|
M-PACI HAND-SCORING STARTER
|
Facility
|
OP
|
$3,795.00
|
|
| Hospital Charge Code |
2973439
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$1,062.60 |
| Max. Negotiated Rate |
$15,180.00 |
| Rate for Payer: Aetna Commercial |
$3,415.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,263.70
|
| Rate for Payer: Aetna Managed Medicare |
$1,062.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,466.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,897.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,821.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,011.35
|
| Rate for Payer: Cash Price |
$1,138.50
|
| Rate for Payer: Cigna Commercial |
$3,491.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,123.68
|
| Rate for Payer: Health EOS Commercial |
$3,377.55
|
| Rate for Payer: HFN Commercial |
$3,491.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,846.25
|
| Rate for Payer: Multiplan Commercial |
$3,036.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,277.00
|
| Rate for Payer: Preferred Network Access Commercial |
$3,491.40
|
| Rate for Payer: Quartz Beloit One Network |
$1,859.55
|
| Rate for Payer: Quartz Commercial |
$2,466.75
|
| Rate for Payer: Quartz Medicare Advantage |
$2,277.00
|
| Rate for Payer: The Alliance Commercial |
$15,180.00
|
| Rate for Payer: WEA Trust Commercial |
$2,087.25
|
| Rate for Payer: WPS Commercial |
$2,810.96
|
|
|
MPL Mutation Analysis
|
Professional
|
Both
|
$890.00
|
|
|
Service Code
|
CPT 81402
|
| Hospital Charge Code |
4534672
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$391.60 |
| Max. Negotiated Rate |
$845.50 |
| Rate for Payer: Aetna Commercial |
$845.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$765.40
|
| Rate for Payer: Cash Price |
$267.00
|
| Rate for Payer: Cash Price |
$267.00
|
| Rate for Payer: Cigna Commercial |
$845.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$445.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$534.00
|
| Rate for Payer: Health EOS Commercial |
$809.90
|
| Rate for Payer: HFN Commercial |
$845.50
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$530.66
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$530.66
|
| Rate for Payer: Multiplan Commercial |
$712.00
|
| Rate for Payer: Preferred Network Access Commercial |
$845.50
|
| Rate for Payer: Quartz Beloit One Network |
$391.60
|
| Rate for Payer: Quartz Commercial |
$507.30
|
| Rate for Payer: The Alliance Commercial |
$445.00
|
| Rate for Payer: WEA Trust Commercial |
$489.50
|
| Rate for Payer: WPS Commercial |
$659.22
|
|
|
MPL Mutation Analysis
|
Facility
|
OP
|
$890.00
|
|
|
Service Code
|
CPT 81402
|
| Hospital Charge Code |
4534672
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$150.33 |
| Max. Negotiated Rate |
$818.80 |
| Rate for Payer: Aetna Commercial |
$801.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$765.40
|
| Rate for Payer: Aetna Managed Medicare |
$150.33
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$563.74
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$263.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$249.55
|
| Rate for Payer: Anthem Medicaid |
$150.33
|
| Rate for Payer: Anthem Medicare Advantage |
$150.33
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$471.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$150.33
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$150.33
|
| Rate for Payer: Cash Price |
$267.00
|
| Rate for Payer: Cash Price |
$267.00
|
| Rate for Payer: Cigna Commercial |
$818.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$150.33
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$150.33
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$498.04
|
| Rate for Payer: Dean Health Medicaid |
$150.33
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$150.33
|
| Rate for Payer: Health EOS Commercial |
$792.10
|
| Rate for Payer: HFN Commercial |
$818.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$559.23
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$150.33
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$150.33
