Code |
2586905
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,496.19 |
| Max. Negotiated Rate |
$2,809.16 |
| Rate for Payer: Aetna Commercial |
$2,748.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,625.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,618.32
|
| Rate for Payer: Cash Price |
$880.80
|
| Rate for Payer: Cigna Commercial |
$2,809.16
|
| Rate for Payer: Health EOS Commercial |
$2,717.56
|
| Rate for Payer: HFN Commercial |
$2,809.16
|
| Rate for Payer: Multiplan Commercial |
$2,442.75
|
| Rate for Payer: Preferred Network Access Commercial |
$2,809.16
|
| Rate for Payer: Quartz Beloit One Network |
$1,496.19
|
| Rate for Payer: Quartz Commercial |
$1,832.06
|
| Rate for Payer: WEA Trust Commercial |
$1,679.39
|
| Rate for Payer: WPS Commercial |
$2,261.60
|
|
|
NM Liver/Spleen Imaging w/ Vascular Flow
|
Facility
|
OP
|
$2,936.00
|
|
|
Service Code
|
CPT 78216
|
| Hospital Charge Code |
2586905
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$420.71 |
| Max. Negotiated Rate |
$2,809.16 |
| Rate for Payer: Aetna Commercial |
$2,748.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,625.96
|
| Rate for Payer: Aetna Managed Medicare |
$420.71
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,589.87
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,271.90
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,208.30
|
| Rate for Payer: Anthem Medicare Advantage |
$420.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,618.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$420.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$420.71
|
| Rate for Payer: Cash Price |
$880.80
|
| Rate for Payer: Cash Price |
$880.80
|
| Rate for Payer: Cash Price |
$880.80
|
| Rate for Payer: Cigna Commercial |
$2,809.16
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$420.71
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,708.75
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$420.71
|
| Rate for Payer: Health EOS Commercial |
$2,717.56
|
| Rate for Payer: HFN Commercial |
$2,809.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,565.05
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$420.71
|
| Rate for Payer: Independent Care Health Plan Medicare |
$420.71
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$420.71
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$420.71
|
| Rate for Payer: Multiplan Commercial |
$2,442.75
|
| Rate for Payer: NAPHCARE Commercial |
$631.07
|
| Rate for Payer: Preferred Network Access Commercial |
$2,809.16
|
| Rate for Payer: Quartz Beloit One Network |
$1,496.19
|
| Rate for Payer: Quartz Commercial |
$1,984.74
|
| Rate for Payer: Quartz Medicare Advantage |
$420.71
|
| Rate for Payer: The Alliance Commercial |
$1,682.84
|
| Rate for Payer: United Healthcare Medicare Advantage |
$420.71
|
| Rate for Payer: United Healthcare PPO |
$2,396.16
|
| Rate for Payer: WEA Trust Commercial |
$1,679.39
|
| Rate for Payer: Wellcare Medicare |
$420.71
|
| Rate for Payer: WPS Commercial |
$2,261.60
|
|
|
NM Lymphoscintigraphy
|
Facility
|
IP
|
$1,658.00
|
|
|
Service Code
|
CPT 78195
|
| Hospital Charge Code |
631350
|
| Min. Negotiated Rate |
$844.92 |
| Max. Negotiated Rate |
$1,586.37 |
| Rate for Payer: Aetna Commercial |
$1,551.89
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,482.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$913.89
|
| Rate for Payer: Cash Price |
$497.40
|
| Rate for Payer: Cigna Commercial |
$1,586.37
|
| Rate for Payer: Health EOS Commercial |
$1,534.64
|
| Rate for Payer: HFN Commercial |
$1,586.37
|
| Rate for Payer: Multiplan Commercial |
$1,379.46
|
| Rate for Payer: Preferred Network Access Commercial |
$1,586.37
|
| Rate for Payer: Quartz Beloit One Network |
$844.92
|
| Rate for Payer: Quartz Commercial |
$1,034.59
|
| Rate for Payer: WEA Trust Commercial |
$948.38
|
| Rate for Payer: WPS Commercial |
$1,277.16
|
|
|
NM Lymphoscintigraphy
|
Facility
|
OP
|
$2,156.00
|
|
|
Service Code
|
CPT 78195
|
| Hospital Charge Code |
2586909
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$571.42 |
| Max. Negotiated Rate |
