|
MRI Brachial Plexis w/o Contrast Right
|
Facility
|
OP
|
$4,721.00
|
|
|
Service Code
|
CPT 73218
|
| Hospital Charge Code |
1608811
|
| Min. Negotiated Rate |
$242.20 |
| Max. Negotiated Rate |
$4,343.32 |
| Rate for Payer: Aetna Commercial |
$4,248.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,060.06
|
| Rate for Payer: Aetna Managed Medicare |
$242.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,068.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,360.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,266.08
|
| Rate for Payer: Anthem Medicare Advantage |
$242.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,502.13
|
| 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 |
$1,416.30
|
| Rate for Payer: Cash Price |
$1,416.30
|
| Rate for Payer: Cigna Commercial |
$4,343.32
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$242.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,641.87
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$242.20
|
| Rate for Payer: Health EOS Commercial |
$4,201.69
|
| Rate for Payer: HFN Commercial |
$4,343.32
|
| 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 |
$3,776.80
|
| Rate for Payer: NAPHCARE Commercial |
$363.30
|
| Rate for Payer: Preferred Network Access Commercial |
$4,343.32
|
| Rate for Payer: Quartz Beloit One Network |
$2,313.29
|
| Rate for Payer: Quartz Commercial |
$3,068.65
|
| 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 |
$2,596.55
|
| Rate for Payer: Wellcare Medicare |
$242.20
|
| Rate for Payer: WPS Commercial |
$3,496.84
|
|
|
MRI Brachial Plexis w/o Contrast Right
|
Professional
|
Both
|
$4,810.00
|
|
|
Service Code
|
CPT 73218 RT,TC
|
| Hospital Charge Code |
1610965
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,180.61 |
| Max. Negotiated Rate |
$4,569.50 |
| Rate for Payer: Aetna Commercial |
$4,569.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,136.60
|
| Rate for Payer: Cash Price |
$1,443.00
|
| Rate for Payer: Cash Price |
$1,443.00
|
| Rate for Payer: Cash Price |
$1,443.00
|
| Rate for Payer: Cigna Commercial |
$4,569.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,405.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,886.00
|
| Rate for Payer: Health EOS Commercial |
$4,377.10
|
| Rate for Payer: HFN Commercial |
$4,569.50
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,180.61
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,180.61
|
| Rate for Payer: Multiplan Commercial |
$3,848.00
|
| Rate for Payer: Preferred Network Access Commercial |
$4,569.50
|
| Rate for Payer: Quartz Beloit One Network |
$2,116.40
|
| Rate for Payer: Quartz Commercial |
$2,741.70
|
| Rate for Payer: The Alliance Commercial |
$2,405.00
|
| Rate for Payer: WEA Trust Commercial |
$2,645.50
|
| Rate for Payer: WPS Commercial |
$3,562.77
|
|
|
MRI Brachial Plexis w/o Contrast Right
|
Facility
|
IP
|
$4,810.00
|
|
|
Service Code
|
CPT 73218 RT,TC
|
| Hospital Charge Code |
1610965
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$2,356.90 |
| Max. Negotiated Rate |
$4,425.20 |
| Rate for Payer: Aetna Commercial |
$4,329.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,136.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,549.30
|
| Rate for Payer: Cash Price |
$1,443.00
|
| Rate for Payer: Cigna Commercial |
$4,425.20
|
| Rate for Payer: Health EOS Commercial |
$4,280.90
|
| Rate for Payer: HFN Commercial |
$4,425.20
|
| Rate for Payer: Multiplan Commercial |
$3,848.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,886.00
|
| Rate for Payer: Preferred Network Access Commercial |
$4,425.20
|
| Rate for Payer: Quartz Beloit One Network |
$2,356.90
|
| Rate for Payer: Quartz Commercial |
$2,886.00
|
| Rate for Payer: WEA Trust Commercial |
$2,645.50
|
| Rate for Payer: WPS Commercial |
$3,562.77
|
|
|
MRI Brachial Plexis w/o Contrast Right
|
Facility
|
OP
|
$4,810.00
|
|
|
Service Code
|
CPT 73218 RT,TC
|
| Hospital Charge Code |
1610965
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$242.20 |
| Max. Negotiated Rate |
$4,425.20 |
| Rate for Payer: Aetna Commercial |
$4,329.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,136.60
|
| 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 |
$2,549.30
|
| 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 |
$1,443.00
|
| Rate for Payer: Cash Price |
$1,443.00
|
| Rate for Payer: Cash Price |
$1,443.00
|
| Rate for Payer: Cash Price |
$1,443.00
|
| Rate for Payer: Cigna Commercial |
$4,425.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$242.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,691.68