|
| Rate for Payer: Independent Care Health Plan Medicare |
$150.33
|
| Rate for Payer: Managed Health Services Medicaid |
$156.34
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$150.33
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$150.33
|
| Rate for Payer: Multiplan Commercial |
$712.00
|
| Rate for Payer: NAPHCARE Commercial |
$225.50
|
| Rate for Payer: Preferred Network Access Commercial |
$818.80
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$150.33
|
| Rate for Payer: Quartz Beloit One Network |
$436.10
|
| Rate for Payer: Quartz Commercial |
$578.50
|
| Rate for Payer: Quartz Medicare Advantage |
$150.33
|
| Rate for Payer: The Alliance Commercial |
$601.32
|
| Rate for Payer: United Healthcare Medicaid |
$150.33
|
| Rate for Payer: United Healthcare Medicare Advantage |
$150.33
|
| Rate for Payer: United Healthcare PPO |
$667.50
|
| Rate for Payer: WEA Trust Commercial |
$489.50
|
| Rate for Payer: Wellcare Medicare |
$150.33
|
| Rate for Payer: WMAP Medicaid |
$150.33
|
| Rate for Payer: WPS Commercial |
$659.22
|
|
|
MPL Mutation Analysis
|
Facility
|
IP
|
$890.00
|
|
|
Service Code
|
CPT 81402
|
| Hospital Charge Code |
4534672
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$436.10 |
| Max. Negotiated Rate |
$818.80 |
| Rate for Payer: Aetna Commercial |
$801.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$765.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$471.70
|
| Rate for Payer: Cash Price |
$267.00
|
| Rate for Payer: Cigna Commercial |
$818.80
|
| Rate for Payer: Health EOS Commercial |
$792.10
|
| Rate for Payer: HFN Commercial |
$818.80
|
| Rate for Payer: Multiplan Commercial |
$712.00
|
| Rate for Payer: NAPHCARE Commercial |
$534.00
|
| Rate for Payer: Preferred Network Access Commercial |
$818.80
|
| Rate for Payer: Quartz Beloit One Network |
$436.10
|
| Rate for Payer: Quartz Commercial |
$534.00
|
| Rate for Payer: WEA Trust Commercial |
$489.50
|
| Rate for Payer: WPS Commercial |
$659.22
|
|
|
MPL Mutation Analysis to US Labs
|
Facility
|
OP
|
$999.00
|
|
|
Service Code
|
CPT 81402
|
| Hospital Charge Code |
4938615
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$150.33 |
| Max. Negotiated Rate |
$919.08 |
| Rate for Payer: Aetna Commercial |
$899.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$859.14
|
| Rate for Payer: Aetna Managed Medicare |
$150.33
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$563.74
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$263.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$249.55
|
| Rate for Payer: Anthem Medicaid |
$150.33
|
| Rate for Payer: Anthem Medicare Advantage |
$150.33
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$529.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$150.33
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$150.33
|
| Rate for Payer: Cash Price |
$299.70
|
| Rate for Payer: Cash Price |
$299.70
|
| Rate for Payer: Cigna Commercial |
$919.08
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$150.33
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$150.33
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$559.04
|
| Rate for Payer: Dean Health Medicaid |
$150.33
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$150.33
|
| Rate for Payer: Health EOS Commercial |
$889.11
|
| Rate for Payer: HFN Commercial |
$919.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$559.23
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$150.33
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$150.33
|
| Rate for Payer: Independent Care Health Plan Medicare |
$150.33
|
| Rate for Payer: Managed Health Services Medicaid |
$156.34
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$150.33
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$150.33
|
| Rate for Payer: Multiplan Commercial |
$799.20
|
| Rate for Payer: NAPHCARE Commercial |
$225.50
|
| Rate for Payer: Preferred Network Access Commercial |
$919.08
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$150.33
|
| Rate for Payer: Quartz Beloit One Network |
