|
N-Telopeptide Cross Links Urine
|
Facility
|
OP
|
$240.00
|
|
|
Service Code
|
CPT 82523
|
| Hospital Charge Code |
978025
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$19.43 |
| Max. Negotiated Rate |
$229.63 |
| Rate for Payer: Aetna Commercial |
$224.64
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$214.66
|
| Rate for Payer: Aetna Managed Medicare |
$19.43
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$72.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$34.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$32.25
|
| Rate for Payer: Anthem Medicare Advantage |
$19.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$132.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$19.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$19.43
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Cigna Commercial |
$229.63
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$19.43
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$139.68
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$19.43
|
| Rate for Payer: Health EOS Commercial |
$222.14
|
| Rate for Payer: HFN Commercial |
$229.63
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$72.27
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$19.43
|
| Rate for Payer: Independent Care Health Plan Medicare |
$19.43
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$19.43
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$19.43
|
| Rate for Payer: Multiplan Commercial |
$199.68
|
| Rate for Payer: NAPHCARE Commercial |
$29.14
|
| Rate for Payer: Preferred Network Access Commercial |
$229.63
|
| Rate for Payer: Quartz Beloit One Network |
$122.30
|
| Rate for Payer: Quartz Commercial |
$162.24
|
| Rate for Payer: Quartz Medicare Advantage |
$19.43
|
| Rate for Payer: The Alliance Commercial |
$77.71
|
| Rate for Payer: United Healthcare Medicare Advantage |
$19.43
|
| Rate for Payer: United Healthcare PPO |
$187.20
|
| Rate for Payer: WEA Trust Commercial |
$137.28
|
| Rate for Payer: Wellcare Medicare |
$19.43
|
| Rate for Payer: WPS Commercial |
$184.87
|
|
|
Nucala Charge
|
Facility
|
OP
|
$4,680.00
|
|
|
Service Code
|
HCPCS J2182
|
| Hospital Charge Code |
5244850
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$33.17 |
| Max. Negotiated Rate |
$4,477.82 |
| Rate for Payer: Aetna Commercial |
$4,380.48
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,185.79
|
| Rate for Payer: Aetna Managed Medicare |
$33.17
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,163.68
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,433.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,336.26
|
| Rate for Payer: Anthem Medicare Advantage |
$33.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,579.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$33.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$33.17
|
| Rate for Payer: Cash Price |
$1,404.00
|
| Rate for Payer: Cash Price |
$1,404.00
|
| Rate for Payer: Cigna Commercial |
$4,477.82
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$33.17
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$41.94
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$33.17
|
| Rate for Payer: Health EOS Commercial |
$4,331.81
|
| Rate for Payer: HFN Commercial |
$4,477.82
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$123.38
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$33.17
|
| Rate for Payer: Independent Care Health Plan Medicare |
$33.17
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$33.17
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$33.17
|
| Rate for Payer: Multiplan Commercial |
$3,893.76
|
| Rate for Payer: NAPHCARE Commercial |
$49.75
|
| Rate for Payer: Preferred Network Access Commercial |
$4,477.82
|
| Rate for Payer: Quartz Beloit One Network |
$2,384.93
|
| Rate for Payer: Quartz Commercial |
$3,163.68
|
| Rate for Payer: Quartz Medicare Advantage |
$33.17
|
| Rate for Payer: The Alliance Commercial |
$132.66
|
| Rate for Payer: United Healthcare Medicare Advantage |
$33.17
|
| Rate for Payer: WEA Trust Commercial |
$2,676.96
|
| Rate for Payer: Wellcare Medicare |
$33.17
|
| Rate for Payer: WPS Commercial |
$79.25
|
|
|
Nucala Charge
|
Professional
|
Both
|
$4,680.00
|
|
|
Service Code
|
HCPCS J2182
|
| Hospital Charge Code |
5244850
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$31.70 |
| Max. Negotiated Rate |
$4,623.84 |
| Rate for Payer: Aetna Commercial |
$4,623.84
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,185.79
