|
MRA Upper Extremity w/ + w/o Contrast Rt
|
Professional
|
Both
|
$5,965.00
|
|
|
Service Code
|
CPT 73225 RT,TC
|
| Hospital Charge Code |
1610876
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,310.83 |
| 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 |
$1,310.83
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,310.83
|
| 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 Upper Extremity w/ + w/o Contrast Rt
|
Facility
|
IP
|
$6,080.00
|
|
|
Service Code
|
CPT 73225
|
| Hospital Charge Code |
711765
|
| 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 Upper Extremity w/ + w/o Contrast Rt
|
Professional
|
Both
|
$6,080.00
|
|
|
Service Code
|
CPT 73225
|
| Hospital Charge Code |
711765
|
| Min. Negotiated Rate |
$1,310.83 |
| 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: Cash Price |
$1,824.00
|
| 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: Humana Commercial/EPO/HMO/POS/PPO |
$1,310.83
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,310.83
|
| 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
|
|
|
MRCP MRI Common Duct/Pancreas w/o
|
Professional
|
Both
|
$4,611.00
|
|
|
Service Code
|
CPT 74181 TC
|
| Hospital Charge Code |
4600643
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$503.91 |
| Max. Negotiated Rate |
$4,380.45 |
| Rate for Payer: Aetna Commercial |
$4,380.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,965.46
|
| Rate for Payer: Cash Price |
$1,383.30
|
| Rate for Payer: Cash Price |
$1,383.30
|
| Rate for Payer: Cash Price |
$1,383.30
|
| Rate for Payer: Cigna Commercial |
$4,380.45
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,305.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,766.60
|
| Rate for Payer: Health EOS Commercial |
$4,196.01
|
| Rate for Payer: HFN Commercial |
$4,380.45
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$503.91
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$503.91
|
| Rate for Payer: Multiplan Commercial |
$3,688.80
|
| Rate for Payer: Preferred Network Access Commercial |
$4,380.45
|
| Rate for Payer: Quartz Beloit One Network |
$2,028.84
|
| Rate for Payer: Quartz Commercial |
$2,628.27
|
| Rate for Payer: The Alliance Commercial |
$2,305.50
|
| Rate for Payer: WEA Trust Commercial |
$2,536.05
|
| Rate for Payer: WPS Commercial |
$3,415.37
|
|
|
MRCP MRI Common Duct/Pancreas w/o
|
Facility
|
IP
|
$4,611.00
|
|
|
Service Code
|
CPT 74181 TC
|
| Hospital Charge Code |
4600643
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$2,259.39 |
| Max. Negotiated Rate |
$4,242.12 |
| Rate for Payer: Aetna Commercial |
$4,149.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,965.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,443.83
|
| Rate for Payer: Cash Price |
$1,383.30
|
| Rate for Payer: Cigna Commercial |
$4,242.12
|
| Rate for Payer: Health EOS Commercial |
$4,103.79
|
| Rate for Payer: HFN Commercial |
$4,242.12
|
| Rate for Payer: Multiplan Commercial |
$3,688.80
|
| Rate for Payer: NAPHCARE Commercial |
$2,766.60
|
| Rate for Payer: Preferred Network Access Commercial |
$4,242.12
|
| Rate for Payer: Quartz Beloit One Network |
$2,259.39
|
| Rate for Payer: Quartz Commercial |
$2,766.60
|
| Rate for Payer: WEA Trust Commercial |
$2,536.05
|
| Rate for Payer: WPS Commercial |
$3,415.37
|
|
|
MRCP MRI Common Duct/Pancreas w/o
|
Facility
|
OP
|
$4,611.00
|
|
|
Service Code
|
CPT 74181 TC
|
| Hospital Charge Code |
4600643
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$242.20 |
| Max. Negotiated Rate |
$4,242.12 |
| Rate for Payer: Aetna Commercial |
$4,149.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,965.46
|
| 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 |
$2,443.83
|
| 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 |
$1,383.30
|
| Rate for Payer: Cash Price |
$1,383.30
|
| Rate for Payer: Cash Price |
$1,383.30
|
| Rate for Payer: Cash Price |
$1,383.30
|
| Rate for Payer: Cigna Commercial |
$4,242.12
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$242.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,580.32