$2,396.16 |
| Rate for Payer: Aetna Commercial |
$2,018.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,928.33
|
| Rate for Payer: Aetna Managed Medicare |
$571.42
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,083.54
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,666.83
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,583.49
|
| Rate for Payer: Anthem Medicare Advantage |
$571.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,188.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$571.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$571.42
|
| Rate for Payer: Cash Price |
$646.80
|
| Rate for Payer: Cash Price |
$646.80
|
| Rate for Payer: Cash Price |
$646.80
|
| Rate for Payer: Cigna Commercial |
$2,062.86
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$571.42
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,254.79
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$571.42
|
| Rate for Payer: Health EOS Commercial |
$1,995.59
|
| Rate for Payer: HFN Commercial |
$2,062.86
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,125.67
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$571.42
|
| Rate for Payer: Independent Care Health Plan Medicare |
$571.42
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$571.42
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$571.42
|
| Rate for Payer: Multiplan Commercial |
$1,793.79
|
| Rate for Payer: NAPHCARE Commercial |
$857.13
|
| Rate for Payer: Preferred Network Access Commercial |
$2,062.86
|
| Rate for Payer: Quartz Beloit One Network |
$1,098.70
|
| Rate for Payer: Quartz Commercial |
$1,457.46
|
| Rate for Payer: Quartz Medicare Advantage |
$571.42
|
| Rate for Payer: The Alliance Commercial |
$2,285.67
|
| Rate for Payer: United Healthcare Medicare Advantage |
$571.42
|
| Rate for Payer: United Healthcare PPO |
$2,396.16
|
| Rate for Payer: WEA Trust Commercial |
$1,233.23
|
| Rate for Payer: Wellcare Medicare |
$571.42
|
| Rate for Payer: WPS Commercial |
$1,660.77
|
|
|
NM Lymphoscintigraphy
|
Professional
|
Both
|
$2,156.00
|
|
|
Service Code
|
CPT 78195
|
| Hospital Charge Code |
2586909
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$309.71 |
| Max. Negotiated Rate |
$2,130.13 |
| Rate for Payer: Aetna Commercial |
$2,130.13
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,928.33
|
| Rate for Payer: Aetna Managed Medicare |
$309.71
|
| Rate for Payer: Anthem Medicare Advantage |
$309.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$309.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$309.71
|
| Rate for Payer: Cash Price |
$646.80
|
| Rate for Payer: Cash Price |
$646.80
|
| Rate for Payer: Cash Price |
$646.80
|
| Rate for Payer: Cigna Commercial |
$2,130.13
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,121.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$309.71
|
| Rate for Payer: Health EOS Commercial |
$2,040.44
|
| Rate for Payer: HFN Commercial |
$2,130.13
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,258.02
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,258.02
|
| Rate for Payer: Independent Care Health Plan Medicare |
$309.71
|
| Rate for Payer: Multiplan Commercial |
$1,793.79
|
| Rate for Payer: NAPHCARE Commercial |
$464.57
|
| Rate for Payer: Preferred Network Access Commercial |
$2,130.13
|
| Rate for Payer: Quartz Beloit One Network |
$986.59
|
| Rate for Payer: Quartz Commercial |
$1,278.08
|
| Rate for Payer: Quartz Medicare Advantage |
$309.71
|
| Rate for Payer: The Alliance Commercial |
$1,176.91
|
| Rate for Payer: United Healthcare Medicare Advantage |
$309.71
|
| Rate for Payer: WEA Trust Commercial |
$1,233.23
|
| Rate for Payer: WPS Commercial |
$1,548.56
|
|
|
NM Lymphoscintigraphy
|
Professional
|
Both
|
$1,658.00
|
|
|
Service Code
|
CPT 78195
|
| Hospital Charge Code |
631350
|
| Min. Negotiated Rate |
$309.71 |
| Max. Negotiated Rate |
$1,638.10 |
| Rate for Payer: Aetna Commercial |
$1,638.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,482.92
|
| Rate for Payer: Aetna Managed Medicare |
$309.71
|
| Rate for Payer: Anthem Medicare Advantage |
