|
MRA Abdomen w/o Contrast
|
Facility
|
OP
|
$5,595.00
|
|
|
Service Code
|
CPT 74185 TC
|
| Hospital Charge Code |
1610803
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$242.20 |
| Max. Negotiated Rate |
$5,147.40 |
| Rate for Payer: Aetna Commercial |
$5,035.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,811.70
|
| 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 |
$2,965.35
|
| 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 |
$1,678.50
|
| 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 |
$5,147.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$242.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,130.96
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$242.20
|
| Rate for Payer: Health EOS Commercial |
$4,979.55
|
| Rate for Payer: HFN Commercial |
$5,147.40
|
| 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 |
$4,476.00
|
| Rate for Payer: NAPHCARE Commercial |
$363.30
|
| Rate for Payer: Preferred Network Access Commercial |
$5,147.40
|
| Rate for Payer: Quartz Beloit One Network |
$2,741.55
|
| Rate for Payer: Quartz Commercial |
$3,636.75
|
| 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 |
$3,077.25
|
| Rate for Payer: Wellcare Medicare |
$242.20
|
| Rate for Payer: WPS Commercial |
$4,144.22
|
|
|
MRA Abdomen w/o Contrast
|
Facility
|
IP
|
$5,595.00
|
|
|
Service Code
|
CPT 74185 TC
|
| Hospital Charge Code |
1610803
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$2,741.55 |
| Max. Negotiated Rate |
$5,147.40 |
| Rate for Payer: Aetna Commercial |
$5,035.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,811.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,965.35
|
| Rate for Payer: Cash Price |
$1,678.50
|
| Rate for Payer: Cigna Commercial |
$5,147.40
|
| Rate for Payer: Health EOS Commercial |
$4,979.55
|
| Rate for Payer: HFN Commercial |
$5,147.40
|
| Rate for Payer: Multiplan Commercial |
$4,476.00
|
| Rate for Payer: NAPHCARE Commercial |
$3,357.00
|
| Rate for Payer: Preferred Network Access Commercial |
$5,147.40
|
| Rate for Payer: Quartz Beloit One Network |
$2,741.55
|
| Rate for Payer: Quartz Commercial |
$3,357.00
|
| Rate for Payer: WEA Trust Commercial |
$3,077.25
|
| Rate for Payer: WPS Commercial |
$4,144.22
|
|
|
MRA Abdomen w/o Contrast
|
Facility
|
OP
|
$5,703.00
|
|
| Hospital Charge Code |
675662
|
| Min. Negotiated Rate |
$1,596.84 |
| Max. Negotiated Rate |
$22,812.00 |
| Rate for Payer: Aetna Commercial |
$5,132.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,904.58
|
| Rate for Payer: Aetna Managed Medicare |
$1,596.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,706.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,851.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,737.44
|
| 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: Dean Health DHI/DHP/ASO |
$3,191.40
|
| Rate for Payer: Health EOS Commercial |
$5,075.67
|
| Rate for Payer: HFN Commercial |
$5,246.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,277.25
|
| 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 |
$3,706.95
|
| Rate for Payer: Quartz Medicare Advantage |
$3,421.80
|
| Rate for Payer: The Alliance Commercial |
$22,812.00
|
| Rate for Payer: WEA Trust Commercial |
$3,136.65
|
| Rate for Payer: WPS Commercial |
$4,224.21
|
|
|
MRA Abdomen w or w/o Contrast
|
Facility
|
IP
|
$6,327.00
|
|
|
Service Code
|
CPT 74185 TC
|
| Hospital Charge Code |
4054123
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$3,100.23 |
| Max. Negotiated Rate |
$5,820.84 |
| Rate for Payer: Aetna Commercial |