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$242.20
|
| Rate for Payer: Health EOS Commercial |
$4,103.79
|
| Rate for Payer: HFN Commercial |
$4,242.12
|
| 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 |
$3,688.80
|
| Rate for Payer: NAPHCARE Commercial |
$363.30
|
| Rate for Payer: Preferred Network Access Commercial |
$4,242.12
|
| Rate for Payer: Quartz Beloit One Network |
$2,259.39
|
| Rate for Payer: Quartz Commercial |
$2,997.15
|
| 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 |
$2,536.05
|
| Rate for Payer: Wellcare Medicare |
$242.20
|
| Rate for Payer: WPS Commercial |
$3,415.37
|
|
|
MRCP MRI Common Duct/Pancreas w/ +w/o
|
Facility
|
OP
|
$5,795.00
|
|
|
Service Code
|
CPT 74183
|
| Hospital Charge Code |
1608800
|
| Min. Negotiated Rate |
$380.12 |
| Max. Negotiated Rate |
$5,331.40 |
| Rate for Payer: Aetna Commercial |
$5,215.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,983.70
|
| Rate for Payer: Aetna Managed Medicare |
$380.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,766.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,897.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,781.60
|
| Rate for Payer: Anthem Medicare Advantage |
$380.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,071.35
|
| 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 |
$1,738.50
|
| Rate for Payer: Cash Price |
$1,738.50
|
| Rate for Payer: Cigna Commercial |
$5,331.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$380.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,242.88
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$380.12
|
| Rate for Payer: Health EOS Commercial |
$5,157.55
|
| Rate for Payer: HFN Commercial |
$5,331.40
|
| 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 |
$4,636.00
|
| Rate for Payer: NAPHCARE Commercial |
$570.18
|
| Rate for Payer: Preferred Network Access Commercial |
$5,331.40
|
| Rate for Payer: Quartz Beloit One Network |
$2,839.55
|
| Rate for Payer: Quartz Commercial |
$3,766.75
|
| 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: WEA Trust Commercial |
$3,187.25
|
| Rate for Payer: Wellcare Medicare |
$380.12
|
| Rate for Payer: WPS Commercial |
$4,292.36
|
|
|
MRCP MRI Common Duct/Pancreas w/ +w/o
|
Facility
|
IP
|
$5,795.00
|
|
|
Service Code
|
CPT 74183
|
| Hospital Charge Code |
1608800
|
| Min. Negotiated Rate |
$2,839.55 |
| Max. Negotiated Rate |
$5,331.40 |
| Rate for Payer: Aetna Commercial |
$5,215.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,983.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,071.35
|
| Rate for Payer: Cash Price |
$1,738.50
|
| Rate for Payer: Cigna Commercial |
$5,331.40
|
| Rate for Payer: Health EOS Commercial |
$5,157.55
|
| Rate for Payer: HFN Commercial |
$5,331.40
|
| Rate for Payer: Multiplan Commercial |
$4,636.00
|
| Rate for Payer: NAPHCARE Commercial |
$3,477.00
|
| Rate for Payer: Preferred Network Access Commercial |
$5,331.40
|
| Rate for Payer: Quartz Beloit One Network |
$2,839.55
|
| Rate for Payer: Quartz Commercial |
$3,477.00
|
| Rate for Payer: WEA Trust Commercial |
$3,187.25
|
| Rate for Payer: WPS Commercial |
$4,292.36
|
|
|
MRCP MRI Common Duct/Pancreas w/ +w/o
|
Professional
|
Both
|
$5,795.00
|
|
|
Service Code
|
CPT 74183
|
| Hospital Charge Code |
1608800
|
| Min. Negotiated Rate |
$1,302.22 |
| Max. Negotiated Rate |
$5,505.25 |
| Rate for Payer: Aetna Commercial |
$5,505.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,983.70
|
| Rate for Payer: Cash Price |
$1,738.50
|
| Rate for Payer: Cash Price |
$1,738.50
|
| Rate for Payer: Cash Price |
$1,738.50
|
| Rate for Payer: Cigna Commercial |
$5,505.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,897.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,477.00
|
| Rate for Payer: Health EOS Commercial |
$5,273.45
|
| Rate for Payer: HFN Commercial |
$5,505.25
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,302.22
