|
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
|
$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
|
$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
|
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
|
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
|
$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
|
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 Interpretation
|
Facility
|
IP
|
$1,231.00
|
|
|
Service Code
|
CPT 78452 26
|
| Hospital Charge Code |
5375849
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$627.32 |
| Max. Negotiated Rate |
$1,177.82 |
| Rate for Payer: Aetna Commercial |
$1,152.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,101.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$678.53
|
| Rate for Payer: Cash Price |
$369.30
|
| Rate for Payer: Cigna Commercial |
$1,177.82
|
| Rate for Payer: Health EOS Commercial |
$1,139.41
|
| Rate for Payer: HFN Commercial |
$1,177.82
|
| Rate for Payer: Multiplan Commercial |
$1,024.19
|
| Rate for Payer: Preferred Network Access Commercial |
$1,177.82
|
| Rate for Payer: Quartz Beloit One Network |
$627.32
|
| Rate for Payer: Quartz Commercial |
$768.14
|
| Rate for Payer: WEA Trust Commercial |
$704.13
|
| Rate for Payer: WPS Commercial |
$948.24
|
|
|
Nuclear Interpretation
|
Facility
|
OP
|
$1,231.00
|
|
|
Service Code
|
CPT 78452 26
|
| Hospital Charge Code |
5375849
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$300.64 |
| Max. Negotiated Rate |
$1,177.82 |
| Rate for Payer: Aetna Commercial |
$1,152.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,101.01
|
| Rate for Payer: Aetna Managed Medicare |
$358.47
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$832.16
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$640.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$614.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$678.53
|
| Rate for Payer: Cash Price |
$369.30
|
| Rate for Payer: Cash Price |
$369.30
|
| Rate for Payer: Cigna Commercial |
$1,177.82
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$716.44
|
| Rate for Payer: Health EOS Commercial |
$1,139.41
|
| Rate for Payer: HFN Commercial |
$1,177.82
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$960.18
|
| Rate for Payer: Multiplan Commercial |
$1,024.19
|
| Rate for Payer: NAPHCARE Commercial |
$768.14
|
| Rate for Payer: Preferred Network Access Commercial |
$1,177.82
|
| Rate for Payer: Quartz Beloit One Network |
$627.32
|
| Rate for Payer: Quartz Commercial |
$832.16
|
| Rate for Payer: Quartz Medicare Advantage |
$768.14
|
| Rate for Payer: The Alliance Commercial |
$300.64
|
| Rate for Payer: WEA Trust Commercial |
$704.13
|
| Rate for Payer: WPS Commercial |
$948.24
|
|
|
Nucleated Cell Count, CSF
|
Facility
|
OP
|
$189.00
|
|
|
Service Code
|
CPT 89051
|
| Hospital Charge Code |
1006928
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.82 |
| Max. Negotiated Rate |
$180.84 |
| Rate for Payer: Aetna Commercial |
$176.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$169.04
|
| Rate for Payer: Aetna Managed Medicare |
$5.82
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$21.84
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$10.19
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$9.67
|
| Rate for Payer: Anthem Medicare Advantage |
$5.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$104.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5.82
|
| Rate for Payer: Cash Price |
$56.70
|
| Rate for Payer: Cash Price |
$56.70
|
| Rate for Payer: Cigna Commercial |
$180.84
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$5.82
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$110.00
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$5.82
|
| Rate for Payer: Health EOS Commercial |
$174.94
|
| Rate for Payer: HFN Commercial |
$180.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$21.67