$5,694.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,441.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,353.31
|
| Rate for Payer: Cash Price |
$1,898.10
|
| Rate for Payer: Cigna Commercial |
$5,820.84
|
| Rate for Payer: Health EOS Commercial |
$5,631.03
|
| Rate for Payer: HFN Commercial |
$5,820.84
|
| Rate for Payer: Multiplan Commercial |
$5,061.60
|
| Rate for Payer: NAPHCARE Commercial |
$3,796.20
|
| Rate for Payer: Preferred Network Access Commercial |
$5,820.84
|
| Rate for Payer: Quartz Beloit One Network |
$3,100.23
|
| Rate for Payer: Quartz Commercial |
$3,796.20
|
| Rate for Payer: WEA Trust Commercial |
$3,479.85
|
| Rate for Payer: WPS Commercial |
$4,686.41
|
|
|
MRA Abdomen w or w/o Contrast
|
Professional
|
Both
|
$6,327.00
|
|
|
Service Code
|
CPT 74185 TC
|
| Hospital Charge Code |
4054123
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$991.19 |
| Max. Negotiated Rate |
$6,010.65 |
| Rate for Payer: Aetna Commercial |
$6,010.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,441.22
|
| Rate for Payer: Cash Price |
$1,898.10
|
| Rate for Payer: Cash Price |
$1,898.10
|
| Rate for Payer: Cash Price |
$1,898.10
|
| Rate for Payer: Cigna Commercial |
$6,010.65
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$3,163.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,796.20
|
| Rate for Payer: Health EOS Commercial |
$5,757.57
|
| Rate for Payer: HFN Commercial |
$6,010.65
|
| 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 |
$5,061.60
|
| Rate for Payer: Preferred Network Access Commercial |
$6,010.65
|
| Rate for Payer: Quartz Beloit One Network |
$2,783.88
|
| Rate for Payer: Quartz Commercial |
$3,606.39
|
| Rate for Payer: The Alliance Commercial |
$3,163.50
|
| Rate for Payer: WEA Trust Commercial |
$3,479.85
|
| Rate for Payer: WPS Commercial |
$4,686.41
|
|
|
MRA Abdomen w or w/o Contrast
|
Facility
|
OP
|
$6,327.00
|
|
|
Service Code
|
CPT 74185 TC
|
| Hospital Charge Code |
4054123
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,771.56 |
| Max. Negotiated Rate |
$25,308.00 |
| Rate for Payer: Aetna Commercial |
$5,694.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,441.22
|
| Rate for Payer: Aetna Managed Medicare |
$1,771.56
|
| 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: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,353.31
|
| Rate for Payer: Cash Price |
$1,898.10
|
| Rate for Payer: Cash Price |
$1,898.10
|
| Rate for Payer: Cash Price |
$1,898.10
|
| Rate for Payer: Cigna Commercial |
$5,820.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,540.59
|
| Rate for Payer: Health EOS Commercial |
$5,631.03
|
| Rate for Payer: HFN Commercial |
$5,820.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,745.25
|
| Rate for Payer: Multiplan Commercial |
$5,061.60
|
| Rate for Payer: NAPHCARE Commercial |
$3,796.20
|
| Rate for Payer: Preferred Network Access Commercial |
$5,820.84
|
| Rate for Payer: Quartz Beloit One Network |
$3,100.23
|
| Rate for Payer: Quartz Commercial |
$4,112.55
|
| Rate for Payer: Quartz Medicare Advantage |
$3,796.20
|
| Rate for Payer: The Alliance Commercial |
$25,308.00
|
| Rate for Payer: United Healthcare PPO |
$3,022.00
|
| Rate for Payer: WEA Trust Commercial |
$3,479.85
|
| Rate for Payer: WPS Commercial |
$4,686.41
|
|
|
MRA Abdomen w + w/o Contrast
|
Facility
|
IP
|
$6,450.00
|
|
| Hospital Charge Code |
675636
|
| Min. Negotiated Rate |
$3,160.50 |
| Max. Negotiated Rate |
$5,934.00 |
| Rate for Payer: Aetna Commercial |
$5,805.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,547.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,418.50
|
| Rate for Payer: Cash Price |