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,302.22
|
| Rate for Payer: Multiplan Commercial |
$4,636.00
|
| Rate for Payer: Preferred Network Access Commercial |
$5,505.25
|
| Rate for Payer: Quartz Beloit One Network |
$2,549.80
|
| Rate for Payer: Quartz Commercial |
$3,303.15
|
| Rate for Payer: The Alliance Commercial |
$2,897.50
|
| Rate for Payer: WEA Trust Commercial |
$3,187.25
|
| Rate for Payer: WPS Commercial |
$4,292.36
|
|
|
MRCP MRI Common Duct/Pancreas w/ +w/o
|
Facility
|
OP
|
$6,365.00
|
|
|
Service Code
|
CPT 74183 TC
|
| Hospital Charge Code |
1610897
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$380.12 |
| Max. Negotiated Rate |
$5,855.80 |
| Rate for Payer: Aetna Commercial |
$5,728.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,473.90
|
| 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 |
$3,373.45
|
| 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 |
$1,909.50
|
| Rate for Payer: Cash Price |
$1,909.50
|
| Rate for Payer: Cash Price |
$1,909.50
|
| Rate for Payer: Cash Price |
$1,909.50
|
| Rate for Payer: Cigna Commercial |
$5,855.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$380.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,561.85
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$380.12
|
| Rate for Payer: Health EOS Commercial |
$5,664.85
|
| Rate for Payer: HFN Commercial |
$5,855.80
|
| 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 |
$5,092.00
|
| Rate for Payer: NAPHCARE Commercial |
$570.18
|
| Rate for Payer: Preferred Network Access Commercial |
$5,855.80
|
| Rate for Payer: Quartz Beloit One Network |
$3,118.85
|
| Rate for Payer: Quartz Commercial |
$4,137.25
|
| 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 |
$3,500.75
|
| Rate for Payer: Wellcare Medicare |
$380.12
|
| Rate for Payer: WPS Commercial |
$4,714.56
|
|
|
MRCP MRI Common Duct/Pancreas w/ +w/o
|
Facility
|
IP
|
$6,365.00
|
|
|
Service Code
|
CPT 74183 TC
|
| Hospital Charge Code |
1610897
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$3,118.85 |
| Max. Negotiated Rate |
$5,855.80 |
| Rate for Payer: Aetna Commercial |
$5,728.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,473.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,373.45
|
| Rate for Payer: Cash Price |
$1,909.50
|
| Rate for Payer: Cigna Commercial |
$5,855.80
|
| Rate for Payer: Health EOS Commercial |
$5,664.85
|
| Rate for Payer: HFN Commercial |
$5,855.80
|
| Rate for Payer: Multiplan Commercial |
$5,092.00
|
| Rate for Payer: NAPHCARE Commercial |
$3,819.00
|
| Rate for Payer: Preferred Network Access Commercial |
$5,855.80
|
| Rate for Payer: Quartz Beloit One Network |
$3,118.85
|
| Rate for Payer: Quartz Commercial |
$3,819.00
|
| Rate for Payer: WEA Trust Commercial |
$3,500.75
|
| Rate for Payer: WPS Commercial |
$4,714.56
|
|
|
MRCP MRI Common Duct/Pancreas w/ +w/o
|
Professional
|
Both
|
$6,365.00
|
|
|
Service Code
|
CPT 74183 TC
|
| Hospital Charge Code |
1610897
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$935.94 |
| Max. Negotiated Rate |
$6,046.75 |
| Rate for Payer: Aetna Commercial |
$6,046.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,473.90
|
| Rate for Payer: Cash Price |
$1,909.50
|
| Rate for Payer: Cash Price |
$1,909.50
|
| Rate for Payer: Cash Price |
$1,909.50
|
| Rate for Payer: Cigna Commercial |
$6,046.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$3,182.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,819.00
|
| Rate for Payer: Health EOS Commercial |
$5,792.15
|
| Rate for Payer: HFN Commercial |
$6,046.75
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$935.94
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$935.94
|
| Rate for Payer: Multiplan Commercial |
$5,092.00
|
| Rate for Payer: Preferred Network Access Commercial |
$6,046.75
|
| Rate for Payer: Quartz Beloit One Network |
$2,800.60
|
| Rate for Payer: Quartz Commercial |
$3,628.05
|
| Rate for Payer: The Alliance Commercial |
$3,182.50
|
| Rate for Payer: WEA Trust Commercial |
$3,500.75
|