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$242.20
|
| Rate for Payer: Health EOS Commercial |
$4,280.90
|
| Rate for Payer: HFN Commercial |
$4,425.20
|
| 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 |
$3,848.00
|
| Rate for Payer: NAPHCARE Commercial |
$363.30
|
| Rate for Payer: Preferred Network Access Commercial |
$4,425.20
|
| Rate for Payer: Quartz Beloit One Network |
$2,356.90
|
| Rate for Payer: Quartz Commercial |
$3,126.50
|
| 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 |
$2,645.50
|
| Rate for Payer: Wellcare Medicare |
$242.20
|
| Rate for Payer: WPS Commercial |
$3,562.77
|
|
|
MRI Brachial Plexis w/o Contrast Right
|
Professional
|
Both
|
$4,721.00
|
|
|
Service Code
|
CPT 73218
|
| Hospital Charge Code |
1608811
|
| Min. Negotiated Rate |
$1,180.61 |
| Max. Negotiated Rate |
$4,484.95 |
| Rate for Payer: Aetna Commercial |
$4,484.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,060.06
|
| Rate for Payer: Cash Price |
$1,416.30
|
| Rate for Payer: Cash Price |
$1,416.30
|
| Rate for Payer: Cash Price |
$1,416.30
|
| Rate for Payer: Cigna Commercial |
$4,484.95
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,360.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,832.60
|
| Rate for Payer: Health EOS Commercial |
$4,296.11
|
| Rate for Payer: HFN Commercial |
$4,484.95
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,180.61
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,180.61
|
| Rate for Payer: Multiplan Commercial |
$3,776.80
|
| Rate for Payer: Preferred Network Access Commercial |
$4,484.95
|
| Rate for Payer: Quartz Beloit One Network |
$2,077.24
|
| Rate for Payer: Quartz Commercial |
$2,690.97
|
| Rate for Payer: The Alliance Commercial |
$2,360.50
|
| Rate for Payer: WEA Trust Commercial |
$2,596.55
|
| Rate for Payer: WPS Commercial |
$3,496.84
|
|
|
MRI Brachial Plexis w + w/o Contrast Lef
|
Facility
|
IP
|
$6,636.00
|
|
|
Service Code
|
CPT 73220 LT,TC
|
| Hospital Charge Code |
1610956
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$3,251.64 |
| Max. Negotiated Rate |
$6,105.12 |
| Rate for Payer: Aetna Commercial |
$5,972.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,706.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,517.08
|
| Rate for Payer: Cash Price |
$1,990.80
|
| Rate for Payer: Cigna Commercial |
$6,105.12
|
| Rate for Payer: Health EOS Commercial |
$5,906.04
|
| Rate for Payer: HFN Commercial |
$6,105.12
|
| Rate for Payer: Multiplan Commercial |
$5,308.80
|
| Rate for Payer: NAPHCARE Commercial |
$3,981.60
|
| Rate for Payer: Preferred Network Access Commercial |
$6,105.12
|
| Rate for Payer: Quartz Beloit One Network |
$3,251.64
|
| Rate for Payer: Quartz Commercial |
$3,981.60
|
| Rate for Payer: WEA Trust Commercial |
$3,649.80
|
| Rate for Payer: WPS Commercial |
$4,915.29
|
|
|
MRI Brachial Plexis w + w/o Contrast Lef
|
Professional
|
Both
|
$6,636.00
|
|
|
Service Code
|
CPT 73220 LT,TC
|
| Hospital Charge Code |
1610956
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,596.12 |
| Max. Negotiated Rate |
$6,304.20 |
| Rate for Payer: Aetna Commercial |
$6,304.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,706.96
|
| Rate for Payer: Cash Price |
$1,990.80
|
| Rate for Payer: Cash Price |
$1,990.80
|
| Rate for Payer: Cash Price |
$1,990.80
|
| Rate for Payer: Cigna Commercial |
$6,304.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$3,318.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,981.60
|
| Rate for Payer: Health EOS Commercial |
$6,038.76
|
| Rate for Payer: HFN Commercial |
$6,304.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,596.12
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,596.12
|
| Rate for Payer: Multiplan Commercial |
$5,308.80
|
| Rate for Payer: Preferred Network Access Commercial |
$6,304.20
|
| Rate for Payer: Quartz Beloit One Network |
$2,919.84
|
| Rate for Payer: Quartz Commercial |
$3,782.52
|
| Rate for Payer: The Alliance Commercial |
$3,318.00
|
| Rate for Payer: WEA Trust Commercial |
$3,649.80
|
| Rate for Payer: WPS Commercial |
$4,915.29
|
|
|
MRI Brachial Plexis w + w/o Contrast Lef
|
Facility
|
OP
|
$6,636.00
|
|
|
Service Code
|
CPT 73220 LT,TC
|
| Hospital Charge Code |
1610956
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$380.12 |
| Max. Negotiated Rate |
$6,105.12 |
| Rate for Payer: Aetna Commercial |
$5,972.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,706.96
|
| 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 |
$3,517.08
|
| 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 |