$309.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$309.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$309.71
|
| Rate for Payer: Cash Price |
$497.40
|
| Rate for Payer: Cash Price |
$497.40
|
| Rate for Payer: Cash Price |
$497.40
|
| Rate for Payer: Cigna Commercial |
$1,638.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$862.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$309.71
|
| Rate for Payer: Health EOS Commercial |
$1,569.13
|
| Rate for Payer: HFN Commercial |
$1,638.10
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,258.02
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,258.02
|
| Rate for Payer: Independent Care Health Plan Medicare |
$309.71
|
| Rate for Payer: Multiplan Commercial |
$1,379.46
|
| Rate for Payer: NAPHCARE Commercial |
$464.57
|
| Rate for Payer: Preferred Network Access Commercial |
$1,638.10
|
| Rate for Payer: Quartz Beloit One Network |
$758.70
|
| Rate for Payer: Quartz Commercial |
$982.86
|
| Rate for Payer: Quartz Medicare Advantage |
$309.71
|
| Rate for Payer: The Alliance Commercial |
$1,176.91
|
| Rate for Payer: United Healthcare Medicare Advantage |
$309.71
|
| Rate for Payer: WEA Trust Commercial |
$948.38
|
| Rate for Payer: WPS Commercial |
$1,548.56
|
|
|
NM Lymphoscintigraphy
|
Facility
|
OP
|
$1,658.00
|
|
|
Service Code
|
CPT 78195
|
| Hospital Charge Code |
631350
|
| Min. Negotiated Rate |
$571.42 |
| Max. Negotiated Rate |
$2,285.67 |
| Rate for Payer: Aetna Commercial |
$1,551.89
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,482.92
|
| Rate for Payer: Aetna Managed Medicare |
$571.42
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,120.81
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$862.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$827.67
|
| Rate for Payer: Anthem Medicare Advantage |
$571.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$913.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$571.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$571.42
|
| Rate for Payer: Cash Price |
$497.40
|
| Rate for Payer: Cash Price |
$497.40
|
| Rate for Payer: Cigna Commercial |
$1,586.37
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$571.42
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$964.96
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$571.42
|
| Rate for Payer: Health EOS Commercial |
$1,534.64
|
| Rate for Payer: HFN Commercial |
$1,586.37
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,125.67
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$571.42
|
| Rate for Payer: Independent Care Health Plan Medicare |
$571.42
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$571.42
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$571.42
|
| Rate for Payer: Multiplan Commercial |
$1,379.46
|
| Rate for Payer: NAPHCARE Commercial |
$857.13
|
| Rate for Payer: Preferred Network Access Commercial |
$1,586.37
|
| Rate for Payer: Quartz Beloit One Network |
$844.92
|
| Rate for Payer: Quartz Commercial |
$1,120.81
|
| Rate for Payer: Quartz Medicare Advantage |
$571.42
|
| Rate for Payer: The Alliance Commercial |
$2,285.67
|
| Rate for Payer: United Healthcare Medicare Advantage |
$571.42
|
| Rate for Payer: WEA Trust Commercial |
$948.38
|
| Rate for Payer: Wellcare Medicare |
$571.42
|
| Rate for Payer: WPS Commercial |
$1,277.16
|
|
|
NM Lymphoscintigraphy
|
Facility
|
IP
|
$2,156.00
|
|
|
Service Code
|
CPT 78195
|
| Hospital Charge Code |
2586909
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,098.70 |
| Max. Negotiated Rate |
$2,062.86 |
| Rate for Payer: Aetna Commercial |
$2,018.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,928.33
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,188.39
|
| Rate for Payer: Cash Price |
$646.80
|
| Rate for Payer: Cigna Commercial |
$2,062.86
|
| Rate for Payer: Health EOS Commercial |
$1,995.59
|
| Rate for Payer: HFN Commercial |
$2,062.86
|
| Rate for Payer: Multiplan Commercial |
$1,793.79
|
| Rate for Payer: Preferred Network Access Commercial |
$2,062.86
|
| Rate for Payer: Quartz Beloit One Network |