|
| Rate for Payer: Aetna Managed Medicare |
$33.17
|
| Rate for Payer: Anthem Medicare Advantage |
$33.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$33.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$33.17
|
| Rate for Payer: Cash Price |
$1,404.00
|
| Rate for Payer: Cash Price |
$1,404.00
|
| Rate for Payer: Cigna Commercial |
$4,623.84
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$33.17
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$31.70
|
| Rate for Payer: Health EOS Commercial |
$4,429.15
|
| Rate for Payer: HFN Commercial |
$4,623.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$43.35
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$43.35
|
| Rate for Payer: Independent Care Health Plan Medicare |
$33.17
|
| Rate for Payer: Multiplan Commercial |
$3,893.76
|
| Rate for Payer: NAPHCARE Commercial |
$49.75
|
| Rate for Payer: Preferred Network Access Commercial |
$4,623.84
|
| Rate for Payer: Quartz Beloit One Network |
$2,141.57
|
| Rate for Payer: Quartz Commercial |
$2,774.30
|
| Rate for Payer: Quartz Medicare Advantage |
$33.17
|
| Rate for Payer: The Alliance Commercial |
$91.21
|
| Rate for Payer: United Healthcare Medicaid |
$33.17
|
| Rate for Payer: United Healthcare Medicare Advantage |
$33.17
|
| Rate for Payer: WEA Trust Commercial |
$2,676.96
|
| Rate for Payer: WPS Commercial |
$79.25
|
|
|
Nucala Charge
|
Facility
|
IP
|
$4,680.00
|
|
|
Service Code
|
HCPCS J2182
|
| Hospital Charge Code |
5244850
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,384.93 |
| Max. Negotiated Rate |
$4,477.82 |
| Rate for Payer: Aetna Commercial |
$4,380.48
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,185.79
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,579.62
|
| Rate for Payer: Cash Price |
$1,404.00
|
| Rate for Payer: Cigna Commercial |
$4,477.82
|
| Rate for Payer: Health EOS Commercial |
$4,331.81
|
| Rate for Payer: HFN Commercial |
$4,477.82
|
| Rate for Payer: Multiplan Commercial |
$3,893.76
|
| Rate for Payer: Preferred Network Access Commercial |
$4,477.82
|
| Rate for Payer: Quartz Beloit One Network |
$2,384.93
|
| Rate for Payer: Quartz Commercial |
$2,920.32
|
| Rate for Payer: WEA Trust Commercial |
$2,676.96
|
| Rate for Payer: WPS Commercial |
$3,605.00
|
|
|
Nucala Injection J2182
|
Professional
|
Both
|
$47.00
|
|
|
Service Code
|
HCPCS J2182
|
| Hospital Charge Code |
5144615
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$21.51 |
| Max. Negotiated Rate |
$91.21 |
| Rate for Payer: Aetna Commercial |
$46.44
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$42.04
|
| Rate for Payer: Aetna Managed Medicare |
$33.17
|
| Rate for Payer: Anthem Medicare Advantage |
$33.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$33.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$33.17
|
| Rate for Payer: Cash Price |
$14.10
|
| Rate for Payer: Cash Price |
$14.10
|
| Rate for Payer: Cigna Commercial |
$46.44
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$33.17
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$31.70
|
| Rate for Payer: Health EOS Commercial |
$44.48
|
| Rate for Payer: HFN Commercial |
$46.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$43.35
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$43.35
|
| Rate for Payer: Independent Care Health Plan Medicare |
$33.17
|
| Rate for Payer: Multiplan Commercial |
$39.10
|
| Rate for Payer: NAPHCARE Commercial |
$49.75
|
| Rate for Payer: Preferred Network Access Commercial |
$46.44
|
| Rate for Payer: Quartz Beloit One Network |
$21.51
|
| Rate for Payer: Quartz Commercial |
$27.86
|
| Rate for Payer: Quartz Medicare Advantage |
$33.17
|
| Rate for Payer: The Alliance Commercial |
$91.21
|
| Rate for Payer: United Healthcare Medicaid |
$33.17
|
| Rate for Payer: United Healthcare Medicare Advantage |
$33.17
|
| Rate for Payer: WEA Trust Commercial |
$26.88
|
| Rate for Payer: WPS Commercial |
$79.25
|
|
|
Nucala Injection J2182
|
Facility
|
IP
|
$47.00
|
|
|
Service Code
|
HCPCS J2182
|
| Hospital Charge Code |
5144615
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$23.95 |
| Max. Negotiated Rate |
$44.97 |
| Rate for Payer: Aetna Commercial |
$43.99
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$42.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$25.91
|
| Rate for Payer: Cash Price |
$14.10
|
| Rate for Payer: Cigna Commercial |
$44.97
|
| Rate for Payer: Health EOS Commercial |
$43.50
|
| Rate for Payer: HFN Commercial |
$44.97