| Rate for Payer: WPS Commercial |
$4,714.56
|
|
|
MRI Abdomen w/ Contrast
|
Facility
|
OP
|
$6,850.00
|
|
|
Service Code
|
CPT 74182 TC
|
| Hospital Charge Code |
1610904
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$380.12 |
| Max. Negotiated Rate |
$6,302.00 |
| Rate for Payer: Aetna Commercial |
$6,165.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,891.00
|
| 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 |
$3,630.50
|
| 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 |
$2,055.00
|
| Rate for Payer: Cash Price |
$2,055.00
|
| Rate for Payer: Cash Price |
$2,055.00
|
| Rate for Payer: Cash Price |
$2,055.00
|
| Rate for Payer: Cigna Commercial |
$6,302.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$380.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,833.26
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$380.12
|
| Rate for Payer: Health EOS Commercial |
$6,096.50
|
| Rate for Payer: HFN Commercial |
$6,302.00
|
| 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 |
$5,480.00
|
| Rate for Payer: NAPHCARE Commercial |
$570.18
|
| Rate for Payer: Preferred Network Access Commercial |
$6,302.00
|
| Rate for Payer: Quartz Beloit One Network |
$3,356.50
|
| Rate for Payer: Quartz Commercial |
$4,452.50
|
| 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 |
$3,767.50
|
| Rate for Payer: Wellcare Medicare |
$380.12
|
| Rate for Payer: WPS Commercial |
$5,073.80
|
|
|
MRI Abdomen w/ Contrast
|
Professional
|
Both
|
$6,850.00
|
|
|
Service Code
|
CPT 74182 TC
|
| Hospital Charge Code |
1610904
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$879.08 |
| Max. Negotiated Rate |
$6,507.50 |
| Rate for Payer: Aetna Commercial |
$6,507.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,891.00
|
| Rate for Payer: Cash Price |
$2,055.00
|
| Rate for Payer: Cash Price |
$2,055.00
|
| Rate for Payer: Cash Price |
$2,055.00
|
| Rate for Payer: Cigna Commercial |
$6,507.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$3,425.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,110.00
|
| Rate for Payer: Health EOS Commercial |
$6,233.50
|
| Rate for Payer: HFN Commercial |
$6,507.50
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$879.08
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$879.08
|
| Rate for Payer: Multiplan Commercial |
$5,480.00
|
| Rate for Payer: Preferred Network Access Commercial |
$6,507.50
|
| Rate for Payer: Quartz Beloit One Network |
$3,014.00
|
| Rate for Payer: Quartz Commercial |
$3,904.50
|
| Rate for Payer: The Alliance Commercial |
$3,425.00
|
| Rate for Payer: WEA Trust Commercial |
$3,767.50
|
| Rate for Payer: WPS Commercial |
$5,073.80
|
|
|
MRI Abdomen w/ Contrast
|
Facility
|
IP
|
$6,850.00
|
|
|
Service Code
|
CPT 74182 TC
|
| Hospital Charge Code |
1610904
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$3,356.50 |
| Max. Negotiated Rate |
$6,302.00 |
| Rate for Payer: Aetna Commercial |
$6,165.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,891.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,630.50
|
| Rate for Payer: Cash Price |
$2,055.00
|
| Rate for Payer: Cigna Commercial |
$6,302.00
|
| Rate for Payer: Health EOS Commercial |
$6,096.50
|
| Rate for Payer: HFN Commercial |
$6,302.00
|
| Rate for Payer: Multiplan Commercial |
$5,480.00
|
| Rate for Payer: NAPHCARE Commercial |
$4,110.00
|
| Rate for Payer: Preferred Network Access Commercial |
$6,302.00
|
| Rate for Payer: Quartz Beloit One Network |
$3,356.50
|
| Rate for Payer: Quartz Commercial |
$4,110.00
|
| Rate for Payer: WEA Trust Commercial |
$3,767.50
|
| Rate for Payer: WPS Commercial |
$5,073.80
|
|
|
MRI Abdomen w/ Contrast
|
Professional
|
Both
|
$4,890.00
|
|
|
Service Code
|
CPT 74182
|
| Hospital Charge Code |
625606
|
| Min. Negotiated Rate |
$1,167.37 |
| Max. Negotiated Rate |
$4,645.50 |
| Rate for Payer: Aetna Commercial |
$4,645.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,205.40
|
| Rate for Payer: Cash Price |
$1,467.00
|
| Rate for Payer: Cash Price |