$1,098.70
|
| Rate for Payer: Quartz Commercial |
$1,345.34
|
| Rate for Payer: WEA Trust Commercial |
$1,233.23
|
| Rate for Payer: WPS Commercial |
$1,660.77
|
|
|
NM Metastatic Thyroid Oral Therapy
|
Professional
|
Both
|
$2,108.00
|
|
|
Service Code
|
CPT 79005
|
| Hospital Charge Code |
2580816
|
| Min. Negotiated Rate |
$132.32 |
| Max. Negotiated Rate |
$2,082.70 |
| Rate for Payer: Aetna Commercial |
$2,082.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,885.40
|
| Rate for Payer: Aetna Managed Medicare |
$132.32
|
| Rate for Payer: Anthem Medicare Advantage |
$132.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$132.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$132.32
|
| Rate for Payer: Cash Price |
$632.40
|
| Rate for Payer: Cash Price |
$632.40
|
| Rate for Payer: Cash Price |
$632.40
|
| Rate for Payer: Cigna Commercial |
$2,082.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,096.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$132.32
|
| Rate for Payer: Health EOS Commercial |
$1,995.01
|
| Rate for Payer: HFN Commercial |
$2,082.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$487.02
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$487.02
|
| Rate for Payer: Independent Care Health Plan Medicare |
$132.32
|
| Rate for Payer: Multiplan Commercial |
$1,753.86
|
| Rate for Payer: NAPHCARE Commercial |
$198.48
|
| Rate for Payer: Preferred Network Access Commercial |
$2,082.70
|
| Rate for Payer: Quartz Beloit One Network |
$964.62
|
| Rate for Payer: Quartz Commercial |
$1,249.62
|
| Rate for Payer: Quartz Medicare Advantage |
$132.32
|
| Rate for Payer: The Alliance Commercial |
$502.81
|
| Rate for Payer: United Healthcare Medicare Advantage |
$132.32
|
| Rate for Payer: WEA Trust Commercial |
$1,205.78
|
| Rate for Payer: WPS Commercial |
$661.60
|
|
|
NM Metastatic Thyroid Oral Therapy
|
Professional
|
Both
|
$2,192.00
|
|
|
Service Code
|
CPT 79005
|
| Hospital Charge Code |
2586911
|
|
Hospital Revenue Code
|
342
|
| Min. Negotiated Rate |
$132.32 |
| Max. Negotiated Rate |
$2,165.70 |
| Rate for Payer: Aetna Commercial |
$2,165.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,960.52
|
| Rate for Payer: Aetna Managed Medicare |
$132.32
|
| Rate for Payer: Anthem Medicare Advantage |
$132.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$132.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$132.32
|
| Rate for Payer: Cash Price |
$657.60
|
| Rate for Payer: Cash Price |
$657.60
|
| Rate for Payer: Cash Price |
$657.60
|
| Rate for Payer: Cigna Commercial |
$2,165.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,139.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$132.32
|
| Rate for Payer: Health EOS Commercial |
$2,074.51
|
| Rate for Payer: HFN Commercial |
$2,165.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$487.02
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$487.02
|
| Rate for Payer: Independent Care Health Plan Medicare |
$132.32
|
| Rate for Payer: Multiplan Commercial |
$1,823.74
|
| Rate for Payer: NAPHCARE Commercial |
$198.48
|
| Rate for Payer: Preferred Network Access Commercial |
$2,165.70
|
| Rate for Payer: Quartz Beloit One Network |
$1,003.06
|
| Rate for Payer: Quartz Commercial |
$1,299.42
|
| Rate for Payer: Quartz Medicare Advantage |
$132.32
|
| Rate for Payer: The Alliance Commercial |
$502.81
|
| Rate for Payer: United Healthcare Medicare Advantage |
$132.32
|
| Rate for Payer: WEA Trust Commercial |
$1,253.82
|
| Rate for Payer: WPS Commercial |
$661.60
|
|
|
NM Metastatic Thyroid Oral Therapy
|
Facility
|
OP
|
$2,192.00
|
|
|
Service Code
|
CPT 79005
|
| Hospital Charge Code |
2586911
|
|
Hospital Revenue Code
|
342
|
| Min. Negotiated Rate |
$245.56 |
| Max. Negotiated Rate |
$2,396.16 |
| Rate for Payer: Aetna Commercial |
$2,051.71
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,960.52
|
| Rate for Payer: Aetna Managed Medicare |
$245.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$959.01
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$767.21
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$728.85