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$5.82
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5.82
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$5.82
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$5.82
|
| Rate for Payer: Multiplan Commercial |
$157.25
|
| Rate for Payer: NAPHCARE Commercial |
$8.74
|
| Rate for Payer: Preferred Network Access Commercial |
$180.84
|
| Rate for Payer: Quartz Beloit One Network |
$96.31
|
| Rate for Payer: Quartz Commercial |
$127.76
|
| Rate for Payer: Quartz Medicare Advantage |
$5.82
|
| Rate for Payer: The Alliance Commercial |
$23.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.82
|
| Rate for Payer: United Healthcare PPO |
$147.42
|
| Rate for Payer: WEA Trust Commercial |
$108.11
|
| Rate for Payer: Wellcare Medicare |
$5.82
|
| Rate for Payer: WPS Commercial |
$145.59
|
|
|
Nucleated Cell Count, CSF
|
Professional
|
Both
|
$189.00
|
|
|
Service Code
|
CPT 89051
|
| Hospital Charge Code |
1006928
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.82 |
| Max. Negotiated Rate |
$186.73 |
| Rate for Payer: Aetna Commercial |
$186.73
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$169.04
|
| Rate for Payer: Aetna Managed Medicare |
$5.82
|
| Rate for Payer: Anthem Medicare Advantage |
$5.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5.82
|
| Rate for Payer: Cash Price |
$56.70
|
| Rate for Payer: Cash Price |
$56.70
|
| Rate for Payer: Cigna Commercial |
$186.73
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$98.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5.82
|
| Rate for Payer: Health EOS Commercial |
$178.87
|
| Rate for Payer: HFN Commercial |
$186.73
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$20.56
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$20.56
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5.82
|
| Rate for Payer: Multiplan Commercial |
$157.25
|
| Rate for Payer: NAPHCARE Commercial |
$8.74
|
| Rate for Payer: Preferred Network Access Commercial |
$186.73
|
| Rate for Payer: Quartz Beloit One Network |
$86.49
|
| Rate for Payer: Quartz Commercial |
$112.04
|
| Rate for Payer: Quartz Medicare Advantage |
$5.82
|
| Rate for Payer: The Alliance Commercial |
$23.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.82
|
| Rate for Payer: WEA Trust Commercial |
$108.11
|
| Rate for Payer: WPS Commercial |
$25.63
|
|
|
Nucleated Cell Count, CSF
|
Facility
|
IP
|
$189.00
|
|
|
Service Code
|
CPT 89051
|
| Hospital Charge Code |
1006928
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$96.31 |
| Max. Negotiated Rate |
$180.84 |
| Rate for Payer: Aetna Commercial |
$176.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$169.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$104.18
|
| Rate for Payer: Cash Price |
$56.70
|
| Rate for Payer: Cigna Commercial |
$180.84
|
| Rate for Payer: Health EOS Commercial |
$174.94
|
| Rate for Payer: HFN Commercial |
$180.84
|
| Rate for Payer: Multiplan Commercial |
$157.25
|
| Rate for Payer: Preferred Network Access Commercial |
$180.84
|
| Rate for Payer: Quartz Beloit One Network |
$96.31
|
| Rate for Payer: Quartz Commercial |
$117.94
|
| Rate for Payer: WEA Trust Commercial |
$108.11
|
| Rate for Payer: WPS Commercial |
$145.59
|
|
|
Nucleic Acid Amplification
|
Facility
|
OP
|
$61.00
|
|
| Hospital Charge Code |
2956831
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.76 |
| Max. Negotiated Rate |
$58.36 |
| Rate for Payer: Aetna Commercial |
$57.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$54.56
|
| Rate for Payer: Aetna Managed Medicare |
$17.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$41.24
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$31.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$30.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$33.62
|
| Rate for Payer: Cash Price |
$18.30
|
| Rate for Payer: Cigna Commercial |
$58.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$35.50