$1,467.00
|
| Rate for Payer: Cash Price |
$1,467.00
|
| Rate for Payer: Cigna Commercial |
$4,645.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,445.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,934.00
|
| Rate for Payer: Health EOS Commercial |
$4,449.90
|
| Rate for Payer: HFN Commercial |
$4,645.50
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,167.37
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,167.37
|
| Rate for Payer: Multiplan Commercial |
$3,912.00
|
| Rate for Payer: Preferred Network Access Commercial |
$4,645.50
|
| Rate for Payer: Quartz Beloit One Network |
$2,151.60
|
| Rate for Payer: Quartz Commercial |
$2,787.30
|
| Rate for Payer: The Alliance Commercial |
$2,445.00
|
| Rate for Payer: WEA Trust Commercial |
$2,689.50
|
| Rate for Payer: WPS Commercial |
$3,622.02
|
|
|
MRI Abdomen w/ Contrast
|
Facility
|
IP
|
$4,890.00
|
|
|
Service Code
|
CPT 74182
|
| Hospital Charge Code |
625606
|
| Min. Negotiated Rate |
$2,396.10 |
| Max. Negotiated Rate |
$4,498.80 |
| Rate for Payer: Aetna Commercial |
$4,401.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,205.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,591.70
|
| Rate for Payer: Cash Price |
$1,467.00
|
| Rate for Payer: Cigna Commercial |
$4,498.80
|
| Rate for Payer: Health EOS Commercial |
$4,352.10
|
| Rate for Payer: HFN Commercial |
$4,498.80
|
| Rate for Payer: Multiplan Commercial |
$3,912.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,934.00
|
| Rate for Payer: Preferred Network Access Commercial |
$4,498.80
|
| Rate for Payer: Quartz Beloit One Network |
$2,396.10
|
| Rate for Payer: Quartz Commercial |
$2,934.00
|
| Rate for Payer: WEA Trust Commercial |
$2,689.50
|
| Rate for Payer: WPS Commercial |
$3,622.02
|
|
|
MRI Abdomen w/ Contrast
|
Facility
|
OP
|
$4,890.00
|
|
|
Service Code
|
CPT 74182
|
| Hospital Charge Code |
625606
|
| Min. Negotiated Rate |
$380.12 |
| Max. Negotiated Rate |
$4,498.80 |
| Rate for Payer: Aetna Commercial |
$4,401.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,205.40
|
| Rate for Payer: Aetna Managed Medicare |
$380.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,178.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,445.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,347.20
|
| Rate for Payer: Anthem Medicare Advantage |
$380.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,591.70
|
| 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 |
$1,467.00
|
| Rate for Payer: Cash Price |
$1,467.00
|
| Rate for Payer: Cigna Commercial |
$4,498.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$380.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,736.44
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$380.12
|
| Rate for Payer: Health EOS Commercial |
$4,352.10
|
| Rate for Payer: HFN Commercial |
$4,498.80
|
| 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 |
$3,912.00
|
| Rate for Payer: NAPHCARE Commercial |
$570.18
|
| Rate for Payer: Preferred Network Access Commercial |
$4,498.80
|
| Rate for Payer: Quartz Beloit One Network |
$2,396.10
|
| Rate for Payer: Quartz Commercial |
$3,178.50
|
| 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 |
$2,689.50
|
| Rate for Payer: Wellcare Medicare |
$380.12
|
| Rate for Payer: WPS Commercial |
$3,622.02
|
|
|
MRI Abdomen w/o Contrast
|
Facility
|
IP
|
$4,014.00
|
|
|
Service Code
|
CPT 74181
|
| Hospital Charge Code |
625612
|
| Min. Negotiated Rate |
$1,966.86 |
| Max. Negotiated Rate |
$3,692.88 |
| Rate for Payer: Aetna Commercial |
$3,612.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,452.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,127.42
|
| Rate for Payer: Cash Price |
$1,204.20
|
| Rate for Payer: Cigna Commercial |
$3,692.88
|
| Rate for Payer: Health EOS Commercial |
$3,572.46
|
| Rate for Payer: HFN Commercial |
$3,692.88
|
| Rate for Payer: Multiplan Commercial |
$3,211.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,408.40
|