$489.51
|
| Rate for Payer: Quartz Commercial |
$649.35
|
| Rate for Payer: Quartz Medicare Advantage |
$150.33
|
| Rate for Payer: The Alliance Commercial |
$601.32
|
| Rate for Payer: United Healthcare Medicaid |
$150.33
|
| Rate for Payer: United Healthcare Medicare Advantage |
$150.33
|
| Rate for Payer: United Healthcare PPO |
$749.25
|
| Rate for Payer: WEA Trust Commercial |
$549.45
|
| Rate for Payer: Wellcare Medicare |
$150.33
|
| Rate for Payer: WMAP Medicaid |
$150.33
|
| Rate for Payer: WPS Commercial |
$739.96
|
|
|
MPL Mutation Analysis to US Labs
|
Facility
|
IP
|
$999.00
|
|
|
Service Code
|
CPT 81402
|
| Hospital Charge Code |
4938615
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$489.51 |
| Max. Negotiated Rate |
$919.08 |
| Rate for Payer: Aetna Commercial |
$899.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$859.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$529.47
|
| Rate for Payer: Cash Price |
$299.70
|
| Rate for Payer: Cigna Commercial |
$919.08
|
| Rate for Payer: Health EOS Commercial |
$889.11
|
| Rate for Payer: HFN Commercial |
$919.08
|
| Rate for Payer: Multiplan Commercial |
$799.20
|
| Rate for Payer: NAPHCARE Commercial |
$599.40
|
| Rate for Payer: Preferred Network Access Commercial |
$919.08
|
| Rate for Payer: Quartz Beloit One Network |
$489.51
|
| Rate for Payer: Quartz Commercial |
$599.40
|
| Rate for Payer: WEA Trust Commercial |
$549.45
|
| Rate for Payer: WPS Commercial |
$739.96
|
|
|
MPL Mutation Analysis to US Labs
|
Professional
|
Both
|
$999.00
|
|
|
Service Code
|
CPT 81402
|
| Hospital Charge Code |
4938615
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$439.56 |
| Max. Negotiated Rate |
$949.05 |
| Rate for Payer: Aetna Commercial |
$949.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$859.14
|
| Rate for Payer: Cash Price |
$299.70
|
| Rate for Payer: Cash Price |
$299.70
|
| Rate for Payer: Cigna Commercial |
$949.05
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$499.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$599.40
|
| Rate for Payer: Health EOS Commercial |
$909.09
|
| Rate for Payer: HFN Commercial |
$949.05
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$530.66
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$530.66
|
| Rate for Payer: Multiplan Commercial |
$799.20
|
| Rate for Payer: Preferred Network Access Commercial |
$949.05
|
| Rate for Payer: Quartz Beloit One Network |
$439.56
|
| Rate for Payer: Quartz Commercial |
$569.43
|
| Rate for Payer: The Alliance Commercial |
$499.50
|
| Rate for Payer: WEA Trust Commercial |
$549.45
|
| Rate for Payer: WPS Commercial |
$739.96
|
|
|
MPL S505 Mutation
|
Facility
|
OP
|
$300.00
|
|
| Hospital Charge Code |
2942932
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$84.00 |
| Max. Negotiated Rate |
$1,200.00 |
| Rate for Payer: Aetna Commercial |
$270.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$258.00
|
| Rate for Payer: Aetna Managed Medicare |
$84.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$195.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$150.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$144.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$159.00
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Cigna Commercial |
$276.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$167.88
|
| Rate for Payer: Health EOS Commercial |
$267.00
|
| Rate for Payer: HFN Commercial |
$276.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$225.00
|
| Rate for Payer: Multiplan Commercial |
$240.00
|
| Rate for Payer: NAPHCARE Commercial |
$180.00
|
| Rate for Payer: Preferred Network Access Commercial |
$276.00
|
| Rate for Payer: Quartz Beloit One Network |
$147.00
|
| Rate for Payer: Quartz Commercial |
$195.00
|
| Rate for Payer: Quartz Medicare Advantage |
$180.00
|
| Rate for Payer: The Alliance Commercial |
$1,200.00
|
| Rate for Payer: United Healthcare PPO |
$225.00
|
| Rate for Payer: WEA Trust Commercial |
$165.00
|
| Rate for Payer: WPS Commercial |
$222.21
|
|
|
MPL S505 Mutation