$1,935.00
|
| Rate for Payer: Cigna Commercial |
$5,934.00
|
| Rate for Payer: Health EOS Commercial |
$5,740.50
|
| Rate for Payer: HFN Commercial |
$5,934.00
|
| Rate for Payer: Multiplan Commercial |
$5,160.00
|
| Rate for Payer: NAPHCARE Commercial |
$3,870.00
|
| Rate for Payer: Preferred Network Access Commercial |
$5,934.00
|
| Rate for Payer: Quartz Beloit One Network |
$3,160.50
|
| Rate for Payer: Quartz Commercial |
$3,870.00
|
| Rate for Payer: WEA Trust Commercial |
$3,547.50
|
| Rate for Payer: WPS Commercial |
$4,777.52
|
|
|
MRA Abdomen w + w/o Contrast
|
Professional
|
Both
|
$6,450.00
|
|
| Hospital Charge Code |
675636
|
| Min. Negotiated Rate |
$2,838.00 |
| Max. Negotiated Rate |
$6,127.50 |
| Rate for Payer: Aetna Commercial |
$6,127.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,547.00
|
| Rate for Payer: Cash Price |
$1,935.00
|
| Rate for Payer: Cigna Commercial |
$6,127.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$3,225.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,870.00
|
| Rate for Payer: Health EOS Commercial |
$5,869.50
|
| Rate for Payer: HFN Commercial |
$6,127.50
|
| Rate for Payer: Multiplan Commercial |
$5,160.00
|
| Rate for Payer: Preferred Network Access Commercial |
$6,127.50
|
| Rate for Payer: Quartz Beloit One Network |
$2,838.00
|
| Rate for Payer: Quartz Commercial |
$3,676.50
|
| Rate for Payer: The Alliance Commercial |
$3,225.00
|
| Rate for Payer: WEA Trust Commercial |
$3,547.50
|
| Rate for Payer: WPS Commercial |
$4,777.52
|
|
|
MRA Abdomen w + w/o Contrast
|
Facility
|
OP
|
$6,450.00
|
|
| Hospital Charge Code |
675636
|
| Min. Negotiated Rate |
$1,806.00 |
| Max. Negotiated Rate |
$25,800.00 |
| Rate for Payer: Aetna Commercial |
$5,805.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,547.00
|
| Rate for Payer: Aetna Managed Medicare |
$1,806.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,192.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,225.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,096.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,418.50
|
| Rate for Payer: Cash Price |
$1,935.00
|
| Rate for Payer: Cigna Commercial |
$5,934.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,609.42
|
| Rate for Payer: Health EOS Commercial |
$5,740.50
|
| Rate for Payer: HFN Commercial |
$5,934.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,837.50
|
| Rate for Payer: Multiplan Commercial |
$5,160.00
|
| Rate for Payer: NAPHCARE Commercial |
$3,870.00
|
| Rate for Payer: Preferred Network Access Commercial |
$5,934.00
|
| Rate for Payer: Quartz Beloit One Network |
$3,160.50
|
| Rate for Payer: Quartz Commercial |
$4,192.50
|
| Rate for Payer: Quartz Medicare Advantage |
$3,870.00
|
| Rate for Payer: The Alliance Commercial |
$25,800.00
|
| Rate for Payer: WEA Trust Commercial |
$3,547.50
|
| Rate for Payer: WPS Commercial |
$4,777.52
|
|
|
MRA Abdomen w/ + w/o Contrast
|
Facility
|
OP
|
$6,327.00
|
|
|
Service Code
|
HCPCS C8902 TC
|
| Hospital Charge Code |
3072690
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$380.12 |
| Max. Negotiated Rate |
$5,820.84 |
| Rate for Payer: Aetna Commercial |
$5,694.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,441.22
|
| 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 |
$3,353.31
|
| 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 |
$1,898.10
|
| Rate for Payer: Cash Price |
$1,898.10
|
| Rate for Payer: Cash Price |
$1,898.10
|
| Rate for Payer: Cash Price |
$1,898.10
|
| Rate for Payer: Cigna Commercial |
$5,820.84