|
| Rate for Payer: Anthem Medicare Advantage |
$245.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,208.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$245.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$245.56
|
| Rate for Payer: Cash Price |
$657.60
|
| Rate for Payer: Cash Price |
$657.60
|
| Rate for Payer: Cash Price |
$657.60
|
| Rate for Payer: Cigna Commercial |
$2,097.31
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$245.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,275.74
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$245.56
|
| Rate for Payer: Health EOS Commercial |
$2,028.92
|
| Rate for Payer: HFN Commercial |
$2,097.31
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$913.50
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$245.56
|
| Rate for Payer: Independent Care Health Plan Medicare |
$245.56
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$245.56
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$245.56
|
| Rate for Payer: Multiplan Commercial |
$1,823.74
|
| Rate for Payer: NAPHCARE Commercial |
$368.35
|
| Rate for Payer: Preferred Network Access Commercial |
$2,097.31
|
| Rate for Payer: Quartz Beloit One Network |
$1,117.04
|
| Rate for Payer: Quartz Commercial |
$1,481.79
|
| Rate for Payer: Quartz Medicare Advantage |
$245.56
|
| Rate for Payer: The Alliance Commercial |
$982.26
|
| Rate for Payer: United Healthcare Medicare Advantage |
$245.56
|
| Rate for Payer: United Healthcare PPO |
$2,396.16
|
| Rate for Payer: WEA Trust Commercial |
$1,253.82
|
| Rate for Payer: Wellcare Medicare |
$245.56
|
| Rate for Payer: WPS Commercial |
$1,688.50
|
|
|
NM Metastatic Thyroid Oral Therapy
|
Facility
|
IP
|
$2,192.00
|
|
|
Service Code
|
CPT 79005
|
| Hospital Charge Code |
2586911
|
|
Hospital Revenue Code
|
342
|
| Min. Negotiated Rate |
$1,117.04 |
| Max. Negotiated Rate |
$2,097.31 |
| Rate for Payer: Aetna Commercial |
$2,051.71
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,960.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,208.23
|
| Rate for Payer: Cash Price |
$657.60
|
| Rate for Payer: Cigna Commercial |
$2,097.31
|
| Rate for Payer: Health EOS Commercial |
$2,028.92
|
| Rate for Payer: HFN Commercial |
$2,097.31
|
| Rate for Payer: Multiplan Commercial |
$1,823.74
|
| Rate for Payer: Preferred Network Access Commercial |
$2,097.31
|
| Rate for Payer: Quartz Beloit One Network |
$1,117.04
|
| Rate for Payer: Quartz Commercial |
$1,367.81
|
| Rate for Payer: WEA Trust Commercial |
$1,253.82
|
| Rate for Payer: WPS Commercial |
$1,688.50
|
|
|
NM Metastatic Thyroid Oral Therapy
|
Facility
|
IP
|
$2,108.00
|
|
|
Service Code
|
CPT 79005
|
| Hospital Charge Code |
2580816
|
| Min. Negotiated Rate |
$1,074.24 |
| Max. Negotiated Rate |
$2,016.93 |
| Rate for Payer: Aetna Commercial |
$1,973.09
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,885.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,161.93
|
| Rate for Payer: Cash Price |
$632.40
|
| Rate for Payer: Cigna Commercial |
$2,016.93
|
| Rate for Payer: Health EOS Commercial |
$1,951.16
|
| Rate for Payer: HFN Commercial |
$2,016.93
|
| Rate for Payer: Multiplan Commercial |
$1,753.86
|
| Rate for Payer: Preferred Network Access Commercial |
$2,016.93
|
| Rate for Payer: Quartz Beloit One Network |
$1,074.24
|
| Rate for Payer: Quartz Commercial |
$1,315.39
|
| Rate for Payer: WEA Trust Commercial |
$1,205.78
|
| Rate for Payer: WPS Commercial |
$1,623.79
|
|
|
NM Metastatic Thyroid Oral Therapy
|
Facility
|
OP
|
$2,108.00
|
|
|
Service Code
|
CPT 79005
|
| Hospital Charge Code |
2580816
|
| Min. Negotiated Rate |
$245.56 |
| Max. Negotiated Rate |
$2,016.93 |
| Rate for Payer: Aetna Commercial |
$1,973.09
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,885.40
|
| Rate for Payer: Aetna Managed Medicare |
$245.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,425.01
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,096.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,052.31
|
| Rate for Payer: Anthem Medicare Advantage |