|
| Rate for Payer: Multiplan Commercial |
$39.10
|
| Rate for Payer: Preferred Network Access Commercial |
$44.97
|
| Rate for Payer: Quartz Beloit One Network |
$23.95
|
| Rate for Payer: Quartz Commercial |
$29.33
|
| Rate for Payer: WEA Trust Commercial |
$26.88
|
| Rate for Payer: WPS Commercial |
$36.20
|
|
|
Nucala Injection J2182
|
Facility
|
OP
|
$47.00
|
|
|
Service Code
|
HCPCS J2182
|
| Hospital Charge Code |
5144615
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$23.46 |
| Max. Negotiated Rate |
$132.66 |
| Rate for Payer: Aetna Commercial |
$43.99
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$42.04
|
| Rate for Payer: Aetna Managed Medicare |
$33.17
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$31.77
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$24.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$23.46
|
| Rate for Payer: Anthem Medicare Advantage |
$33.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$25.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$33.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$33.17
|
| Rate for Payer: Cash Price |
$14.10
|
| Rate for Payer: Cash Price |
$14.10
|
| Rate for Payer: Cigna Commercial |
$44.97
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$33.17
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$41.94
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$33.17
|
| Rate for Payer: Health EOS Commercial |
$43.50
|
| Rate for Payer: HFN Commercial |
$44.97
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$123.38
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$33.17
|
| Rate for Payer: Independent Care Health Plan Medicare |
$33.17
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$33.17
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$33.17
|
| Rate for Payer: Multiplan Commercial |
$39.10
|
| Rate for Payer: NAPHCARE Commercial |
$49.75
|
| Rate for Payer: Preferred Network Access Commercial |
$44.97
|
| Rate for Payer: Quartz Beloit One Network |
$23.95
|
| Rate for Payer: Quartz Commercial |
$31.77
|
| Rate for Payer: Quartz Medicare Advantage |
$33.17
|
| Rate for Payer: The Alliance Commercial |
$132.66
|
| Rate for Payer: United Healthcare Medicare Advantage |
$33.17
|
| Rate for Payer: WEA Trust Commercial |
$26.88
|
| Rate for Payer: Wellcare Medicare |
$33.17
|
| Rate for Payer: WPS Commercial |
$79.25
|
|
|
Nuclear Acquisition
|
Facility
|
IP
|
$6,737.00
|
|
|
Service Code
|
CPT 78452
|
| Hospital Charge Code |
5375847
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$3,433.18 |
| Max. Negotiated Rate |
$6,445.96 |
| Rate for Payer: Aetna Commercial |
$6,305.83
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,025.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,713.43
|
| Rate for Payer: Cash Price |
$2,021.10
|
| Rate for Payer: Cigna Commercial |
$6,445.96
|
| Rate for Payer: Health EOS Commercial |
$6,235.77
|
| Rate for Payer: HFN Commercial |
$6,445.96
|
| Rate for Payer: Multiplan Commercial |
$5,605.18
|
| Rate for Payer: Preferred Network Access Commercial |
$6,445.96
|
| Rate for Payer: Quartz Beloit One Network |
$3,433.18
|
| Rate for Payer: Quartz Commercial |
$4,203.89
|
| Rate for Payer: WEA Trust Commercial |
$3,853.56
|
| Rate for Payer: WPS Commercial |
$5,189.51
|
|
|
Nuclear Acquisition
|
Facility
|
IP
|
$7,362.00
|
|
|
Service Code
|
CPT 78454
|
| Hospital Charge Code |
5375835
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$3,751.68 |
| Max. Negotiated Rate |
$7,043.96 |
| Rate for Payer: Aetna Commercial |
$6,890.83
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,584.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,057.93
|
| Rate for Payer: Cash Price |
$2,208.60
|
| Rate for Payer: Cigna Commercial |
$7,043.96
|
| Rate for Payer: Health EOS Commercial |
$6,814.27
|
| Rate for Payer: HFN Commercial |
$7,043.96
|
| Rate for Payer: Multiplan Commercial |
$6,125.18
|
| Rate for Payer: Preferred Network Access Commercial |
$7,043.96
|
| Rate for Payer: Quartz Beloit One Network |
$3,751.68
|
| Rate for Payer: Quartz Commercial |
$4,593.89
|
| Rate for Payer: WEA Trust Commercial |
$4,211.06
|
| Rate for Payer: WPS Commercial |
$5,670.95
|
|
|
Nuclear Acquisition
|
Facility
|
OP
|
$6,737.00
|
|
|
Service Code
|
CPT 78452
|
| Hospital Charge Code |
5375847
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,362.47 |
| Max. Negotiated Rate |
$6,445.96 |
| Rate for Payer: Aetna Commercial |
$6,305.83
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,025.57