| Rate for Payer: Preferred Network Access Commercial |
$3,692.88
|
| Rate for Payer: Quartz Beloit One Network |
$1,966.86
|
| Rate for Payer: Quartz Commercial |
$2,408.40
|
| Rate for Payer: WEA Trust Commercial |
$2,207.70
|
| Rate for Payer: WPS Commercial |
$2,973.17
|
|
|
MRI Abdomen w/o Contrast
|
Facility
|
OP
|
$4,014.00
|
|
|
Service Code
|
CPT 74181 TC
|
| Hospital Charge Code |
1610906
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$242.20 |
| Max. Negotiated Rate |
$3,692.88 |
| Rate for Payer: Aetna Commercial |
$3,612.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,452.04
|
| 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 |
$2,127.42
|
| 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 |
$1,204.20
|
| Rate for Payer: Cash Price |
$1,204.20
|
| Rate for Payer: Cash Price |
$1,204.20
|
| Rate for Payer: Cash Price |
$1,204.20
|
| Rate for Payer: Cigna Commercial |
$3,692.88
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$242.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,246.23
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$242.20
|
| Rate for Payer: Health EOS Commercial |
$3,572.46
|
| Rate for Payer: HFN Commercial |
$3,692.88
|
| 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 |
$3,211.20
|
| Rate for Payer: NAPHCARE Commercial |
$363.30
|
| Rate for Payer: Preferred Network Access Commercial |
$3,692.88
|
| Rate for Payer: Quartz Beloit One Network |
$1,966.86
|
| Rate for Payer: Quartz Commercial |
$2,609.10
|
| 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 |
$2,207.70
|
| Rate for Payer: Wellcare Medicare |
$242.20
|
| Rate for Payer: WPS Commercial |
$2,973.17
|
|
|
MRI Abdomen w/o Contrast
|
Professional
|
Both
|
$4,014.00
|
|
|
Service Code
|
CPT 74181
|
| Hospital Charge Code |
625612
|
| Min. Negotiated Rate |
$746.28 |
| Max. Negotiated Rate |
$3,813.30 |
| Rate for Payer: Aetna Commercial |
$3,813.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,452.04
|
| Rate for Payer: Cash Price |
$1,204.20
|
| Rate for Payer: Cash Price |
$1,204.20
|
| Rate for Payer: Cash Price |
$1,204.20
|
| Rate for Payer: Cigna Commercial |
$3,813.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,007.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,408.40
|
| Rate for Payer: Health EOS Commercial |
$3,652.74
|
| Rate for Payer: HFN Commercial |
$3,813.30
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$746.28
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$746.28
|
| Rate for Payer: Multiplan Commercial |
$3,211.20
|
| Rate for Payer: Preferred Network Access Commercial |
$3,813.30
|
| Rate for Payer: Quartz Beloit One Network |
$1,766.16
|
| Rate for Payer: Quartz Commercial |
$2,287.98
|
| Rate for Payer: The Alliance Commercial |
$2,007.00
|
| Rate for Payer: WEA Trust Commercial |
$2,207.70
|
| Rate for Payer: WPS Commercial |
$2,973.17
|
|
|
MRI Abdomen w/o Contrast
|
Facility
|
OP
|
$4,014.00
|
|
|
Service Code
|
CPT 74181
|
| Hospital Charge Code |
625612
|
| Min. Negotiated Rate |
$242.20 |
| Max. Negotiated Rate |
$3,692.88 |
| Rate for Payer: Aetna Commercial |
$3,612.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,452.04
|
| Rate for Payer: Aetna Managed Medicare |
$242.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,609.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,007.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,926.72
|
| Rate for Payer: Anthem Medicare Advantage |
$242.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,127.42
|
| 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 |
$1,204.20
|
| Rate for Payer: Cash Price |
$1,204.20
|
| Rate for Payer: Cigna Commercial |
$3,692.88
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$242.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,246.23
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$242.20
|
| Rate for Payer: Health EOS Commercial |
$3,572.46
|
| Rate for Payer: HFN Commercial |
$3,692.88
|
| 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 |
$3,211.20
|
