|
MRA Chest w/ Contrast
|
Facility
|
IP
|
$6,642.00
|
|
|
Service Code
|
CPT 71555 TC
|
| Hospital Charge Code |
1610819
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$3,254.58 |
| Max. Negotiated Rate |
$6,110.64 |
| Rate for Payer: Aetna Commercial |
$5,977.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,712.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,520.26
|
| Rate for Payer: Cash Price |
$1,992.60
|
| Rate for Payer: Cigna Commercial |
$6,110.64
|
| Rate for Payer: Health EOS Commercial |
$5,911.38
|
| Rate for Payer: HFN Commercial |
$6,110.64
|
| Rate for Payer: Multiplan Commercial |
$5,313.60
|
| Rate for Payer: NAPHCARE Commercial |
$3,985.20
|
| Rate for Payer: Preferred Network Access Commercial |
$6,110.64
|
| Rate for Payer: Quartz Beloit One Network |
$3,254.58
|
| Rate for Payer: Quartz Commercial |
$3,985.20
|
| Rate for Payer: WEA Trust Commercial |
$3,653.10
|
| Rate for Payer: WPS Commercial |
$4,919.73
|
|
|
MRA Chest w/ Contrast
|
Facility
|
OP
|
$6,642.00
|
|
|
Service Code
|
CPT 71555 TC
|
| Hospital Charge Code |
1610819
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$242.20 |
| Max. Negotiated Rate |
$6,110.64 |
| Rate for Payer: Aetna Commercial |
$5,977.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,712.12
|
| 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 |
$3,520.26
|
| 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 |
$1,992.60
|
| 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 |
$6,110.64
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$242.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,716.86
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$242.20
|
| Rate for Payer: Health EOS Commercial |
$5,911.38
|
| Rate for Payer: HFN Commercial |
$6,110.64
|
| 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 |
$5,313.60
|
| Rate for Payer: NAPHCARE Commercial |
$363.30
|
| Rate for Payer: Preferred Network Access Commercial |
$6,110.64
|
| Rate for Payer: Quartz Beloit One Network |
$3,254.58
|
| Rate for Payer: Quartz Commercial |
$4,317.30
|
| 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 |
$3,653.10
|
| Rate for Payer: Wellcare Medicare |
$242.20
|
| Rate for Payer: WPS Commercial |
$4,919.73
|
|
|
MRA Chest w/o Contrast
|
Professional
|
Both
|
$5,965.00
|
|
|
Service Code
|
CPT 71555 TC
|
| Hospital Charge Code |
1610821
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$980.74 |
| 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 |
$980.74
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$980.74
|
| 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 Chest w/o Contrast
|
Facility
|
IP
|
$5,965.00
|
|
|
Service Code
|
CPT 71555 TC
|
| Hospital Charge Code |
1610821
|
|
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 Chest w/o Contrast
|
Facility
|
OP
|
$5,965.00
|
|
|
Service Code
|
CPT 71555 TC
|
| Hospital Charge Code |
1610821
|
|
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 Chest w/o Contrast
|
Professional
|
Both
|
$6,080.00
|
|
| Hospital Charge Code |
675664
|
| 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 Chest w/o Contrast
|
Facility
|
OP
|
$6,080.00
|
|
| Hospital Charge Code |
675664
|
| 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 Chest w/o Contrast
|
Facility
|
IP
|
$6,080.00
|
|
| Hospital Charge Code |
675664
|
| 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 Chest w + w/o Contrast
|
Professional
|
Both
|
$7,771.00
|
|
| Hospital Charge Code |
675637
|
| Min. Negotiated Rate |
$3,419.24 |
| Max. Negotiated Rate |
$7,382.45 |
| Rate for Payer: Aetna Commercial |
$7,382.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,683.06
|
| Rate for Payer: Cash Price |
$2,331.30
|
| Rate for Payer: Cigna Commercial |
$7,382.45
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$3,885.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,662.60
|
| Rate for Payer: Health EOS Commercial |
$7,071.61