|
| Rate for Payer: Aetna Managed Medicare |
$1,362.47
|
| 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 |
$1,362.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,713.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$1,362.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$1,362.47
|
| Rate for Payer: Cash Price |
$2,021.10
|
| Rate for Payer: Cash Price |
$2,021.10
|
| Rate for Payer: Cash Price |
$2,021.10
|
| Rate for Payer: Cigna Commercial |
$6,445.96
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$1,362.47
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,920.93
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$1,362.47
|
| Rate for Payer: Health EOS Commercial |
$6,235.77
|
| Rate for Payer: HFN Commercial |
$6,445.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,068.40
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,362.47
|
| Rate for Payer: Independent Care Health Plan Medicare |
$1,362.47
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$1,362.47
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$1,362.47
|
| Rate for Payer: Multiplan Commercial |
$5,605.18
|
| Rate for Payer: NAPHCARE Commercial |
$2,043.71
|
| Rate for Payer: Preferred Network Access Commercial |
$6,445.96
|
| Rate for Payer: Quartz Beloit One Network |
$3,433.18
|
| Rate for Payer: Quartz Commercial |
$4,554.21
|
| Rate for Payer: Quartz Medicare Advantage |
$1,362.47
|
| Rate for Payer: The Alliance Commercial |
$5,449.89
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,362.47
|
| Rate for Payer: United Healthcare PPO |
$2,396.16
|
| Rate for Payer: WEA Trust Commercial |
$3,853.56
|
| Rate for Payer: Wellcare Medicare |
$1,362.47
|
| Rate for Payer: WPS Commercial |
$5,189.51
|
|
|
Nuclear Acquisition
|
Facility
|
IP
|
$4,343.00
|
|
|
Service Code
|
CPT 78451
|
| Hospital Charge Code |
5375843
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$2,213.19 |
| Max. Negotiated Rate |
$4,155.38 |
| Rate for Payer: Aetna Commercial |
$4,065.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,884.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,393.86
|
| Rate for Payer: Cash Price |
$1,302.90
|
| Rate for Payer: Cigna Commercial |
$4,155.38
|
| Rate for Payer: Health EOS Commercial |
$4,019.88
|
| Rate for Payer: HFN Commercial |
$4,155.38
|
| Rate for Payer: Multiplan Commercial |
$3,613.38
|
| Rate for Payer: Preferred Network Access Commercial |
$4,155.38
|
| Rate for Payer: Quartz Beloit One Network |
$2,213.19
|
| Rate for Payer: Quartz Commercial |
$2,710.03
|
| Rate for Payer: WEA Trust Commercial |
$2,484.20
|
| Rate for Payer: WPS Commercial |
$3,345.41
|
|
|
Nuclear Acquisition
|
Facility
|
OP
|
$3,396.00
|
|
|
Service Code
|
CPT 78453
|
| Hospital Charge Code |
5375839
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,362.47 |
| Max. Negotiated Rate |
$5,473.65 |
| Rate for Payer: Aetna Commercial |
$3,178.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,037.38
|
| Rate for Payer: Aetna Managed Medicare |
$1,362.47
|
| 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 |
$1,362.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,871.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$1,362.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$1,362.47
|
| Rate for Payer: Cash Price |
$1,018.80
|
| Rate for Payer: Cash Price |
$1,018.80
|
| Rate for Payer: Cash Price |
$1,018.80
|
| Rate for Payer: Cigna Commercial |
$3,249.29
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$1,362.47
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,976.47
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$1,362.47
|
| Rate for Payer: Health EOS Commercial |
$3,143.34
|
| Rate for Payer: HFN Commercial |
$3,249.29
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,068.40
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,362.47
|
| Rate for Payer: Independent Care Health Plan Medicare |
$1,362.47
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$1,362.47
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$1,362.47
|
| Rate for Payer: Multiplan Commercial |
$2,825.47
|
| Rate for Payer: NAPHCARE Commercial |
$2,043.71
|
| Rate for Payer: Preferred Network Access Commercial |
$3,249.29
|
| Rate for Payer: Quartz Beloit One Network |
$1,730.60
|
| Rate for Payer: Quartz Commercial |
$2,295.70
|
| Rate for Payer: Quartz Medicare Advantage |
$1,362.47
|
| Rate for Payer: The Alliance Commercial |
$5,449.89