|
| Rate for Payer: Health EOS Commercial |
$56.46
|
| Rate for Payer: HFN Commercial |
$58.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$47.58
|
| Rate for Payer: Multiplan Commercial |
$50.75
|
| Rate for Payer: NAPHCARE Commercial |
$38.06
|
| Rate for Payer: Preferred Network Access Commercial |
$58.36
|
| Rate for Payer: Quartz Beloit One Network |
$31.09
|
| Rate for Payer: Quartz Commercial |
$41.24
|
| Rate for Payer: Quartz Medicare Advantage |
$38.06
|
| Rate for Payer: The Alliance Commercial |
$31.72
|
| Rate for Payer: United Healthcare PPO |
$47.58
|
| Rate for Payer: WEA Trust Commercial |
$34.89
|
| Rate for Payer: WPS Commercial |
$46.99
|
|
|
Nucleic Acid Amplification
|
Professional
|
Both
|
$61.00
|
|
| Hospital Charge Code |
2956831
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$27.91 |
| Max. Negotiated Rate |
$60.27 |
| Rate for Payer: Aetna Commercial |
$60.27
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$54.56
|
| Rate for Payer: Cash Price |
$18.30
|
| Rate for Payer: Cigna Commercial |
$60.27
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$31.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$38.06
|
| Rate for Payer: Health EOS Commercial |
$57.73
|
| Rate for Payer: HFN Commercial |
$60.27
|
| Rate for Payer: Multiplan Commercial |
$50.75
|
| Rate for Payer: Preferred Network Access Commercial |
$60.27
|
| Rate for Payer: Quartz Beloit One Network |
$27.91
|
| Rate for Payer: Quartz Commercial |
$36.16
|
| Rate for Payer: The Alliance Commercial |
$31.72
|
| Rate for Payer: WEA Trust Commercial |
$34.89
|
| Rate for Payer: WPS Commercial |
$46.99
|
|
|
Nucleic Acid Amplification
|
Facility
|
IP
|
$61.00
|
|
| Hospital Charge Code |
2956831
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$31.09 |
| Max. Negotiated Rate |
$58.36 |
| Rate for Payer: Aetna Commercial |
$57.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$54.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$33.62
|
| Rate for Payer: Cash Price |
$18.30
|
| Rate for Payer: Cigna Commercial |
$58.36
|
| Rate for Payer: Health EOS Commercial |
$56.46
|
| Rate for Payer: HFN Commercial |
$58.36
|
| Rate for Payer: Multiplan Commercial |
$50.75
|
| Rate for Payer: Preferred Network Access Commercial |
$58.36
|
| Rate for Payer: Quartz Beloit One Network |
$31.09
|
| Rate for Payer: Quartz Commercial |
$38.06
|
| Rate for Payer: WEA Trust Commercial |
$34.89
|
| Rate for Payer: WPS Commercial |
$46.99
|
|
|
Nucleic Acid Interp/Report
|
Professional
|
Both
|
$126.00
|
|
| Hospital Charge Code |
2956832
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$57.66 |
| Max. Negotiated Rate |
$124.49 |
| Rate for Payer: Aetna Commercial |
$124.49
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$112.69
|
| Rate for Payer: Cash Price |
$37.80
|
| Rate for Payer: Cigna Commercial |
$124.49
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$65.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$78.62
|
| Rate for Payer: Health EOS Commercial |
$119.25
|
| Rate for Payer: HFN Commercial |
$124.49
|
| Rate for Payer: Multiplan Commercial |
$104.83
|
| Rate for Payer: Preferred Network Access Commercial |
$124.49
|
| Rate for Payer: Quartz Beloit One Network |
$57.66
|
| Rate for Payer: Quartz Commercial |
$74.69
|
| Rate for Payer: The Alliance Commercial |
$65.52
|
| Rate for Payer: WEA Trust Commercial |
$72.07
|
| Rate for Payer: WPS Commercial |
$97.06
|
|
|
Nucleic Acid Interp/Report
|
Facility
|
IP
|
$126.00
|
|
| Hospital Charge Code |
2956832
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$64.21 |
| Max. Negotiated Rate |
$120.56 |
| Rate for Payer: Aetna Commercial |
$117.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$112.69
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$69.45
|
| Rate for Payer: Cash Price |
$37.80
|
| Rate for Payer: Cigna Commercial |
$120.56
|