|
Professional
|
Both
|
$300.00
|
|
| Hospital Charge Code |
2942932
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$132.00 |
| Max. Negotiated Rate |
$285.00 |
| Rate for Payer: Aetna Commercial |
$285.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$258.00
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Cigna Commercial |
$285.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$150.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$180.00
|
| Rate for Payer: Health EOS Commercial |
$273.00
|
| Rate for Payer: HFN Commercial |
$285.00
|
| Rate for Payer: Multiplan Commercial |
$240.00
|
| Rate for Payer: Preferred Network Access Commercial |
$285.00
|
| Rate for Payer: Quartz Beloit One Network |
$132.00
|
| Rate for Payer: Quartz Commercial |
$171.00
|
| Rate for Payer: The Alliance Commercial |
$150.00
|
| Rate for Payer: WEA Trust Commercial |
$165.00
|
| Rate for Payer: WPS Commercial |
$222.21
|
|
|
MPL S505 Mutation
|
Facility
|
IP
|
$300.00
|
|
| Hospital Charge Code |
2942932
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$147.00 |
| Max. Negotiated Rate |
$276.00 |
| Rate for Payer: Aetna Commercial |
$270.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$258.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$159.00
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Cigna Commercial |
$276.00
|
| Rate for Payer: Health EOS Commercial |
$267.00
|
| Rate for Payer: HFN Commercial |
$276.00
|
| Rate for Payer: Multiplan Commercial |
$240.00
|
| Rate for Payer: NAPHCARE Commercial |
$180.00
|
| Rate for Payer: Preferred Network Access Commercial |
$276.00
|
| Rate for Payer: Quartz Beloit One Network |
$147.00
|
| Rate for Payer: Quartz Commercial |
$180.00
|
| Rate for Payer: WEA Trust Commercial |
$165.00
|
| Rate for Payer: WPS Commercial |
$222.21
|
|
|
MPL W515 Mutation
|
Facility
|
OP
|
$285.00
|
|
| Hospital Charge Code |
2942931
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$79.80 |
| Max. Negotiated Rate |
$1,140.00 |
| Rate for Payer: Aetna Commercial |
$256.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$245.10
|
| Rate for Payer: Aetna Managed Medicare |
$79.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$185.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$142.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$136.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$151.05
|
| Rate for Payer: Cash Price |
$85.50
|
| Rate for Payer: Cigna Commercial |
$262.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$159.49
|
| Rate for Payer: Health EOS Commercial |
$253.65
|
| Rate for Payer: HFN Commercial |
$262.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$213.75
|
| Rate for Payer: Multiplan Commercial |
$228.00
|
| Rate for Payer: NAPHCARE Commercial |
$171.00
|
| Rate for Payer: Preferred Network Access Commercial |
$262.20
|
| Rate for Payer: Quartz Beloit One Network |
$139.65
|
| Rate for Payer: Quartz Commercial |
$185.25
|
| Rate for Payer: Quartz Medicare Advantage |
$171.00
|
| Rate for Payer: The Alliance Commercial |
$1,140.00
|
| Rate for Payer: United Healthcare PPO |
$213.75
|
| Rate for Payer: WEA Trust Commercial |
$156.75
|
| Rate for Payer: WPS Commercial |
$211.10
|
|
|
MPL W515 Mutation
|
Facility
|
IP
|
$285.00
|
|
| Hospital Charge Code |
2942931
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$139.65 |
| Max. Negotiated Rate |
$262.20 |
| Rate for Payer: Aetna Commercial |
$256.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$245.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$151.05
|
| Rate for Payer: Cash Price |
$85.50
|
| Rate for Payer: Cigna Commercial |
$262.20
|
| Rate for Payer: Health EOS Commercial |
$253.65
|
| Rate for Payer: HFN Commercial |
$262.20
|
| Rate for Payer: Multiplan Commercial |
$228.00
|
| Rate for Payer: NAPHCARE Commercial |
$171.00
|
| Rate for Payer: Preferred Network Access Commercial |
$262.20
|
| Rate for Payer: Quartz Beloit One Network |
$139.65
|
| Rate for Payer: Quartz Commercial |
$171.00
|
| Rate for Payer: WEA Trust Commercial |
$156.75