$245.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,161.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$245.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$245.56
|
| Rate for Payer: Cash Price |
$632.40
|
| Rate for Payer: Cash Price |
$632.40
|
| Rate for Payer: Cigna Commercial |
$2,016.93
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$245.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,226.86
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$245.56
|
| Rate for Payer: Health EOS Commercial |
$1,951.16
|
| Rate for Payer: HFN Commercial |
$2,016.93
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$913.50
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$245.56
|
| Rate for Payer: Independent Care Health Plan Medicare |
$245.56
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$245.56
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$245.56
|
| Rate for Payer: Multiplan Commercial |
$1,753.86
|
| Rate for Payer: NAPHCARE Commercial |
$368.35
|
| Rate for Payer: Preferred Network Access Commercial |
$2,016.93
|
| Rate for Payer: Quartz Beloit One Network |
$1,074.24
|
| Rate for Payer: Quartz Commercial |
$1,425.01
|
| Rate for Payer: Quartz Medicare Advantage |
$245.56
|
| Rate for Payer: The Alliance Commercial |
$982.26
|
| Rate for Payer: United Healthcare Medicare Advantage |
$245.56
|
| Rate for Payer: WEA Trust Commercial |
$1,205.78
|
| Rate for Payer: Wellcare Medicare |
$245.56
|
| Rate for Payer: WPS Commercial |
$1,623.79
|
|
|
NM Parathyroid Study
|
Professional
|
Both
|
$1,115.00
|
|
|
Service Code
|
CPT 78071
|
| Hospital Charge Code |
2586936
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$307.72 |
| Max. Negotiated Rate |
$1,538.58 |
| Rate for Payer: Aetna Commercial |
$1,101.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$997.26
|
| Rate for Payer: Aetna Managed Medicare |
$307.72
|
| Rate for Payer: Anthem Medicare Advantage |
$307.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$307.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$307.72
|
| Rate for Payer: Cash Price |
$334.50
|
| Rate for Payer: Cash Price |
$334.50
|
| Rate for Payer: Cash Price |
$334.50
|
| Rate for Payer: Cigna Commercial |
$1,101.62
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$579.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$307.72
|
| Rate for Payer: Health EOS Commercial |
$1,055.24
|
| Rate for Payer: HFN Commercial |
$1,101.62
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,250.78
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,250.78
|
| Rate for Payer: Independent Care Health Plan Medicare |
$307.72
|
| Rate for Payer: Multiplan Commercial |
$927.68
|
| Rate for Payer: NAPHCARE Commercial |
$461.57
|
| Rate for Payer: Preferred Network Access Commercial |
$1,101.62
|
| Rate for Payer: Quartz Beloit One Network |
$510.22
|
| Rate for Payer: Quartz Commercial |
$660.97
|
| Rate for Payer: Quartz Medicare Advantage |
$307.72
|
| Rate for Payer: The Alliance Commercial |
$1,169.32
|
| Rate for Payer: United Healthcare Medicare Advantage |
$307.72
|
| Rate for Payer: WEA Trust Commercial |
$637.78
|
| Rate for Payer: WPS Commercial |
$1,538.58
|
|
|
NM Parathyroid Study
|
Facility
|
OP
|
$857.00
|
|
|
Service Code
|
CPT 78070
|
| Hospital Charge Code |
631473
|
| Min. Negotiated Rate |
$420.71 |
| Max. Negotiated Rate |
$1,682.84 |
| Rate for Payer: Aetna Commercial |
$802.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$766.50
|
| Rate for Payer: Aetna Managed Medicare |
$420.71
|
| 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: Anthem Medicare Advantage |
$420.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$472.38
|
| 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 |
$257.10
|
| Rate for Payer: Cash Price |
$257.10
|
| Rate for Payer: Cigna Commercial |
$819.98
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$420.71
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$498.77
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$420.71
|
| Rate for Payer: Health EOS Commercial |
$793.24
|
| Rate for Payer: HFN Commercial |
$819.98
|