| Rate for Payer: NAPHCARE Commercial |
$363.30
|
| Rate for Payer: Preferred Network Access Commercial |
$3,692.88
|
| Rate for Payer: Quartz Beloit One Network |
$1,966.86
|
| Rate for Payer: Quartz Commercial |
$2,609.10
|
| 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: WEA Trust Commercial |
$2,207.70
|
| Rate for Payer: Wellcare Medicare |
$242.20
|
| Rate for Payer: WPS Commercial |
$2,973.17
|
|
|
MRI Abdomen w/o Contrast
|
Professional
|
Both
|
$4,014.00
|
|
|
Service Code
|
CPT 74181 TC
|
| Hospital Charge Code |
1610906
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$503.91 |
| Max. Negotiated Rate |
$3,813.30 |
| Rate for Payer: Aetna Commercial |
$3,813.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,452.04
|
| Rate for Payer: Cash Price |
$1,204.20
|
| Rate for Payer: Cash Price |
$1,204.20
|
| Rate for Payer: Cash Price |
$1,204.20
|
| Rate for Payer: Cigna Commercial |
$3,813.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,007.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,408.40
|
| Rate for Payer: Health EOS Commercial |
$3,652.74
|
| Rate for Payer: HFN Commercial |
$3,813.30
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$503.91
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$503.91
|
| Rate for Payer: Multiplan Commercial |
$3,211.20
|
| Rate for Payer: Preferred Network Access Commercial |
$3,813.30
|
| Rate for Payer: Quartz Beloit One Network |
$1,766.16
|
| Rate for Payer: Quartz Commercial |
$2,287.98
|
| Rate for Payer: The Alliance Commercial |
$2,007.00
|
| Rate for Payer: WEA Trust Commercial |
$2,207.70
|
| Rate for Payer: WPS Commercial |
$2,973.17
|
|
|
MRI Abdomen w/o Contrast
|
Facility
|
IP
|
$4,014.00
|
|
|
Service Code
|
CPT 74181 TC
|
| Hospital Charge Code |
1610906
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,966.86 |
| Max. Negotiated Rate |
$3,692.88 |
| Rate for Payer: Aetna Commercial |
$3,612.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,452.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,127.42
|
| Rate for Payer: Cash Price |
$1,204.20
|
| Rate for Payer: Cigna Commercial |
$3,692.88
|
| Rate for Payer: Health EOS Commercial |
$3,572.46
|
| Rate for Payer: HFN Commercial |
$3,692.88
|
| Rate for Payer: Multiplan Commercial |
$3,211.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,408.40
|
| Rate for Payer: Preferred Network Access Commercial |
$3,692.88
|
| Rate for Payer: Quartz Beloit One Network |
$1,966.86
|
| Rate for Payer: Quartz Commercial |
$2,408.40
|
| Rate for Payer: WEA Trust Commercial |
$2,207.70
|
| Rate for Payer: WPS Commercial |
$2,973.17
|
|
|
MRI Abdomen w/ + w/o Contrast
|
Facility
|
OP
|
$6,365.00
|
|
|
Service Code
|
CPT 74183 TC
|
| Hospital Charge Code |
1610902
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$380.12 |
| Max. Negotiated Rate |
$5,855.80 |
| Rate for Payer: Aetna Commercial |
$5,728.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,473.90
|
| 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 |
$3,373.45
|
| 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 |
$1,909.50
|
| Rate for Payer: Cash Price |
$1,909.50
|
| Rate for Payer: Cash Price |
$1,909.50
|
| Rate for Payer: Cash Price |
$1,909.50
|
| Rate for Payer: Cigna Commercial |
$5,855.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$380.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,561.85
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$380.12
|
| Rate for Payer: Health EOS Commercial |
$5,664.85
|
| Rate for Payer: HFN Commercial |
$5,855.80
|
| 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 |
$5,092.00
|
| Rate for Payer: NAPHCARE Commercial |
$570.18
|
| Rate for Payer: Preferred Network Access Commercial |
$5,855.80
|
| Rate for Payer: Quartz Beloit One Network |
$3,118.85
|
| Rate for Payer: Quartz Commercial |
$4,137.25
|
| 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 |
$3,500.75
|
| Rate for Payer: Wellcare Medicare |
$380.12
|
| Rate for Payer: WPS Commercial |
$4,714.56
|
|