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,362.47
|
| Rate for Payer: United Healthcare PPO |
$2,396.16
|
| Rate for Payer: WEA Trust Commercial |
$1,942.51
|
| Rate for Payer: Wellcare Medicare |
$1,362.47
|
| Rate for Payer: WPS Commercial |
$2,615.94
|
|
|
Nuclear Acquisition
|
Facility
|
OP
|
$7,362.00
|
|
|
Service Code
|
CPT 78454
|
| Hospital Charge Code |
5375835
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,362.47 |
| Max. Negotiated Rate |
$7,043.96 |
| Rate for Payer: Aetna Commercial |
$6,890.83
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,584.57
|
| Rate for Payer: Aetna Managed Medicare |
$1,362.47
|
| 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 |
$1,362.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,057.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$1,362.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$1,362.47
|
| Rate for Payer: Cash Price |
$2,208.60
|
| Rate for Payer: Cash Price |
$2,208.60
|
| Rate for Payer: Cash Price |
$2,208.60
|
| Rate for Payer: Cigna Commercial |
$7,043.96
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$1,362.47
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,284.68
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$1,362.47
|
| Rate for Payer: Health EOS Commercial |
$6,814.27
|
| Rate for Payer: HFN Commercial |
$7,043.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,068.40
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,362.47
|
| Rate for Payer: Independent Care Health Plan Medicare |
$1,362.47
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$1,362.47
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$1,362.47
|
| Rate for Payer: Multiplan Commercial |
$6,125.18
|
| Rate for Payer: NAPHCARE Commercial |
$2,043.71
|
| Rate for Payer: Preferred Network Access Commercial |
$7,043.96
|
| Rate for Payer: Quartz Beloit One Network |
$3,751.68
|
| Rate for Payer: Quartz Commercial |
$4,976.71
|
| Rate for Payer: Quartz Medicare Advantage |
$1,362.47
|
| Rate for Payer: The Alliance Commercial |
$5,449.89
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,362.47
|
| Rate for Payer: United Healthcare PPO |
$2,396.16
|
| Rate for Payer: WEA Trust Commercial |
$4,211.06
|
| Rate for Payer: Wellcare Medicare |
$1,362.47
|
| Rate for Payer: WPS Commercial |
$5,670.95
|
|
|
Nuclear Acquisition
|
Facility
|
OP
|
$6,548.00
|
|
|
Service Code
|
CPT 78494
|
| Hospital Charge Code |
5375820
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$420.71 |
| Max. Negotiated Rate |
$6,265.13 |
| Rate for Payer: Aetna Commercial |
$6,128.93
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,856.53
|
| 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 |
$3,609.26
|
| 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 |
$1,964.40
|
| Rate for Payer: Cash Price |
$1,964.40
|
| Rate for Payer: Cash Price |
$1,964.40
|
| Rate for Payer: Cigna Commercial |
$6,265.13
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$420.71
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,810.94
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$420.71
|
| Rate for Payer: Health EOS Commercial |
$6,060.83
|
| Rate for Payer: HFN Commercial |
$6,265.13
|
| 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 |
$5,447.94
|
| Rate for Payer: NAPHCARE Commercial |
$631.07
|
| Rate for Payer: Preferred Network Access Commercial |
$6,265.13
|
| Rate for Payer: Quartz Beloit One Network |
$3,336.86
|
| Rate for Payer: Quartz Commercial |
$4,426.45
|
| 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 |
$3,745.46
|
| Rate for Payer: Wellcare Medicare |
$420.71
|
| Rate for Payer: WPS Commercial |
$5,043.92
|
|
|
Nuclear Acquisition
|
Facility
|
IP
|
$6,548.00
|
|
|
Service Code
|
CPT 78494
|
| Hospital Charge Code |
5375820
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$3,336.86 |
| Max. Negotiated Rate |
$6,265.13 |
| Rate for Payer: Aetna Commercial |
$6,128.93
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,856.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,609.26
|
| Rate for Payer: Cash Price |
$1,964.40
|
| Rate for Payer: Cigna Commercial |
$6,265.13
|
| Rate for Payer: Health EOS Commercial |
$6,060.83
|
| Rate for Payer: HFN Commercial |
$6,265.13
|
| Rate for Payer: Multiplan Commercial |
$5,447.94
|
| Rate for Payer: Preferred Network Access Commercial |
$6,265.13
|
| Rate for Payer: Quartz Beloit One Network |
$3,336.86
|
| Rate for Payer: Quartz Commercial |
$4,085.95
|
| Rate for Payer: WEA Trust Commercial |