|
| Rate for Payer: HFN Commercial |
$7,382.45
|
| Rate for Payer: Multiplan Commercial |
$6,216.80
|
| Rate for Payer: Preferred Network Access Commercial |
$7,382.45
|
| Rate for Payer: Quartz Beloit One Network |
$3,419.24
|
| Rate for Payer: Quartz Commercial |
$4,429.47
|
| Rate for Payer: The Alliance Commercial |
$3,885.50
|
| Rate for Payer: WEA Trust Commercial |
$4,274.05
|
| Rate for Payer: WPS Commercial |
$5,755.98
|
|
|
MRA Chest w + w/o Contrast
|
Facility
|
OP
|
$7,771.00
|
|
| Hospital Charge Code |
675637
|
| Min. Negotiated Rate |
$2,175.88 |
| Max. Negotiated Rate |
$31,084.00 |
| Rate for Payer: Aetna Commercial |
$6,993.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,683.06
|
| Rate for Payer: Aetna Managed Medicare |
$2,175.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,051.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,885.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,730.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,118.63
|
| Rate for Payer: Cash Price |
$2,331.30
|
| Rate for Payer: Cigna Commercial |
$7,149.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,348.65
|
| Rate for Payer: Health EOS Commercial |
$6,916.19
|
| Rate for Payer: HFN Commercial |
$7,149.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,828.25
|
| Rate for Payer: Multiplan Commercial |
$6,216.80
|
| Rate for Payer: NAPHCARE Commercial |
$4,662.60
|
| Rate for Payer: Preferred Network Access Commercial |
$7,149.32
|
| Rate for Payer: Quartz Beloit One Network |
$3,807.79
|
| Rate for Payer: Quartz Commercial |
$5,051.15
|
| Rate for Payer: Quartz Medicare Advantage |
$4,662.60
|
| Rate for Payer: The Alliance Commercial |
$31,084.00
|
| Rate for Payer: WEA Trust Commercial |
$4,274.05
|
| Rate for Payer: WPS Commercial |
$5,755.98
|
|
|
MRA Chest w + w/o Contrast
|
Facility
|
IP
|
$7,771.00
|
|
| Hospital Charge Code |
675637
|
| Min. Negotiated Rate |
$3,807.79 |
| Max. Negotiated Rate |
$7,149.32 |
| Rate for Payer: Aetna Commercial |
$6,993.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,683.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,118.63
|
| Rate for Payer: Cash Price |
$2,331.30
|
| Rate for Payer: Cigna Commercial |
$7,149.32
|
| Rate for Payer: Health EOS Commercial |
$6,916.19
|
| Rate for Payer: HFN Commercial |
$7,149.32
|
| Rate for Payer: Multiplan Commercial |
$6,216.80
|
| Rate for Payer: NAPHCARE Commercial |
$4,662.60
|
| Rate for Payer: Preferred Network Access Commercial |
$7,149.32
|
| Rate for Payer: Quartz Beloit One Network |
$3,807.79
|
| Rate for Payer: Quartz Commercial |
$4,662.60
|
| Rate for Payer: WEA Trust Commercial |
$4,274.05
|
| Rate for Payer: WPS Commercial |
$5,755.98
|
|
|
MRA Chest w/ + w/o Contrast
|
Facility
|
OP
|
$7,625.00
|
|
|
Service Code
|
CPT 71555 TC
|
| Hospital Charge Code |
1610817
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$380.12 |
| Max. Negotiated Rate |
$7,015.00 |
| Rate for Payer: Aetna Commercial |
$6,862.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,557.50
|
| 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 |
$4,041.25
|
| 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 |
$2,287.50
|
| Rate for Payer: Cash Price |
$2,287.50
|
| Rate for Payer: Cash Price |
$2,287.50
|
| Rate for Payer: Cash Price |
$2,287.50
|
| Rate for Payer: Cigna Commercial |
$7,015.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$380.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,266.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$380.12
|
| Rate for Payer: Health EOS Commercial |
$6,786.25
|
| Rate for Payer: HFN Commercial |
$7,015.00
|
| 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 |
$6,100.00
|
| Rate for Payer: NAPHCARE Commercial |
$570.18
|
| Rate for Payer: Preferred Network Access Commercial |
$7,015.00
|
| Rate for Payer: Quartz Beloit One Network |
$3,736.25
|
| Rate for Payer: Quartz Commercial |
$4,956.25