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$380.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,540.59
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$380.12
|
| Rate for Payer: Health EOS Commercial |
$5,631.03
|
| Rate for Payer: HFN Commercial |
$5,820.84
|
| 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 |
$5,061.60
|
| Rate for Payer: NAPHCARE Commercial |
$570.18
|
| Rate for Payer: Preferred Network Access Commercial |
$5,820.84
|
| Rate for Payer: Quartz Beloit One Network |
$3,100.23
|
| Rate for Payer: Quartz Commercial |
$4,112.55
|
| 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 |
$3,479.85
|
| Rate for Payer: Wellcare Medicare |
$380.12
|
| Rate for Payer: WPS Commercial |
$4,686.41
|
|
|
MRA Abdomen w/ + w/o Contrast
|
Professional
|
Both
|
$6,327.00
|
|
|
Service Code
|
HCPCS C8902 TC
|
| Hospital Charge Code |
3072690
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$2,783.88 |
| Max. Negotiated Rate |
$6,010.65 |
| Rate for Payer: Aetna Commercial |
$6,010.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,441.22
|
| Rate for Payer: Cash Price |
$1,898.10
|
| Rate for Payer: Cigna Commercial |
$6,010.65
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$3,163.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,796.20
|
| Rate for Payer: Health EOS Commercial |
$5,757.57
|
| Rate for Payer: HFN Commercial |
$6,010.65
|
| Rate for Payer: Multiplan Commercial |
$5,061.60
|
| Rate for Payer: Preferred Network Access Commercial |
$6,010.65
|
| Rate for Payer: Quartz Beloit One Network |
$2,783.88
|
| Rate for Payer: Quartz Commercial |
$3,606.39
|
| Rate for Payer: The Alliance Commercial |
$3,163.50
|
| Rate for Payer: WEA Trust Commercial |
$3,479.85
|
| Rate for Payer: WPS Commercial |
$4,686.41
|
|
|
MRA Abdomen w/ + w/o Contrast
|
Facility
|
IP
|
$6,327.00
|
|
|
Service Code
|
CPT 74185 TC
|
| Hospital Charge Code |
1610799
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$3,100.23 |
| Max. Negotiated Rate |
$5,820.84 |
| Rate for Payer: Aetna Commercial |
$5,694.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,441.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,353.31
|
| Rate for Payer: Cash Price |
$1,898.10
|
| Rate for Payer: Cigna Commercial |
$5,820.84
|
| Rate for Payer: Health EOS Commercial |
$5,631.03
|
| Rate for Payer: HFN Commercial |
$5,820.84
|
| Rate for Payer: Multiplan Commercial |
$5,061.60
|
| Rate for Payer: NAPHCARE Commercial |
$3,796.20
|
| Rate for Payer: Preferred Network Access Commercial |
$5,820.84
|
| Rate for Payer: Quartz Beloit One Network |
$3,100.23
|
| Rate for Payer: Quartz Commercial |
$3,796.20
|
| Rate for Payer: WEA Trust Commercial |
$3,479.85
|
| Rate for Payer: WPS Commercial |
$4,686.41
|
|
|
MRA Abdomen w/ + w/o Contrast
|
Professional
|
Both
|
$6,327.00
|
|
|
Service Code
|
CPT 74185 TC
|
| Hospital Charge Code |
1610799
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$991.19 |
| Max. Negotiated Rate |
$6,010.65 |
| Rate for Payer: Aetna Commercial |
$6,010.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,441.22
|
| Rate for Payer: Cash Price |
$1,898.10
|
| Rate for Payer: Cash Price |
$1,898.10
|
| Rate for Payer: Cash Price |
$1,898.10
|
| Rate for Payer: Cigna Commercial |
$6,010.65
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$3,163.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,796.20
|
| Rate for Payer: Health EOS Commercial |
$5,757.57
|
| Rate for Payer: HFN Commercial |
$6,010.65
|
| 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 |
$5,061.60
|
| Rate for Payer: Preferred Network Access Commercial |
$6,010.65
|