| 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 |
$713.02
|
| Rate for Payer: NAPHCARE Commercial |
$631.07
|
| 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 |
$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 |
$490.20
|
| Rate for Payer: Wellcare Medicare |
$420.71
|
| Rate for Payer: WPS Commercial |
$660.15
|
|
|
NM Parathyroid Study
|
Facility
|
IP
|
$857.00
|
|
|
Service Code
|
CPT 78070
|
| Hospital Charge Code |
631473
|
| 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 Parathyroid Study
|
Professional
|
Both
|
$857.00
|
|
|
Service Code
|
CPT 78070
|
| Hospital Charge Code |
631473
|
| Min. Negotiated Rate |
$259.23 |
| Max. Negotiated Rate |
$1,296.15 |
| Rate for Payer: Aetna Commercial |
$846.72
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$766.50
|
| Rate for Payer: Aetna Managed Medicare |
$259.23
|
| Rate for Payer: Anthem Medicare Advantage |
$259.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$259.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$259.23
|
| Rate for Payer: Cash Price |
$257.10
|
| Rate for Payer: Cash Price |
$257.10
|
| 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 |
$259.23
|
| Rate for Payer: Health EOS Commercial |
$811.06
|
| Rate for Payer: HFN Commercial |
$846.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,046.73
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,046.73
|
| Rate for Payer: Independent Care Health Plan Medicare |
$259.23
|
| Rate for Payer: Multiplan Commercial |
$713.02
|
| Rate for Payer: NAPHCARE Commercial |
$388.85
|
| 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: Quartz Medicare Advantage |
$259.23
|
| Rate for Payer: The Alliance Commercial |
$985.08
|
| Rate for Payer: United Healthcare Medicare Advantage |
$259.23
|
| Rate for Payer: WEA Trust Commercial |
$490.20
|
| Rate for Payer: WPS Commercial |
$1,296.15
|
|
|
NM Parathyroid Study
|
Facility
|
IP
|
$1,115.00
|
|
|
Service Code
|
CPT 78071
|
| Hospital Charge Code |
2586936
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$568.20 |
| Max. Negotiated Rate |
$1,066.83 |
| Rate for Payer: Aetna Commercial |
$1,043.64
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$997.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$614.59
|
| Rate for Payer: Cash Price |
$334.50
|
| Rate for Payer: Cigna Commercial |
$1,066.83
|
| Rate for Payer: Health EOS Commercial |
$1,032.04
|
| Rate for Payer: HFN Commercial |
$1,066.83
|
| Rate for Payer: Multiplan Commercial |
$927.68
|
| Rate for Payer: Preferred Network Access Commercial |
$1,066.83
|
| Rate for Payer: Quartz Beloit One Network |
$568.20
|
| Rate for Payer: Quartz Commercial |
$695.76
|
| Rate for Payer: WEA Trust Commercial |
$637.78
|
| Rate for Payer: WPS Commercial |
$858.88
|
|
|
NM Parathyroid Study
|
Facility
|
OP
|
$1,115.00
|
|
|
Service Code
|
CPT 78071
|
| Hospital Charge Code |
2586936
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$420.71 |
| Max. Negotiated Rate |
$2,396.16 |
| Rate for Payer: Aetna Commercial |
$1,043.64
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$997.26
|
| 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 |
$614.59
|
| 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 |
$334.50
|
| Rate for Payer: Cash Price |
$334.50
|
| Rate for Payer: Cash Price |
$334.50
|
| Rate for Payer: Cigna Commercial |
$1,066.83
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$420.71
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$648.93
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$420.71
|
| Rate for Payer: Health EOS Commercial |
$1,032.04
|
| Rate for Payer: HFN Commercial |
$1,066.83
|
| 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 |
$927.68
|
| Rate for Payer: NAPHCARE Commercial |
$631.07
|
| Rate for Payer: Preferred Network Access Commercial |
$1,066.83
|
| Rate for Payer: Quartz Beloit One Network |
$568.20
|
| Rate for Payer: Quartz Commercial |
$753.74
|
| Rate for Payer: Quartz Medicare Advantage |
$420.71
|
| Rate for Payer: The Alliance Commercial |
$1,682.84
|
| Rate for Payer: United Healthcare Medicare Advantage |