$3,745.46
|
| Rate for Payer: WPS Commercial |
$5,043.92
|
|
|
Nuclear Acquisition
|
Facility
|
IP
|
$6,737.00
|
|
|
Service Code
|
CPT 78452
|
| Hospital Charge Code |
5375823
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$3,433.18 |
| Max. Negotiated Rate |
$6,445.96 |
| Rate for Payer: Aetna Commercial |
$6,305.83
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,025.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,713.43
|
| Rate for Payer: Cash Price |
$2,021.10
|
| Rate for Payer: Cigna Commercial |
$6,445.96
|
| Rate for Payer: Health EOS Commercial |
$6,235.77
|
| Rate for Payer: HFN Commercial |
$6,445.96
|
| Rate for Payer: Multiplan Commercial |
$5,605.18
|
| Rate for Payer: Preferred Network Access Commercial |
$6,445.96
|
| Rate for Payer: Quartz Beloit One Network |
$3,433.18
|
| Rate for Payer: Quartz Commercial |
$4,203.89
|
| Rate for Payer: WEA Trust Commercial |
$3,853.56
|
| Rate for Payer: WPS Commercial |
$5,189.51
|
|
|
Nuclear Acquisition
|
Facility
|
OP
|
$3,479.00
|
|
|
Service Code
|
CPT 78469
|
| Hospital Charge Code |
5375832
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$571.42 |
| Max. Negotiated Rate |
$3,328.71 |
| Rate for Payer: Aetna Commercial |
$3,256.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,111.62
|
| 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 |
$1,917.62
|
| 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 |
$1,043.70
|
| Rate for Payer: Cash Price |
$1,043.70
|
| Rate for Payer: Cash Price |
$1,043.70
|
| Rate for Payer: Cigna Commercial |
$3,328.71
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$571.42
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,024.78
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$571.42
|
| Rate for Payer: Health EOS Commercial |
$3,220.16
|
| Rate for Payer: HFN Commercial |
$3,328.71
|
| 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 |
$2,894.53
|
| Rate for Payer: NAPHCARE Commercial |
$857.13
|
| Rate for Payer: Preferred Network Access Commercial |
$3,328.71
|
| Rate for Payer: Quartz Beloit One Network |
$1,772.90
|
| Rate for Payer: Quartz Commercial |
$2,351.80
|
| 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 |
$1,989.99
|
| Rate for Payer: Wellcare Medicare |
$571.42
|
| Rate for Payer: WPS Commercial |
$2,679.87
|
|
|
Nuclear Acquisition
|
Facility
|
OP
|
$6,737.00
|
|
|
Service Code
|
CPT 78452
|
| Hospital Charge Code |
5375828
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,362.47 |
| Max. Negotiated Rate |
$6,445.96 |
| Rate for Payer: Aetna Commercial |
$6,305.83
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,025.57
|
| Rate for Payer: Aetna Managed Medicare |
$1,362.47
|
| 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 |
$1,362.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,713.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$1,362.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$1,362.47
|
| Rate for Payer: Cash Price |
$2,021.10
|
| Rate for Payer: Cash Price |
$2,021.10
|
| Rate for Payer: Cash Price |
$2,021.10
|
| Rate for Payer: Cigna Commercial |
$6,445.96
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$1,362.47
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,920.93
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$1,362.47
|
| Rate for Payer: Health EOS Commercial |
$6,235.77
|
| Rate for Payer: HFN Commercial |
$6,445.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,068.40
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,362.47
|
| Rate for Payer: Independent Care Health Plan Medicare |
$1,362.47
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$1,362.47
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$1,362.47
|
| Rate for Payer: Multiplan Commercial |
$5,605.18
|
| Rate for Payer: NAPHCARE Commercial |
$2,043.71
|
| Rate for Payer: Preferred Network Access Commercial |
$6,445.96
|
| Rate for Payer: Quartz Beloit One Network |
$3,433.18
|
| Rate for Payer: Quartz Commercial |
$4,554.21
|
| Rate for Payer: Quartz Medicare Advantage |
$1,362.47
|
| Rate for Payer: The Alliance Commercial |
$5,449.89
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,362.47
|
| Rate for Payer: United Healthcare PPO |
$2,396.16
|
| Rate for Payer: WEA Trust Commercial |
$3,853.56
|
| Rate for Payer: Wellcare Medicare |
$1,362.47
|
| Rate for Payer: WPS Commercial |
$5,189.51
|
|
|
Nuclear Acquisition
|
Facility
|
IP
|
$3,713.00
|
|
|
Service Code
|
CPT 78472
|
| Hospital Charge Code |