| Rate for Payer: Quartz Beloit One Network |
$2,783.88
|
| Rate for Payer: Quartz Commercial |
$3,606.39
|
| Rate for Payer: The Alliance Commercial |
$3,163.50
|
| Rate for Payer: WEA Trust Commercial |
$3,479.85
|
| Rate for Payer: WPS Commercial |
$4,686.41
|
|
|
MRA Abdomen w/ + w/o Contrast
|
Facility
|
OP
|
$6,327.00
|
|
|
Service Code
|
CPT 74185 TC
|
| Hospital Charge Code |
1610799
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$380.12 |
| Max. Negotiated Rate |
$5,820.84 |
| Rate for Payer: Aetna Commercial |
$5,694.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,441.22
|
| 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 |
$3,353.31
|
| 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 |
$1,898.10
|
| Rate for Payer: Cash Price |
$1,898.10
|
| Rate for Payer: Cash Price |
$1,898.10
|
| Rate for Payer: Cash Price |
$1,898.10
|
| Rate for Payer: Cigna Commercial |
$5,820.84
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$380.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,540.59
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$380.12
|
| Rate for Payer: Health EOS Commercial |
$5,631.03
|
| Rate for Payer: HFN Commercial |
$5,820.84
|
| 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 |
$5,061.60
|
| Rate for Payer: NAPHCARE Commercial |
$570.18
|
| Rate for Payer: Preferred Network Access Commercial |
$5,820.84
|
| Rate for Payer: Quartz Beloit One Network |
$3,100.23
|
| Rate for Payer: Quartz Commercial |
$4,112.55
|
| 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 |
$3,479.85
|
| Rate for Payer: Wellcare Medicare |
$380.12
|
| Rate for Payer: WPS Commercial |
$4,686.41
|
|
|
MRA Abdomen w/ + w/o Contrast
|
Facility
|
IP
|
$6,327.00
|
|
|
Service Code
|
HCPCS C8902 TC
|
| Hospital Charge Code |
3072690
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$3,100.23 |
| Max. Negotiated Rate |
$5,820.84 |
| Rate for Payer: Aetna Commercial |
$5,694.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,441.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,353.31
|
| Rate for Payer: Cash Price |
$1,898.10
|
| Rate for Payer: Cigna Commercial |
$5,820.84
|
| Rate for Payer: Health EOS Commercial |
$5,631.03
|
| Rate for Payer: HFN Commercial |
$5,820.84
|
| Rate for Payer: Multiplan Commercial |
$5,061.60
|
| Rate for Payer: NAPHCARE Commercial |
$3,796.20
|
| Rate for Payer: Preferred Network Access Commercial |
$5,820.84
|
| Rate for Payer: Quartz Beloit One Network |
$3,100.23
|
| Rate for Payer: Quartz Commercial |
$3,796.20
|
| Rate for Payer: WEA Trust Commercial |
$3,479.85
|
| Rate for Payer: WPS Commercial |
$4,686.41
|
|
|
MRA Brain w/ Contrast
|
Facility
|
IP
|
$4,679.00
|
|
|
Service Code
|
CPT 70545
|
| Hospital Charge Code |
630721
|
| Min. Negotiated Rate |
$2,292.71 |
| Max. Negotiated Rate |
$4,304.68 |
| Rate for Payer: Aetna Commercial |
$4,211.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,023.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,479.87
|
| Rate for Payer: Cash Price |
$1,403.70
|
| Rate for Payer: Cigna Commercial |
$4,304.68
|
| Rate for Payer: Health EOS Commercial |
$4,164.31
|
| Rate for Payer: HFN Commercial |
$4,304.68
|
| Rate for Payer: Multiplan Commercial |
$3,743.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,807.40
|
| Rate for Payer: Preferred Network Access Commercial |
$4,304.68
|
| Rate for Payer: Quartz Beloit One Network |
$2,292.71
|
| Rate for Payer: Quartz Commercial |
$2,807.40
|
| Rate for Payer: WEA Trust Commercial |
$2,573.45
|
| Rate for Payer: WPS Commercial |
$3,465.74
|
|
|
MRA Brain w/ Contrast
|
Professional
|
Both