|
| Rate for Payer: WPS Commercial |
$211.10
|
|
|
MPL W515 Mutation
|
Professional
|
Both
|
$285.00
|
|
| Hospital Charge Code |
2942931
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$125.40 |
| Max. Negotiated Rate |
$270.75 |
| Rate for Payer: Aetna Commercial |
$270.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$245.10
|
| Rate for Payer: Cash Price |
$85.50
|
| Rate for Payer: Cigna Commercial |
$270.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$142.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$171.00
|
| Rate for Payer: Health EOS Commercial |
$259.35
|
| Rate for Payer: HFN Commercial |
$270.75
|
| Rate for Payer: Multiplan Commercial |
$228.00
|
| Rate for Payer: Preferred Network Access Commercial |
$270.75
|
| Rate for Payer: Quartz Beloit One Network |
$125.40
|
| Rate for Payer: Quartz Commercial |
$162.45
|
| Rate for Payer: The Alliance Commercial |
$142.50
|
| Rate for Payer: WEA Trust Commercial |
$156.75
|
| Rate for Payer: WPS Commercial |
$211.10
|
|
|
MRA Abdomen w Contrast
|
Facility
|
IP
|
$6,080.00
|
|
| Hospital Charge Code |
675635
|
| Min. Negotiated Rate |
$2,979.20 |
| Max. Negotiated Rate |
$5,593.60 |
| Rate for Payer: Aetna Commercial |
$5,472.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,228.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,222.40
|
| Rate for Payer: Cash Price |
$1,824.00
|
| Rate for Payer: Cigna Commercial |
$5,593.60
|
| Rate for Payer: Health EOS Commercial |
$5,411.20
|
| Rate for Payer: HFN Commercial |
$5,593.60
|
| Rate for Payer: Multiplan Commercial |
$4,864.00
|
| Rate for Payer: NAPHCARE Commercial |
$3,648.00
|
| Rate for Payer: Preferred Network Access Commercial |
$5,593.60
|
| Rate for Payer: Quartz Beloit One Network |
$2,979.20
|
| Rate for Payer: Quartz Commercial |
$3,648.00
|
| Rate for Payer: WEA Trust Commercial |
$3,344.00
|
| Rate for Payer: WPS Commercial |
$4,503.46
|
|
|
MRA Abdomen w Contrast
|
Professional
|
Both
|
$6,080.00
|
|
| Hospital Charge Code |
675635
|
| Min. Negotiated Rate |
$2,675.20 |
| Max. Negotiated Rate |
$5,776.00 |
| Rate for Payer: Aetna Commercial |
$5,776.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,228.80
|
| Rate for Payer: Cash Price |
$1,824.00
|
| Rate for Payer: Cigna Commercial |
$5,776.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$3,040.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,648.00
|
| Rate for Payer: Health EOS Commercial |
$5,532.80
|
| Rate for Payer: HFN Commercial |
$5,776.00
|
| Rate for Payer: Multiplan Commercial |
$4,864.00
|
| Rate for Payer: Preferred Network Access Commercial |
$5,776.00
|
| Rate for Payer: Quartz Beloit One Network |
$2,675.20
|
| Rate for Payer: Quartz Commercial |
$3,465.60
|
| Rate for Payer: The Alliance Commercial |
$3,040.00
|
| Rate for Payer: WEA Trust Commercial |
$3,344.00
|
| Rate for Payer: WPS Commercial |
$4,503.46
|
|
|
MRA Abdomen w Contrast
|
Facility
|
OP
|
$6,080.00
|
|
| Hospital Charge Code |
675635
|
| Min. Negotiated Rate |
$1,702.40 |
| Max. Negotiated Rate |
$24,320.00 |
| Rate for Payer: Aetna Commercial |
$5,472.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,228.80
|
| Rate for Payer: Aetna Managed Medicare |
$1,702.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,952.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,040.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,918.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,222.40
|
| Rate for Payer: Cash Price |
$1,824.00
|
| Rate for Payer: Cigna Commercial |
$5,593.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,402.37
|
| Rate for Payer: Health EOS Commercial |
$5,411.20
|
| Rate for Payer: HFN Commercial |
$5,593.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,560.00
|
| Rate for Payer: Multiplan Commercial |
$4,864.00
|
| Rate for Payer: NAPHCARE Commercial |
$3,648.00
|
| Rate for Payer: Preferred Network Access Commercial |
$5,593.60
|
| Rate for Payer: Quartz Beloit One Network |
$2,979.20
|
| Rate for Payer: Quartz Commercial |
$3,952.00
|
| Rate for Payer: Quartz Medicare Advantage |