$420.71
|
| Rate for Payer: United Healthcare PPO |
$2,396.16
|
| Rate for Payer: WEA Trust Commercial |
$637.78
|
| Rate for Payer: Wellcare Medicare |
$420.71
|
| Rate for Payer: WPS Commercial |
$858.88
|
|
|
NM Pulmonary Perfusion Imaging
|
Facility
|
OP
|
$2,009.00
|
|
|
Service Code
|
CPT 78580
|
| Hospital Charge Code |
2586943
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$420.71 |
| Max. Negotiated Rate |
$2,396.16 |
| Rate for Payer: Aetna Commercial |
$1,880.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,796.85
|
| 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 |
$1,107.36
|
| 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 |
$602.70
|
| Rate for Payer: Cash Price |
$602.70
|
| Rate for Payer: Cash Price |
$602.70
|
| Rate for Payer: Cigna Commercial |
$1,922.21
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$420.71
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,169.24
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$420.71
|
| Rate for Payer: Health EOS Commercial |
$1,859.53
|
| Rate for Payer: HFN Commercial |
$1,922.21
|
| 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 |
$1,671.49
|
| Rate for Payer: NAPHCARE Commercial |
$631.07
|
| Rate for Payer: Preferred Network Access Commercial |
$1,922.21
|
| Rate for Payer: Quartz Beloit One Network |
$1,023.79
|
| Rate for Payer: Quartz Commercial |
$1,358.08
|
| 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 |
$1,149.15
|
| Rate for Payer: Wellcare Medicare |
$420.71
|
| Rate for Payer: WPS Commercial |
$1,547.53
|
|
|
NM Pulmonary Perfusion Imaging
|
Professional
|
Both
|
$1,862.00
|
|
|
Service Code
|
CPT 78580
|
| Hospital Charge Code |
631505
|
| Min. Negotiated Rate |
$207.90 |
| Max. Negotiated Rate |
$1,839.66 |
| Rate for Payer: Aetna Commercial |
$1,839.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,665.37
|
| Rate for Payer: Aetna Managed Medicare |
$207.90
|
| Rate for Payer: Anthem Medicare Advantage |
$207.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$207.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$207.90
|
| Rate for Payer: Cash Price |
$558.60
|
| Rate for Payer: Cash Price |
$558.60
|
| Rate for Payer: Cash Price |
$558.60
|
| Rate for Payer: Cigna Commercial |
$1,839.66
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$968.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$207.90
|
| Rate for Payer: Health EOS Commercial |
$1,762.20
|
| Rate for Payer: HFN Commercial |
$1,839.66
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$838.72
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$838.72
|
| Rate for Payer: Independent Care Health Plan Medicare |
$207.90
|
| Rate for Payer: Multiplan Commercial |
$1,549.18
|
| Rate for Payer: NAPHCARE Commercial |
$311.84
|
| Rate for Payer: Preferred Network Access Commercial |
$1,839.66
|
| Rate for Payer: Quartz Beloit One Network |
$852.05
|
| Rate for Payer: Quartz Commercial |
$1,103.79
|
| Rate for Payer: Quartz Medicare Advantage |
$207.90
|
| Rate for Payer: The Alliance Commercial |
$790.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$207.90
|
| Rate for Payer: WEA Trust Commercial |
$1,065.06
|
| Rate for Payer: WPS Commercial |
$1,039.48
|
|
|
NM Pulmonary Perfusion Imaging
|
Facility
|
IP
|
$1,862.00
|
|
|
Service Code
|
CPT 78580
|
| Hospital Charge Code |
631505
|
| Min. Negotiated Rate |
$948.88 |
| Max. Negotiated Rate |
$1,781.56 |
| Rate for Payer: Aetna Commercial |
$1,742.83
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,665.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,026.33
|
| Rate for Payer: Cash Price |
$558.60
|
| Rate for Payer: Cigna Commercial |
$1,781.56
|
| Rate for Payer: Health EOS Commercial |
$1,723.47
|
| Rate for Payer: HFN Commercial |
$1,781.56
|
| Rate for Payer: Multiplan Commercial |
$1,549.18
|
| Rate for Payer: Preferred Network Access Commercial |
$1,781.56
|
| Rate for Payer: Quartz Beloit One Network |
$948.88
|
| Rate for Payer: Quartz Commercial |
$1,161.89
|
| Rate for Payer: WEA Trust Commercial |
$1,065.06
|
| Rate for Payer: WPS Commercial |
$1,434.30
|
|