|
$4,679.00
|
|
|
Service Code
|
CPT 70545
|
| Hospital Charge Code |
630721
|
| Min. Negotiated Rate |
$855.81 |
| Max. Negotiated Rate |
$4,445.05 |
| Rate for Payer: Aetna Commercial |
$4,445.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,023.94
|
| Rate for Payer: Cash Price |
$1,403.70
|
| Rate for Payer: Cash Price |
$1,403.70
|
| Rate for Payer: Cash Price |
$1,403.70
|
| Rate for Payer: Cigna Commercial |
$4,445.05
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,339.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,807.40
|
| Rate for Payer: Health EOS Commercial |
$4,257.89
|
| Rate for Payer: HFN Commercial |
$4,445.05
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$855.81
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$855.81
|
| Rate for Payer: Multiplan Commercial |
$3,743.20
|
| Rate for Payer: Preferred Network Access Commercial |
$4,445.05
|
| Rate for Payer: Quartz Beloit One Network |
$2,058.76
|
| Rate for Payer: Quartz Commercial |
$2,667.03
|
| Rate for Payer: The Alliance Commercial |
$2,339.50
|
| Rate for Payer: WEA Trust Commercial |
$2,573.45
|
| Rate for Payer: WPS Commercial |
$3,465.74
|
|
|
MRA Brain w/ Contrast
|
Facility
|
OP
|
$4,679.00
|
|
|
Service Code
|
CPT 70545
|
| Hospital Charge Code |
630721
|
| Min. Negotiated Rate |
$380.12 |
| Max. Negotiated Rate |
$4,304.68 |
| Rate for Payer: Aetna Commercial |
$4,211.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,023.94
|
| Rate for Payer: Aetna Managed Medicare |
$380.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,041.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,339.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,245.92
|
| Rate for Payer: Anthem Medicare Advantage |
$380.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,479.87
|
| 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 |
$1,403.70
|
| Rate for Payer: Cash Price |
$1,403.70
|
| Rate for Payer: Cigna Commercial |
$4,304.68
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$380.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,618.37
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$380.12
|
| Rate for Payer: Health EOS Commercial |
$4,164.31
|
| Rate for Payer: HFN Commercial |
$4,304.68
|
| 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 |
$3,743.20
|
| Rate for Payer: NAPHCARE Commercial |
$570.18
|
| Rate for Payer: Preferred Network Access Commercial |
$4,304.68
|
| Rate for Payer: Quartz Beloit One Network |
$2,292.71
|
| Rate for Payer: Quartz Commercial |
$3,041.35
|
| 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: WEA Trust Commercial |
$2,573.45
|
| Rate for Payer: Wellcare Medicare |
$380.12
|
| Rate for Payer: WPS Commercial |
$3,465.74
|
|
|
MRA Carotids w/ Contrast
|
Professional
|
Both
|
$6,216.00
|
|
|
Service Code
|
CPT 70548 TC
|
| Hospital Charge Code |
5965680
|
|
Hospital Revenue Code
|
615
|
| Min. Negotiated Rate |
$671.37 |
| Max. Negotiated Rate |
$5,905.20 |
| Rate for Payer: Aetna Commercial |
$5,905.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,345.76
|
| Rate for Payer: Cash Price |
$1,864.80
|
| Rate for Payer: Cash Price |
$1,864.80
|
| Rate for Payer: Cash Price |
$1,864.80
|
| Rate for Payer: Cigna Commercial |
$5,905.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$3,108.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,729.60
|
| Rate for Payer: Health EOS Commercial |
$5,656.56
|
| Rate for Payer: HFN Commercial |
$5,905.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$671.37
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$671.37
|