$3,648.00
|
| Rate for Payer: The Alliance Commercial |
$24,320.00
|
| Rate for Payer: WEA Trust Commercial |
$3,344.00
|
| Rate for Payer: WPS Commercial |
$4,503.46
|
|
|
MRA Abdomen w/ Contrast
|
Facility
|
IP
|
$6,194.00
|
|
|
Service Code
|
CPT 74185 TC
|
| Hospital Charge Code |
1610801
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$3,035.06 |
| Max. Negotiated Rate |
$5,698.48 |
| Rate for Payer: Aetna Commercial |
$5,574.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,326.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,282.82
|
| Rate for Payer: Cash Price |
$1,858.20
|
| Rate for Payer: Cigna Commercial |
$5,698.48
|
| Rate for Payer: Health EOS Commercial |
$5,512.66
|
| Rate for Payer: HFN Commercial |
$5,698.48
|
| Rate for Payer: Multiplan Commercial |
$4,955.20
|
| Rate for Payer: NAPHCARE Commercial |
$3,716.40
|
| Rate for Payer: Preferred Network Access Commercial |
$5,698.48
|
| Rate for Payer: Quartz Beloit One Network |
$3,035.06
|
| Rate for Payer: Quartz Commercial |
$3,716.40
|
| Rate for Payer: WEA Trust Commercial |
$3,406.70
|
| Rate for Payer: WPS Commercial |
$4,587.90
|
|
|
MRA Abdomen w/ Contrast
|
Facility
|
OP
|
$6,194.00
|
|
|
Service Code
|
CPT 74185 TC
|
| Hospital Charge Code |
1610801
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$380.12 |
| Max. Negotiated Rate |
$5,698.48 |
| Rate for Payer: Aetna Commercial |
$5,574.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,326.84
|
| Rate for Payer: Aetna Managed Medicare |
$380.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,496.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,871.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,726.00
|
| Rate for Payer: Anthem Medicare Advantage |
$380.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,282.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$380.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$380.12
|
| Rate for Payer: Cash Price |
$1,858.20
|
| Rate for Payer: Cash Price |
$1,858.20
|
| Rate for Payer: Cash Price |
$1,858.20
|
| Rate for Payer: Cash Price |
$1,858.20
|
| Rate for Payer: Cigna Commercial |
$5,698.48
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$380.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,466.16
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$380.12
|
| Rate for Payer: Health EOS Commercial |
$5,512.66
|
| Rate for Payer: HFN Commercial |
$5,698.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,414.05
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$380.12
|
| Rate for Payer: Independent Care Health Plan Medicare |
$380.12
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$380.12
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$380.12
|
| Rate for Payer: Multiplan Commercial |
$4,955.20
|
| Rate for Payer: NAPHCARE Commercial |
$570.18
|
| Rate for Payer: Preferred Network Access Commercial |
$5,698.48
|
| Rate for Payer: Quartz Beloit One Network |
$3,035.06
|
| Rate for Payer: Quartz Commercial |
$4,026.10
|
| Rate for Payer: Quartz Medicare Advantage |
$380.12
|
| Rate for Payer: The Alliance Commercial |
$1,520.48
|
| Rate for Payer: United Healthcare Medicare Advantage |
$380.12
|
| Rate for Payer: United Healthcare PPO |
$3,022.00
|
| Rate for Payer: WEA Trust Commercial |
$3,406.70
|
| Rate for Payer: Wellcare Medicare |
$380.12
|
| Rate for Payer: WPS Commercial |
$4,587.90
|
|
|
MRA Abdomen w/ Contrast
|
Facility
|
OP
|
$5,965.00
|
|
|
Service Code
|
CPT 74185 TC
|
| Hospital Charge Code |
3072667
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$242.20 |
| Max. Negotiated Rate |
$5,487.80 |
| Rate for Payer: Aetna Commercial |
$5,368.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,129.90
|
| Rate for Payer: Aetna Managed Medicare |
$242.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,496.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,871.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,726.00
|
| Rate for Payer: Anthem Medicare Advantage |