|
| 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 |
$4,193.75
|
| Rate for Payer: Wellcare Medicare |
$380.12
|
| Rate for Payer: WPS Commercial |
$5,647.84
|
|
|
MRA Chest w/ + w/o Contrast
|
Facility
|
IP
|
$7,625.00
|
|
|
Service Code
|
CPT 71555 TC
|
| Hospital Charge Code |
1610817
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$3,736.25 |
| Max. Negotiated Rate |
$7,015.00 |
| Rate for Payer: Aetna Commercial |
$6,862.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,557.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,041.25
|
| Rate for Payer: Cash Price |
$2,287.50
|
| Rate for Payer: Cigna Commercial |
$7,015.00
|
| Rate for Payer: Health EOS Commercial |
$6,786.25
|
| Rate for Payer: HFN Commercial |
$7,015.00
|
| Rate for Payer: Multiplan Commercial |
$6,100.00
|
| Rate for Payer: NAPHCARE Commercial |
$4,575.00
|
| Rate for Payer: Preferred Network Access Commercial |
$7,015.00
|
| Rate for Payer: Quartz Beloit One Network |
$3,736.25
|
| Rate for Payer: Quartz Commercial |
$4,575.00
|
| Rate for Payer: WEA Trust Commercial |
$4,193.75
|
| Rate for Payer: WPS Commercial |
$5,647.84
|
|
|
MRA Chest w/ + w/o Contrast
|
Professional
|
Both
|
$7,625.00
|
|
|
Service Code
|
CPT 71555 TC
|
| Hospital Charge Code |
1610817
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$980.74 |
| Max. Negotiated Rate |
$7,243.75 |
| Rate for Payer: Aetna Commercial |
$7,243.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,557.50
|
| Rate for Payer: Cash Price |
$2,287.50
|
| Rate for Payer: Cash Price |
$2,287.50
|
| Rate for Payer: Cash Price |
$2,287.50
|
| Rate for Payer: Cigna Commercial |
$7,243.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$3,812.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,575.00
|
| Rate for Payer: Health EOS Commercial |
$6,938.75
|
| Rate for Payer: HFN Commercial |
$7,243.75
|
| 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 |
$6,100.00
|
| Rate for Payer: Preferred Network Access Commercial |
$7,243.75
|
| Rate for Payer: Quartz Beloit One Network |
$3,355.00
|
| Rate for Payer: Quartz Commercial |
$4,346.25
|
| Rate for Payer: The Alliance Commercial |
$3,812.50
|
| Rate for Payer: WEA Trust Commercial |
$4,193.75
|
| Rate for Payer: WPS Commercial |
$5,647.84
|
|
|
MRA Head w/ Contrast
|
Facility
|
OP
|
$6,015.00
|
|
|
Service Code
|
CPT 70545 TC
|
| Hospital Charge Code |
1610825
|
|
Hospital Revenue Code
|
615
|
| Min. Negotiated Rate |
$380.12 |
| Max. Negotiated Rate |
$5,533.80 |
| Rate for Payer: Aetna Commercial |
$5,413.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,172.90
|
| 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 |
$3,187.95
|
| 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 |
$1,804.50
|
| Rate for Payer: Cash Price |
$1,804.50
|
| Rate for Payer: Cash Price |
$1,804.50
|
| Rate for Payer: Cash Price |
$1,804.50
|
| Rate for Payer: Cigna Commercial |
$5,533.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$380.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,365.99
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$380.12
|
| Rate for Payer: Health EOS Commercial |
$5,353.35
|
| Rate for Payer: HFN Commercial |
$5,533.80
|
| 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 |
$4,812.00
|
| Rate for Payer: NAPHCARE Commercial |
$570.18
|
| Rate for Payer: Preferred Network Access Commercial |
$5,533.80
|
| Rate for Payer: Quartz Beloit One Network |
$2,947.35
|
| Rate for Payer: Quartz Commercial |
$3,909.75
|
| 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 |
$3,308.25
|
| Rate for Payer: Wellcare Medicare |
$380.12
|
| Rate for Payer: WPS Commercial |
$4,455.31
|
|
|
MRA Head w/ Contrast
|
Professional
|
Both
|
$6,015.00
|
|
|
Service Code
|
CPT 70545 TC
|
| Hospital Charge Code |
1610825
|
|
Hospital Revenue Code
|
615
|
| Min. Negotiated Rate |
$656.30 |
| Max. Negotiated Rate |
$5,714.25 |
| Rate for Payer: Aetna Commercial |