5375814
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,892.14 |
| Max. Negotiated Rate |
$3,552.60 |
| Rate for Payer: Aetna Commercial |
$3,475.37
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,320.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,046.61
|
| Rate for Payer: Cash Price |
$1,113.90
|
| Rate for Payer: Cigna Commercial |
$3,552.60
|
| Rate for Payer: Health EOS Commercial |
$3,436.75
|
| Rate for Payer: HFN Commercial |
$3,552.60
|
| Rate for Payer: Multiplan Commercial |
$3,089.22
|
| Rate for Payer: Preferred Network Access Commercial |
$3,552.60
|
| Rate for Payer: Quartz Beloit One Network |
$1,892.14
|
| Rate for Payer: Quartz Commercial |
$2,316.91
|
| Rate for Payer: WEA Trust Commercial |
$2,123.84
|
| Rate for Payer: WPS Commercial |
$2,860.12
|
|
|
Nuclear Acquisition
|
Facility
|
OP
|
$4,343.00
|
|
|
Service Code
|
CPT 78451
|
| Hospital Charge Code |
5375843
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,362.47 |
| Max. Negotiated Rate |
$5,473.65 |
| Rate for Payer: Aetna Commercial |
$4,065.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,884.38
|
| Rate for Payer: Aetna Managed Medicare |
$1,362.47
|
| 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 |
$1,362.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,393.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$1,362.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$1,362.47
|
| Rate for Payer: Cash Price |
$1,302.90
|
| Rate for Payer: Cash Price |
$1,302.90
|
| Rate for Payer: Cash Price |
$1,302.90
|
| Rate for Payer: Cigna Commercial |
$4,155.38
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$1,362.47
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,527.63
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$1,362.47
|
| Rate for Payer: Health EOS Commercial |
$4,019.88
|
| Rate for Payer: HFN Commercial |
$4,155.38
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,068.40
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,362.47
|
| Rate for Payer: Independent Care Health Plan Medicare |
$1,362.47
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$1,362.47
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$1,362.47
|
| Rate for Payer: Multiplan Commercial |
$3,613.38
|
| Rate for Payer: NAPHCARE Commercial |
$2,043.71
|
| Rate for Payer: Preferred Network Access Commercial |
$4,155.38
|
| Rate for Payer: Quartz Beloit One Network |
$2,213.19
|
| Rate for Payer: Quartz Commercial |
$2,935.87
|
| Rate for Payer: Quartz Medicare Advantage |
$1,362.47
|
| Rate for Payer: The Alliance Commercial |
$5,449.89
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,362.47
|
| Rate for Payer: United Healthcare PPO |
$2,396.16
|
| Rate for Payer: WEA Trust Commercial |
$2,484.20
|
| Rate for Payer: Wellcare Medicare |
$1,362.47
|
| Rate for Payer: WPS Commercial |
$3,345.41
|
|
|
Nuclear Acquisition
|
Facility
|
OP
|
$6,737.00
|
|
|
Service Code
|
CPT 78452
|
| Hospital Charge Code |
5375823
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,362.47 |
| Max. Negotiated Rate |
$6,445.96 |
| Rate for Payer: Aetna Commercial |
$6,305.83
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,025.57
|
| Rate for Payer: Aetna Managed Medicare |
$1,362.47
|
| 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 |
$1,362.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,713.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$1,362.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$1,362.47
|
| Rate for Payer: Cash Price |
$2,021.10
|
| Rate for Payer: Cash Price |
$2,021.10
|
| Rate for Payer: Cash Price |
$2,021.10
|
| Rate for Payer: Cigna Commercial |
$6,445.96
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$1,362.47
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,920.93
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$1,362.47
|
| Rate for Payer: Health EOS Commercial |
$6,235.77
|
| Rate for Payer: HFN Commercial |
$6,445.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,068.40
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,362.47
|
| Rate for Payer: Independent Care Health Plan Medicare |
$1,362.47
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$1,362.47
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$1,362.47
|
| Rate for Payer: Multiplan Commercial |
$5,605.18
|
| Rate for Payer: NAPHCARE Commercial |
$2,043.71
|
| Rate for Payer: Preferred Network Access Commercial |
$6,445.96
|
| Rate for Payer: Quartz Beloit One Network |