| Rate for Payer: Multiplan Commercial |
$4,972.80
|
| Rate for Payer: Preferred Network Access Commercial |
$5,905.20
|
| Rate for Payer: Quartz Beloit One Network |
$2,735.04
|
| Rate for Payer: Quartz Commercial |
$3,543.12
|
| Rate for Payer: The Alliance Commercial |
$3,108.00
|
| Rate for Payer: WEA Trust Commercial |
$3,418.80
|
| Rate for Payer: WPS Commercial |
$4,604.19
|
|
|
MRA Carotids w/ Contrast
|
Facility
|
OP
|
$6,216.00
|
|
|
Service Code
|
CPT 70548 TC
|
| Hospital Charge Code |
5965680
|
|
Hospital Revenue Code
|
615
|
| Min. Negotiated Rate |
$380.12 |
| Max. Negotiated Rate |
$5,718.72 |
| Rate for Payer: Aetna Commercial |
$5,594.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,345.76
|
| 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 |
$3,294.48
|
| 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 |
$1,864.80
|
| Rate for Payer: Cash Price |
$1,864.80
|
| Rate for Payer: Cash Price |
$1,864.80
|
| Rate for Payer: Cash Price |
$1,864.80
|
| Rate for Payer: Cigna Commercial |
$5,718.72
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$380.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,478.47
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$380.12
|
| Rate for Payer: Health EOS Commercial |
$5,532.24
|
| Rate for Payer: HFN Commercial |
$5,718.72
|
| 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 |
$4,972.80
|
| Rate for Payer: NAPHCARE Commercial |
$570.18
|
| Rate for Payer: Preferred Network Access Commercial |
$5,718.72
|
| Rate for Payer: Quartz Beloit One Network |
$3,045.84
|
| Rate for Payer: Quartz Commercial |
$4,040.40
|
| 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 |
$3,418.80
|
| Rate for Payer: Wellcare Medicare |
$380.12
|
| Rate for Payer: WPS Commercial |
$4,604.19
|
|
|
MRA Carotids w/ Contrast
|
Facility
|
IP
|
$6,216.00
|
|
|
Service Code
|
CPT 70548 TC
|
| Hospital Charge Code |
5965680
|
|
Hospital Revenue Code
|
615
|
| Min. Negotiated Rate |
$3,045.84 |
| Max. Negotiated Rate |
$5,718.72 |
| Rate for Payer: Aetna Commercial |
$5,594.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,345.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,294.48
|
| Rate for Payer: Cash Price |
$1,864.80
|
| Rate for Payer: Cigna Commercial |
$5,718.72
|
| Rate for Payer: Health EOS Commercial |
$5,532.24
|
| Rate for Payer: HFN Commercial |
$5,718.72
|
| Rate for Payer: Multiplan Commercial |
$4,972.80
|
| Rate for Payer: NAPHCARE Commercial |
$3,729.60
|
| Rate for Payer: Preferred Network Access Commercial |
$5,718.72
|
| Rate for Payer: Quartz Beloit One Network |
$3,045.84
|
| Rate for Payer: Quartz Commercial |
$3,729.60
|
| Rate for Payer: WEA Trust Commercial |
$3,418.80
|
| Rate for Payer: WPS Commercial |
$4,604.19
|
|
|
MRA Chest w Contrast
|
Facility
|
OP
|
$6,520.00
|
|
| Hospital Charge Code |
675638
|
| Min. Negotiated Rate |
$1,825.60 |
| Max. Negotiated Rate |
$26,080.00 |
| Rate for Payer: Aetna Commercial |
$5,868.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,607.20
|
| Rate for Payer: Aetna Managed Medicare |
$1,825.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,238.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,260.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,129.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,455.60
|
| Rate for Payer: Cash Price |
$1,956.00
|
| Rate for Payer: Cigna Commercial |
$5,998.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,648.59
|
| Rate for Payer: Health EOS Commercial |
$5,802.80
|
| Rate for Payer: HFN Commercial |
$5,998.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,890.00
|