$5,714.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,172.90
|
| Rate for Payer: Cash Price |
$1,804.50
|
| Rate for Payer: Cash Price |
$1,804.50
|
| Rate for Payer: Cash Price |
$1,804.50
|
| Rate for Payer: Cigna Commercial |
$5,714.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$3,007.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,609.00
|
| Rate for Payer: Health EOS Commercial |
$5,473.65
|
| Rate for Payer: HFN Commercial |
$5,714.25
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$656.30
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$656.30
|
| Rate for Payer: Multiplan Commercial |
$4,812.00
|
| Rate for Payer: Preferred Network Access Commercial |
$5,714.25
|
| Rate for Payer: Quartz Beloit One Network |
$2,646.60
|
| Rate for Payer: Quartz Commercial |
$3,428.55
|
| Rate for Payer: The Alliance Commercial |
$3,007.50
|
| Rate for Payer: WEA Trust Commercial |
$3,308.25
|
| Rate for Payer: WPS Commercial |
$4,455.31
|
|
|
MRA Head w/ Contrast
|
Facility
|
IP
|
$6,015.00
|
|
|
Service Code
|
CPT 70545 TC
|
| Hospital Charge Code |
1610825
|
|
Hospital Revenue Code
|
615
|
| Min. Negotiated Rate |
$2,947.35 |
| Max. Negotiated Rate |
$5,533.80 |
| Rate for Payer: Aetna Commercial |
$5,413.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,172.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,187.95
|
| Rate for Payer: Cash Price |
$1,804.50
|
| Rate for Payer: Cigna Commercial |
$5,533.80
|
| Rate for Payer: Health EOS Commercial |
$5,353.35
|
| Rate for Payer: HFN Commercial |
$5,533.80
|
| Rate for Payer: Multiplan Commercial |
$4,812.00
|
| Rate for Payer: NAPHCARE Commercial |
$3,609.00
|
| Rate for Payer: Preferred Network Access Commercial |
$5,533.80
|
| Rate for Payer: Quartz Beloit One Network |
$2,947.35
|
| Rate for Payer: Quartz Commercial |
$3,609.00
|
| Rate for Payer: WEA Trust Commercial |
$3,308.25
|
| Rate for Payer: WPS Commercial |
$4,455.31
|
|
|
MRA Head w/o Contrast
|
Professional
|
Both
|
$4,293.00
|
|
|
Service Code
|
CPT 70544 TC
|
| Hospital Charge Code |
3073259
|
|
Hospital Revenue Code
|
615
|
| Min. Negotiated Rate |
$613.37 |
| Max. Negotiated Rate |
$4,078.35 |
| Rate for Payer: Aetna Commercial |
$4,078.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,691.98
|
| Rate for Payer: Cash Price |
$1,287.90
|
| Rate for Payer: Cash Price |
$1,287.90
|
| Rate for Payer: Cash Price |
$1,287.90
|
| Rate for Payer: Cigna Commercial |
$4,078.35
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,146.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,575.80
|
| Rate for Payer: Health EOS Commercial |
$3,906.63
|
| Rate for Payer: HFN Commercial |
$4,078.35
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$613.37
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$613.37
|
| Rate for Payer: Multiplan Commercial |
$3,434.40
|
| Rate for Payer: Preferred Network Access Commercial |
$4,078.35
|
| Rate for Payer: Quartz Beloit One Network |
$1,888.92
|
| Rate for Payer: Quartz Commercial |
$2,447.01
|
| Rate for Payer: The Alliance Commercial |
$2,146.50
|
| Rate for Payer: WEA Trust Commercial |
$2,361.15
|
| Rate for Payer: WPS Commercial |
$3,179.83
|
|
|
MRA Head w/o Contrast
|
Professional
|
Both
|
$4,293.00
|
|
|
Service Code
|
CPT 70544 TC
|
| Hospital Charge Code |
3072651
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$613.37 |
| Max. Negotiated Rate |
$4,078.35 |
| Rate for Payer: Aetna Commercial |
$4,078.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,691.98
|
| Rate for Payer: Cash Price |
$1,287.90
|
| Rate for Payer: Cash Price |
$1,287.90
|
| Rate for Payer: Cash Price |
$1,287.90
|
| Rate for Payer: Cigna Commercial |
$4,078.35
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,146.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,575.80
|
| Rate for Payer: Health EOS Commercial |
$3,906.63
|
| Rate for Payer: HFN Commercial |
$4,078.35