$3,433.18
|
| Rate for Payer: Quartz Commercial |
$4,554.21
|
| Rate for Payer: Quartz Medicare Advantage |
$1,362.47
|
| Rate for Payer: The Alliance Commercial |
$5,449.89
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,362.47
|
| Rate for Payer: United Healthcare PPO |
$2,396.16
|
| Rate for Payer: WEA Trust Commercial |
$3,853.56
|
| Rate for Payer: Wellcare Medicare |
$1,362.47
|
| Rate for Payer: WPS Commercial |
$5,189.51
|
|
|
Nuclear Acquisition
|
Facility
|
IP
|
$3,396.00
|
|
|
Service Code
|
CPT 78453
|
| Hospital Charge Code |
5375839
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,730.60 |
| Max. Negotiated Rate |
$3,249.29 |
| Rate for Payer: Aetna Commercial |
$3,178.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,037.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,871.88
|
| Rate for Payer: Cash Price |
$1,018.80
|
| Rate for Payer: Cigna Commercial |
$3,249.29
|
| Rate for Payer: Health EOS Commercial |
$3,143.34
|
| Rate for Payer: HFN Commercial |
$3,249.29
|
| Rate for Payer: Multiplan Commercial |
$2,825.47
|
| Rate for Payer: Preferred Network Access Commercial |
$3,249.29
|
| Rate for Payer: Quartz Beloit One Network |
$1,730.60
|
| Rate for Payer: Quartz Commercial |
$2,119.10
|
| Rate for Payer: WEA Trust Commercial |
$1,942.51
|
| Rate for Payer: WPS Commercial |
$2,615.94
|
|
|
Nuclear Acquisition
|
Facility
|
OP
|
$3,713.00
|
|
|
Service Code
|
CPT 78472
|
| Hospital Charge Code |
5375814
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$420.71 |
| Max. Negotiated Rate |
$3,552.60 |
| Rate for Payer: Aetna Commercial |
$3,475.37
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,320.91
|
| 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 |
$2,046.61
|
| 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 |
$1,113.90
|
| Rate for Payer: Cash Price |
$1,113.90
|
| Rate for Payer: Cash Price |
$1,113.90
|
| Rate for Payer: Cigna Commercial |
$3,552.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$420.71
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,160.97
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$420.71
|
| Rate for Payer: Health EOS Commercial |
$3,436.75
|
| Rate for Payer: HFN Commercial |
$3,552.60
|
| 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 |
$3,089.22
|
| Rate for Payer: NAPHCARE Commercial |
$631.07
|
| Rate for Payer: Preferred Network Access Commercial |
$3,552.60
|
| Rate for Payer: Quartz Beloit One Network |
$1,892.14
|
| Rate for Payer: Quartz Commercial |
$2,509.99
|
| 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 |
$2,123.84
|
| Rate for Payer: Wellcare Medicare |
$420.71
|
| Rate for Payer: WPS Commercial |
$2,860.12
|
|
|
Nuclear Acquisition
|
Facility
|
IP
|
$3,479.00
|
|
|
Service Code
|
CPT 78469
|
| Hospital Charge Code |
5375832
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,772.90 |
| Max. Negotiated Rate |
$3,328.71 |
| Rate for Payer: Aetna Commercial |
$3,256.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,111.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,917.62
|
| Rate for Payer: Cash Price |
$1,043.70
|
| Rate for Payer: Cigna Commercial |
$3,328.71
|
| Rate for Payer: Health EOS Commercial |
$3,220.16
|
| Rate for Payer: HFN Commercial |
$3,328.71
|
| Rate for Payer: Multiplan Commercial |
$2,894.53
|
| Rate for Payer: Preferred Network Access Commercial |
$3,328.71
|
| Rate for Payer: Quartz Beloit One Network |
$1,772.90
|
| Rate for Payer: Quartz Commercial |
$2,170.90
|
| Rate for Payer: WEA Trust Commercial |
$1,989.99
|
| Rate for Payer: WPS Commercial |
$2,679.87
|
|
|
Nuclear Acquisition
|
Facility
|
IP
|
$6,737.00
|
|
|
Service Code
|
CPT 78452
|
| Hospital Charge Code |
5375828
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$3,433.18 |
| Max. Negotiated Rate |
$6,445.96 |
| Rate for Payer: Aetna Commercial |
$6,305.83
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,025.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,713.43
|
| Rate for Payer: Cash Price |
$2,021.10
|
| Rate for Payer: Cigna Commercial |
$6,445.96
|
| Rate for Payer: Health EOS Commercial |
$6,235.77
|
| Rate for Payer: HFN Commercial |
$6,445.96
|
| Rate for Payer: Multiplan Commercial |
$5,605.18
|
| Rate for Payer: Preferred Network Access Commercial |
$6,445.96
|
| Rate for Payer: Quartz Beloit One Network |
$3,433.18
|
| Rate for Payer: Quartz Commercial |
$4,203.89
|
| Rate for Payer: WEA Trust Commercial |
$3,853.56
|
| Rate for Payer: WPS Commercial |
$5,189.51
|
|