| Rate for Payer: Multiplan Commercial |
$5,216.00
|
| Rate for Payer: NAPHCARE Commercial |
$3,912.00
|
| Rate for Payer: Preferred Network Access Commercial |
$5,998.40
|
| Rate for Payer: Quartz Beloit One Network |
$3,194.80
|
| Rate for Payer: Quartz Commercial |
$4,238.00
|
| Rate for Payer: Quartz Medicare Advantage |
$3,912.00
|
| Rate for Payer: The Alliance Commercial |
$26,080.00
|
| Rate for Payer: WEA Trust Commercial |
$3,586.00
|
| Rate for Payer: WPS Commercial |
$4,829.36
|
|
|
MRA Chest w Contrast
|
Facility
|
IP
|
$6,520.00
|
|
| Hospital Charge Code |
675638
|
| Min. Negotiated Rate |
$3,194.80 |
| Max. Negotiated Rate |
$5,998.40 |
| Rate for Payer: Aetna Commercial |
$5,868.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,607.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,455.60
|
| Rate for Payer: Cash Price |
$1,956.00
|
| Rate for Payer: Cigna Commercial |
$5,998.40
|
| Rate for Payer: Health EOS Commercial |
$5,802.80
|
| Rate for Payer: HFN Commercial |
$5,998.40
|
| Rate for Payer: Multiplan Commercial |
$5,216.00
|
| Rate for Payer: NAPHCARE Commercial |
$3,912.00
|
| Rate for Payer: Preferred Network Access Commercial |
$5,998.40
|
| Rate for Payer: Quartz Beloit One Network |
$3,194.80
|
| Rate for Payer: Quartz Commercial |
$3,912.00
|
| Rate for Payer: WEA Trust Commercial |
$3,586.00
|
| Rate for Payer: WPS Commercial |
$4,829.36
|
|
|
MRA Chest w Contrast
|
Professional
|
Both
|
$6,520.00
|
|
| Hospital Charge Code |
675638
|
| Min. Negotiated Rate |
$2,868.80 |
| Max. Negotiated Rate |
$6,194.00 |
| Rate for Payer: Aetna Commercial |
$6,194.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,607.20
|
| Rate for Payer: Cash Price |
$1,956.00
|
| Rate for Payer: Cigna Commercial |
$6,194.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$3,260.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,912.00
|
| Rate for Payer: Health EOS Commercial |
$5,933.20
|
| Rate for Payer: HFN Commercial |
$6,194.00
|
| Rate for Payer: Multiplan Commercial |
$5,216.00
|
| Rate for Payer: Preferred Network Access Commercial |
$6,194.00
|
| Rate for Payer: Quartz Beloit One Network |
$2,868.80
|
| Rate for Payer: Quartz Commercial |
$3,716.40
|
| Rate for Payer: The Alliance Commercial |
$3,260.00
|
| Rate for Payer: WEA Trust Commercial |
$3,586.00
|
| Rate for Payer: WPS Commercial |
$4,829.36
|
|
|
MRA Chest w/ Contrast
|
Professional
|
Both
|
$6,642.00
|
|
|
Service Code
|
CPT 71555 TC
|
| Hospital Charge Code |
1610819
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$980.74 |
| Max. Negotiated Rate |
$6,309.90 |
| Rate for Payer: Aetna Commercial |
$6,309.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,712.12
|
| Rate for Payer: Cash Price |
$1,992.60
|
| Rate for Payer: Cash Price |
$1,992.60
|
| Rate for Payer: Cash Price |
$1,992.60
|
| Rate for Payer: Cigna Commercial |
$6,309.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$3,321.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,985.20
|
| Rate for Payer: Health EOS Commercial |
$6,044.22
|
| Rate for Payer: HFN Commercial |
$6,309.90
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$980.74
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$980.74
|
| Rate for Payer: Multiplan Commercial |
$5,313.60
|
| Rate for Payer: Preferred Network Access Commercial |
$6,309.90
|
| Rate for Payer: Quartz Beloit One Network |
$2,922.48
|
| Rate for Payer: Quartz Commercial |
$3,785.94
|
| Rate for Payer: The Alliance Commercial |
$3,321.00
|
| Rate for Payer: WEA Trust Commercial |
$3,653.10
|
| Rate for Payer: WPS Commercial |
$4,919.73
|
|