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$613.37
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$613.37
|
| Rate for Payer: Multiplan Commercial |
$3,434.40
|
| Rate for Payer: Preferred Network Access Commercial |
$4,078.35
|
| Rate for Payer: Quartz Beloit One Network |
$1,888.92
|
| Rate for Payer: Quartz Commercial |
$2,447.01
|
| Rate for Payer: The Alliance Commercial |
$2,146.50
|
| Rate for Payer: WEA Trust Commercial |
$2,361.15
|
| Rate for Payer: WPS Commercial |
$3,179.83
|
|
|
MRA Head w/o Contrast
|
Facility
|
IP
|
$4,293.00
|
|
|
Service Code
|
CPT 70544 TC
|
| Hospital Charge Code |
3072651
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$2,103.57 |
| Max. Negotiated Rate |
$3,949.56 |
| Rate for Payer: Aetna Commercial |
$3,863.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,691.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,275.29
|
| Rate for Payer: Cash Price |
$1,287.90
|
| Rate for Payer: Cigna Commercial |
$3,949.56
|
| Rate for Payer: Health EOS Commercial |
$3,820.77
|
| Rate for Payer: HFN Commercial |
$3,949.56
|
| Rate for Payer: Multiplan Commercial |
$3,434.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,575.80
|
| Rate for Payer: Preferred Network Access Commercial |
$3,949.56
|
| Rate for Payer: Quartz Beloit One Network |
$2,103.57
|
| Rate for Payer: Quartz Commercial |
$2,575.80
|
| Rate for Payer: WEA Trust Commercial |
$2,361.15
|
| Rate for Payer: WPS Commercial |
$3,179.83
|
|
|
MRA Head w/o Contrast
|
Facility
|
OP
|
$4,293.00
|
|
|
Service Code
|
CPT 70544 TC
|
| Hospital Charge Code |
3073259
|
|
Hospital Revenue Code
|
615
|
| Min. Negotiated Rate |
$242.20 |
| Max. Negotiated Rate |
$3,949.56 |
| Rate for Payer: Aetna Commercial |
$3,863.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,691.98
|
| 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 |
$2,275.29
|
| 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 |
$1,287.90
|
| Rate for Payer: Cash Price |
$1,287.90
|
| Rate for Payer: Cash Price |
$1,287.90
|
| Rate for Payer: Cash Price |
$1,287.90
|
| Rate for Payer: Cigna Commercial |
$3,949.56
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$242.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,402.36
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$242.20
|
| Rate for Payer: Health EOS Commercial |
$3,820.77
|
| Rate for Payer: HFN Commercial |
$3,949.56
|
| 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 |
$3,434.40
|
| Rate for Payer: NAPHCARE Commercial |
$363.30
|
| Rate for Payer: Preferred Network Access Commercial |
$3,949.56
|
| Rate for Payer: Quartz Beloit One Network |
$2,103.57
|
| Rate for Payer: Quartz Commercial |
$2,790.45
|
| 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 |
$2,361.15
|
| Rate for Payer: Wellcare Medicare |
$242.20
|
| Rate for Payer: WPS Commercial |
$3,179.83
|
|
|
MRA Head w/o Contrast
|
Facility
|
IP
|
$4,293.00
|
|
|
Service Code
|
CPT 70544 TC
|
| Hospital Charge Code |
3073259
|
|
Hospital Revenue Code
|
615
|
| Min. Negotiated Rate |
$2,103.57 |
| Max. Negotiated Rate |
$3,949.56 |
| Rate for Payer: Aetna Commercial |
$3,863.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,691.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,275.29
|
| Rate for Payer: Cash Price |
$1,287.90
|
| Rate for Payer: Cigna Commercial |
$3,949.56
|
| Rate for Payer: Health EOS Commercial |
$3,820.77
|
| Rate for Payer: HFN Commercial |
$3,949.56
|
| Rate for Payer: Multiplan Commercial |
$3,434.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,575.80
|
| Rate for Payer: Preferred Network Access Commercial |
$3,949.56
|
| Rate for Payer: Quartz Beloit One Network |
$2,103.57
|
| Rate for Payer: Quartz Commercial |
$2,575.80
|
| Rate for Payer: WEA Trust Commercial |
$2,361.15
|
| Rate for Payer: WPS Commercial |
$3,179.83
|
|
|
MRA Head w/o Contrast
|
Facility
|
OP
|
$4,293.00
|
|
|
Service Code
|
CPT 70544 TC
|
| Hospital Charge Code |