$242.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,161.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$242.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$242.20
|
| Rate for Payer: Cash Price |
$1,789.50
|
| Rate for Payer: Cash Price |
$1,789.50
|
| Rate for Payer: Cash Price |
$1,789.50
|
| Rate for Payer: Cash Price |
$1,789.50
|
| Rate for Payer: Cigna Commercial |
$5,487.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$242.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,338.01
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$242.20
|
| Rate for Payer: Health EOS Commercial |
$5,308.85
|
| Rate for Payer: HFN Commercial |
$5,487.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$900.98
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$242.20
|
| Rate for Payer: Independent Care Health Plan Medicare |
$242.20
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$242.20
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$242.20
|
| Rate for Payer: Multiplan Commercial |
$4,772.00
|
| Rate for Payer: NAPHCARE Commercial |
$363.30
|
| Rate for Payer: Preferred Network Access Commercial |
$5,487.80
|
| Rate for Payer: Quartz Beloit One Network |
$2,922.85
|
| Rate for Payer: Quartz Commercial |
$3,877.25
|
| Rate for Payer: Quartz Medicare Advantage |
$242.20
|
| Rate for Payer: The Alliance Commercial |
$968.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$242.20
|
| Rate for Payer: United Healthcare PPO |
$3,022.00
|
| Rate for Payer: WEA Trust Commercial |
$3,280.75
|
| Rate for Payer: Wellcare Medicare |
$242.20
|
| Rate for Payer: WPS Commercial |
$4,418.28
|
|
|
MRA Abdomen w/ Contrast
|
Professional
|
Both
|
$5,965.00
|
|
|
Service Code
|
CPT 74185 TC
|
| Hospital Charge Code |
3072667
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$991.19 |
| Max. Negotiated Rate |
$5,666.75 |
| Rate for Payer: Aetna Commercial |
$5,666.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,129.90
|
| Rate for Payer: Cash Price |
$1,789.50
|
| Rate for Payer: Cash Price |
$1,789.50
|
| Rate for Payer: Cash Price |
$1,789.50
|
| Rate for Payer: Cigna Commercial |
$5,666.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,982.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,579.00
|
| Rate for Payer: Health EOS Commercial |
$5,428.15
|
| Rate for Payer: HFN Commercial |
$5,666.75
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$991.19
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$991.19
|
| Rate for Payer: Multiplan Commercial |
$4,772.00
|
| Rate for Payer: Preferred Network Access Commercial |
$5,666.75
|
| Rate for Payer: Quartz Beloit One Network |
$2,624.60
|
| Rate for Payer: Quartz Commercial |
$3,400.05
|
| Rate for Payer: The Alliance Commercial |
$2,982.50
|
| Rate for Payer: WEA Trust Commercial |
$3,280.75
|
| Rate for Payer: WPS Commercial |
$4,418.28
|
|
|
MRA Abdomen w/ Contrast
|
Facility
|
IP
|
$5,965.00
|
|
|
Service Code
|
CPT 74185 TC
|
| Hospital Charge Code |
3072667
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$2,922.85 |
| Max. Negotiated Rate |
$5,487.80 |
| Rate for Payer: Aetna Commercial |
$5,368.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,129.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,161.45
|
| Rate for Payer: Cash Price |
$1,789.50
|
| Rate for Payer: Cigna Commercial |
$5,487.80
|
| Rate for Payer: Health EOS Commercial |
$5,308.85
|
| Rate for Payer: HFN Commercial |
$5,487.80
|
| Rate for Payer: Multiplan Commercial |
$4,772.00
|
| Rate for Payer: NAPHCARE Commercial |
$3,579.00
|
| Rate for Payer: Preferred Network Access Commercial |
$5,487.80
|
| Rate for Payer: Quartz Beloit One Network |
$2,922.85
|
| Rate for Payer: Quartz Commercial |
$3,579.00
|
| Rate for Payer: WEA Trust Commercial |
$3,280.75
|
| Rate for Payer: WPS Commercial |
$4,418.28
|
|
|
MRA Abdomen w/ Contrast
|
Professional
|
Both
|
$6,194.00
|
|
|
Service Code
|
CPT 74185 TC
|
| Hospital Charge Code |
1610801
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$991.19 |
| Max. Negotiated Rate |
$5,884.30 |
| Rate for Payer: Aetna Commercial |