| Rate for Payer: Health EOS Commercial |
$116.63
|
| Rate for Payer: HFN Commercial |
$120.56
|
| Rate for Payer: Multiplan Commercial |
$104.83
|
| Rate for Payer: Preferred Network Access Commercial |
$120.56
|
| Rate for Payer: Quartz Beloit One Network |
$64.21
|
| Rate for Payer: Quartz Commercial |
$78.62
|
| Rate for Payer: WEA Trust Commercial |
$72.07
|
| Rate for Payer: WPS Commercial |
$97.06
|
|
|
Nucleic Acid Interp/Report
|
Facility
|
OP
|
$126.00
|
|
| Hospital Charge Code |
2956832
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$36.69 |
| Max. Negotiated Rate |
$120.56 |
| Rate for Payer: Aetna Commercial |
$117.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$112.69
|
| Rate for Payer: Aetna Managed Medicare |
$36.69
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$85.18
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$65.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$62.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$69.45
|
| Rate for Payer: Cash Price |
$37.80
|
| Rate for Payer: Cigna Commercial |
$120.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$73.33
|
| Rate for Payer: Health EOS Commercial |
$116.63
|
| Rate for Payer: HFN Commercial |
$120.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$98.28
|
| Rate for Payer: Multiplan Commercial |
$104.83
|
| Rate for Payer: NAPHCARE Commercial |
$78.62
|
| Rate for Payer: Preferred Network Access Commercial |
$120.56
|
| Rate for Payer: Quartz Beloit One Network |
$64.21
|
| Rate for Payer: Quartz Commercial |
$85.18
|
| Rate for Payer: Quartz Medicare Advantage |
$78.62
|
| Rate for Payer: The Alliance Commercial |
$65.52
|
| Rate for Payer: United Healthcare PPO |
$98.28
|
| Rate for Payer: WEA Trust Commercial |
$72.07
|
| Rate for Payer: WPS Commercial |
$97.06
|
|
|
Nucleic Acid Probe
|
Facility
|
IP
|
$79.00
|
|
| Hospital Charge Code |
2778800
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$40.26 |
| Max. Negotiated Rate |
$75.59 |
| Rate for Payer: Aetna Commercial |
$73.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$70.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$43.54
|
| Rate for Payer: Cash Price |
$23.70
|
| Rate for Payer: Cigna Commercial |
$75.59
|
| Rate for Payer: Health EOS Commercial |
$73.12
|
| Rate for Payer: HFN Commercial |
$75.59
|
| Rate for Payer: Multiplan Commercial |
$65.73
|
| Rate for Payer: Preferred Network Access Commercial |
$75.59
|
| Rate for Payer: Quartz Beloit One Network |
$40.26
|
| Rate for Payer: Quartz Commercial |
$49.30
|
| Rate for Payer: WEA Trust Commercial |
$45.19
|
| Rate for Payer: WPS Commercial |
$60.85
|
|
|
Nucleic Acid Probe
|
Facility
|
OP
|
$79.00
|
|
| Hospital Charge Code |
2778800
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$23.00 |
| Max. Negotiated Rate |
$75.59 |
| Rate for Payer: Aetna Commercial |
$73.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$70.66
|
| Rate for Payer: Aetna Managed Medicare |
$23.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$53.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$41.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$39.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$43.54
|
| Rate for Payer: Cash Price |
$23.70
|
| Rate for Payer: Cigna Commercial |
$75.59
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$45.98
|
| Rate for Payer: Health EOS Commercial |
$73.12
|
| Rate for Payer: HFN Commercial |
$75.59
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$61.62
|
| Rate for Payer: Multiplan Commercial |
$65.73
|
| Rate for Payer: NAPHCARE Commercial |
$49.30
|
| Rate for Payer: Preferred Network Access Commercial |
$75.59
|
| Rate for Payer: Quartz Beloit One Network |
$40.26
|
| Rate for Payer: Quartz Commercial |
$53.40
|
| Rate for Payer: Quartz Medicare Advantage |
$49.30
|
| Rate for Payer: The Alliance Commercial |
$41.08
|
| Rate for Payer: United Healthcare PPO |
$61.62
|