3072651
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$242.20 |
| Max. Negotiated Rate |
$3,949.56 |
| Rate for Payer: Aetna Commercial |
$3,863.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,691.98
|
| 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 |
$2,275.29
|
| 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 |
$1,287.90
|
| Rate for Payer: Cash Price |
$1,287.90
|
| Rate for Payer: Cash Price |
$1,287.90
|
| Rate for Payer: Cash Price |
$1,287.90
|
| Rate for Payer: Cigna Commercial |
$3,949.56
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$242.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,402.36
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$242.20
|
| Rate for Payer: Health EOS Commercial |
$3,820.77
|
| Rate for Payer: HFN Commercial |
$3,949.56
|
| 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 |
$3,434.40
|
| Rate for Payer: NAPHCARE Commercial |
$363.30
|
| Rate for Payer: Preferred Network Access Commercial |
$3,949.56
|
| Rate for Payer: Quartz Beloit One Network |
$2,103.57
|
| Rate for Payer: Quartz Commercial |
$2,790.45
|
| 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 |
$2,361.15
|
| Rate for Payer: Wellcare Medicare |
$242.20
|
| Rate for Payer: WPS Commercial |
$3,179.83
|
|
|
MRA LE w or w/o Contrast
|
Professional
|
Both
|
$4,802.00
|
|
|
Service Code
|
CPT 73725 TC
|
| Hospital Charge Code |
4054124
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$984.23 |
| Max. Negotiated Rate |
$4,561.90 |
| Rate for Payer: Aetna Commercial |
$4,561.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,129.72
|
| Rate for Payer: Cash Price |
$1,440.60
|
| Rate for Payer: Cash Price |
$1,440.60
|
| Rate for Payer: Cash Price |
$1,440.60
|
| Rate for Payer: Cigna Commercial |
$4,561.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,401.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,881.20
|
| Rate for Payer: Health EOS Commercial |
$4,369.82
|
| Rate for Payer: HFN Commercial |
$4,561.90
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$984.23
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$984.23
|
| Rate for Payer: Multiplan Commercial |
$3,841.60
|
| Rate for Payer: Preferred Network Access Commercial |
$4,561.90
|
| Rate for Payer: Quartz Beloit One Network |
$2,112.88
|
| Rate for Payer: Quartz Commercial |
$2,737.14
|
| Rate for Payer: The Alliance Commercial |
$2,401.00
|
| Rate for Payer: WEA Trust Commercial |
$2,641.10
|
| Rate for Payer: WPS Commercial |
$3,556.84
|
|
|
MRA LE w or w/o Contrast
|
Facility
|
OP
|
$4,802.00
|
|
|
Service Code
|
CPT 73725 TC
|
| Hospital Charge Code |
4054124
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,344.56 |
| Max. Negotiated Rate |
$19,208.00 |
| Rate for Payer: Aetna Commercial |
$4,321.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,129.72
|
| Rate for Payer: Aetna Managed Medicare |
$1,344.56
|
| 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 |
$2,545.06
|
| Rate for Payer: Cash Price |
$1,440.60
|
| Rate for Payer: Cash Price |
$1,440.60
|
| Rate for Payer: Cash Price |
$1,440.60
|
| Rate for Payer: Cigna Commercial |
$4,417.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,687.20
|
| Rate for Payer: Health EOS Commercial |
$4,273.78
|
| Rate for Payer: HFN Commercial |
$4,417.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,601.50
|
| Rate for Payer: Multiplan Commercial |
$3,841.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,881.20
|
| Rate for Payer: Preferred Network Access Commercial |
$4,417.84
|
| Rate for Payer: Quartz Beloit One Network |
$2,352.98
|
| Rate for Payer: Quartz Commercial |
$3,121.30
|
| Rate for Payer: Quartz Medicare Advantage |
$2,881.20
|
| Rate for Payer: The Alliance Commercial |
$19,208.00
|
| Rate for Payer: United Healthcare PPO |
$3,022.00
|
| Rate for Payer: WEA Trust Commercial |
$2,641.10
|
| Rate for Payer: WPS Commercial |
$3,556.84
|
|