$5,884.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,326.84
|
| Rate for Payer: Cash Price |
$1,858.20
|
| Rate for Payer: Cash Price |
$1,858.20
|
| Rate for Payer: Cash Price |
$1,858.20
|
| Rate for Payer: Cigna Commercial |
$5,884.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$3,097.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,716.40
|
| Rate for Payer: Health EOS Commercial |
$5,636.54
|
| Rate for Payer: HFN Commercial |
$5,884.30
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$991.19
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$991.19
|
| Rate for Payer: Multiplan Commercial |
$4,955.20
|
| Rate for Payer: Preferred Network Access Commercial |
$5,884.30
|
| Rate for Payer: Quartz Beloit One Network |
$2,725.36
|
| Rate for Payer: Quartz Commercial |
$3,530.58
|
| Rate for Payer: The Alliance Commercial |
$3,097.00
|
| Rate for Payer: WEA Trust Commercial |
$3,406.70
|
| Rate for Payer: WPS Commercial |
$4,587.90
|
|
|
MRA Abdomen w/o Contrast
|
Professional
|
Both
|
$5,703.00
|
|
| Hospital Charge Code |
675662
|
| Min. Negotiated Rate |
$2,509.32 |
| Max. Negotiated Rate |
$5,417.85 |
| Rate for Payer: Aetna Commercial |
$5,417.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,904.58
|
| Rate for Payer: Cash Price |
$1,710.90
|
| Rate for Payer: Cigna Commercial |
$5,417.85
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,851.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,421.80
|
| Rate for Payer: Health EOS Commercial |
$5,189.73
|
| Rate for Payer: HFN Commercial |
$5,417.85
|
| Rate for Payer: Multiplan Commercial |
$4,562.40
|
| Rate for Payer: Preferred Network Access Commercial |
$5,417.85
|
| Rate for Payer: Quartz Beloit One Network |
$2,509.32
|
| Rate for Payer: Quartz Commercial |
$3,250.71
|
| Rate for Payer: The Alliance Commercial |
$2,851.50
|
| Rate for Payer: WEA Trust Commercial |
$3,136.65
|
| Rate for Payer: WPS Commercial |
$4,224.21
|
|
|
MRA Abdomen w/o Contrast
|
Facility
|
IP
|
$5,703.00
|
|
| Hospital Charge Code |
675662
|
| Min. Negotiated Rate |
$2,794.47 |
| Max. Negotiated Rate |
$5,246.76 |
| Rate for Payer: Aetna Commercial |
$5,132.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,904.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,022.59
|
| Rate for Payer: Cash Price |
$1,710.90
|
| Rate for Payer: Cigna Commercial |
$5,246.76
|
| Rate for Payer: Health EOS Commercial |
$5,075.67
|
| Rate for Payer: HFN Commercial |
$5,246.76
|
| Rate for Payer: Multiplan Commercial |
$4,562.40
|
| Rate for Payer: NAPHCARE Commercial |
$3,421.80
|
| Rate for Payer: Preferred Network Access Commercial |
$5,246.76
|
| Rate for Payer: Quartz Beloit One Network |
$2,794.47
|
| Rate for Payer: Quartz Commercial |
$3,421.80
|
| Rate for Payer: WEA Trust Commercial |
$3,136.65
|
| Rate for Payer: WPS Commercial |
$4,224.21
|
|
|
MRA Abdomen w/o Contrast
|
Professional
|
Both
|
$5,595.00
|
|
|
Service Code
|
CPT 74185 TC
|
| Hospital Charge Code |
1610803
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$991.19 |
| Max. Negotiated Rate |
$5,315.25 |
| Rate for Payer: Aetna Commercial |
$5,315.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,811.70
|
| Rate for Payer: Cash Price |
$1,678.50
|
| Rate for Payer: Cash Price |
$1,678.50
|
| Rate for Payer: Cash Price |
$1,678.50
|
| Rate for Payer: Cigna Commercial |
$5,315.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,797.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,357.00
|
| Rate for Payer: Health EOS Commercial |
$5,091.45
|
| Rate for Payer: HFN Commercial |
$5,315.25
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$991.19
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$991.19
|
| Rate for Payer: Multiplan Commercial |
$4,476.00
|
| Rate for Payer: Preferred Network Access Commercial |
$5,315.25
|
| Rate for Payer: Quartz Beloit One Network |
$2,461.80
|
| Rate for Payer: Quartz Commercial |
$3,189.15
|
| Rate for Payer: The Alliance Commercial |
$2,797.50
|
| Rate for Payer: WEA Trust Commercial |
$3,077.25
|
| Rate for Payer: WPS Commercial |
$4,144.22
|
|