| Rate for Payer: WEA Trust Commercial |
$45.19
|
| Rate for Payer: WPS Commercial |
$60.85
|
|
|
Nucleic Acid Probe
|
Professional
|
Both
|
$79.00
|
|
| Hospital Charge Code |
2778800
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$36.15 |
| Max. Negotiated Rate |
$78.05 |
| Rate for Payer: Aetna Commercial |
$78.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$70.66
|
| Rate for Payer: Cash Price |
$23.70
|
| Rate for Payer: Cigna Commercial |
$78.05
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$41.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$49.30
|
| Rate for Payer: Health EOS Commercial |
$74.77
|
| Rate for Payer: HFN Commercial |
$78.05
|
| Rate for Payer: Multiplan Commercial |
$65.73
|
| Rate for Payer: Preferred Network Access Commercial |
$78.05
|
| Rate for Payer: Quartz Beloit One Network |
$36.15
|
| Rate for Payer: Quartz Commercial |
$46.83
|
| Rate for Payer: The Alliance Commercial |
$41.08
|
| Rate for Payer: WEA Trust Commercial |
$45.19
|
| Rate for Payer: WPS Commercial |
$60.85
|
|
|
Nucleic Acid Probe Each
|
Facility
|
IP
|
$2.00
|
|
| Hospital Charge Code |
2956830
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$1.02 |
| Max. Negotiated Rate |
$1.91 |
| Rate for Payer: Aetna Commercial |
$1.87
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1.79
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1.10
|
| Rate for Payer: Cash Price |
$0.60
|
| Rate for Payer: Cigna Commercial |
$1.91
|
| Rate for Payer: Health EOS Commercial |
$1.85
|
| Rate for Payer: HFN Commercial |
$1.91
|
| Rate for Payer: Multiplan Commercial |
$1.66
|
| Rate for Payer: Preferred Network Access Commercial |
$1.91
|
| Rate for Payer: Quartz Beloit One Network |
$1.02
|
| Rate for Payer: Quartz Commercial |
$1.25
|
| Rate for Payer: WEA Trust Commercial |
$1.14
|
| Rate for Payer: WPS Commercial |
$1.54
|
|
|
Nucleic Acid Probe Each
|
Facility
|
OP
|
$2.00
|
|
| Hospital Charge Code |
2956830
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$0.58 |
| Max. Negotiated Rate |
$1.91 |
| Rate for Payer: Aetna Commercial |
$1.87
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1.79
|
| Rate for Payer: Aetna Managed Medicare |
$0.58
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1.10
|
| Rate for Payer: Cash Price |
$0.60
|
| Rate for Payer: Cigna Commercial |
$1.91
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1.16
|
| Rate for Payer: Health EOS Commercial |
$1.85
|
| Rate for Payer: HFN Commercial |
$1.91
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1.56
|
| Rate for Payer: Multiplan Commercial |
$1.66
|
| Rate for Payer: NAPHCARE Commercial |
$1.25
|
| Rate for Payer: Preferred Network Access Commercial |
$1.91
|
| Rate for Payer: Quartz Beloit One Network |
$1.02
|
| Rate for Payer: Quartz Commercial |
$1.35
|
| Rate for Payer: Quartz Medicare Advantage |
$1.25
|
| Rate for Payer: The Alliance Commercial |
$1.04
|
| Rate for Payer: United Healthcare PPO |
$1.56
|
| Rate for Payer: WEA Trust Commercial |
$1.14
|
| Rate for Payer: WPS Commercial |
$1.54
|
|
|
Nucleic Acid Probe Each
|
Professional
|
Both
|
$2.00
|
|
| Hospital Charge Code |
2956830
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$0.92 |
| Max. Negotiated Rate |
$1.98 |
| Rate for Payer: Aetna Commercial |
$1.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1.79
|
| Rate for Payer: Cash Price |
$0.60
|
| Rate for Payer: Cigna Commercial |
$1.98
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1.25
|
| Rate for Payer: Health EOS Commercial |
$1.89
|
| Rate for Payer: HFN Commercial |
$1.98
|
| Rate for Payer: Multiplan Commercial |
$1.66
|
| Rate for Payer: Preferred Network Access Commercial |
$1.98
|
| Rate for Payer: Quartz Beloit One Network |
$0.92
|
| Rate for Payer: Quartz Commercial |
$1.19
|
| Rate for Payer: The Alliance Commercial |
$1.04
|
| Rate for Payer: WEA Trust Commercial |
$1.14
|
| Rate for Payer: WPS Commercial |
$1.54
|
|