$1,990.80
|
| Rate for Payer: Cash Price |
$1,990.80
|
| Rate for Payer: Cash Price |
$1,990.80
|
| Rate for Payer: Cash Price |
$1,990.80
|
| Rate for Payer: Cigna Commercial |
$6,105.12
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$380.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,713.51
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$380.12
|
| Rate for Payer: Health EOS Commercial |
$5,906.04
|
| Rate for Payer: HFN Commercial |
$6,105.12
|
| 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 |
$5,308.80
|
| Rate for Payer: NAPHCARE Commercial |
$570.18
|
| Rate for Payer: Preferred Network Access Commercial |
$6,105.12
|
| Rate for Payer: Quartz Beloit One Network |
$3,251.64
|
| Rate for Payer: Quartz Commercial |
$4,313.40
|
| 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 |
$3,649.80
|
| Rate for Payer: Wellcare Medicare |
$380.12
|
| Rate for Payer: WPS Commercial |
$4,915.29
|
|
|
MRI Brachial Plexis w + w/o Contrast Rig
|
Facility
|
IP
|
$6,636.00
|
|
|
Service Code
|
CPT 73220 RT,TC
|
| Hospital Charge Code |
1610959
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$3,251.64 |
| Max. Negotiated Rate |
$6,105.12 |
| Rate for Payer: Aetna Commercial |
$5,972.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,706.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,517.08
|
| Rate for Payer: Cash Price |
$1,990.80
|
| Rate for Payer: Cigna Commercial |
$6,105.12
|
| Rate for Payer: Health EOS Commercial |
$5,906.04
|
| Rate for Payer: HFN Commercial |
$6,105.12
|
| Rate for Payer: Multiplan Commercial |
$5,308.80
|
| Rate for Payer: NAPHCARE Commercial |
$3,981.60
|
| Rate for Payer: Preferred Network Access Commercial |
$6,105.12
|
| Rate for Payer: Quartz Beloit One Network |
$3,251.64
|
| Rate for Payer: Quartz Commercial |
$3,981.60
|
| Rate for Payer: WEA Trust Commercial |
$3,649.80
|
| Rate for Payer: WPS Commercial |
$4,915.29
|
|
|
MRI Brachial Plexis w + w/o Contrast Rig
|
Facility
|
OP
|
$6,636.00
|
|
|
Service Code
|
CPT 73220 RT,TC
|
| Hospital Charge Code |
1610959
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$380.12 |
| Max. Negotiated Rate |
$6,105.12 |
| Rate for Payer: Aetna Commercial |
$5,972.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,706.96
|
| 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 |
$3,517.08
|
| 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 |
$1,990.80
|
| Rate for Payer: Cash Price |
$1,990.80
|
| Rate for Payer: Cash Price |
$1,990.80
|
| Rate for Payer: Cash Price |
$1,990.80
|
| Rate for Payer: Cigna Commercial |
$6,105.12
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$380.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,713.51
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$380.12
|
| Rate for Payer: Health EOS Commercial |
$5,906.04
|
| Rate for Payer: HFN Commercial |
$6,105.12
|
| 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 |
$5,308.80
|
| Rate for Payer: NAPHCARE Commercial |
$570.18
|
| Rate for Payer: Preferred Network Access Commercial |
$6,105.12
|
| Rate for Payer: Quartz Beloit One Network |
$3,251.64
|
| Rate for Payer: Quartz Commercial |
$4,313.40
|
| 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 |
$3,649.80
|
| Rate for Payer: Wellcare Medicare |
$380.12
|
| Rate for Payer: WPS Commercial |
$4,915.29
|
|
|
MRI Brachial Plexis w + w/o Contrast Rig
|
Professional
|
Both
|
$6,636.00
|
|
|
Service Code
|
CPT 73220 RT,TC
|
| Hospital Charge Code |
1610959
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,596.12 |
| Max. Negotiated Rate |
$6,304.20 |
| Rate for Payer: Aetna Commercial |
$6,304.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,706.96
|
| Rate for Payer: Cash Price |
$1,990.80
|
| Rate for Payer: Cash Price |
$1,990.80
|
| Rate for Payer: Cash Price |
$1,990.80
|
| Rate for Payer: Cigna Commercial |
$6,304.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$3,318.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,981.60
|
| Rate for Payer: Health EOS Commercial |
$6,038.76
|
| Rate for Payer: HFN Commercial |
$6,304.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,596.12
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,596.12
|
| Rate for Payer: Multiplan Commercial |
$5,308.80
|
| Rate for Payer: Preferred Network Access Commercial |
$6,304.20
|
| Rate for Payer: Quartz Beloit One Network |
$2,919.84
|
| Rate for Payer: Quartz Commercial |
$3,782.52
|
| Rate for Payer: The Alliance Commercial |
$3,318.00
|
| Rate for Payer: WEA Trust Commercial |
$3,649.80
|
| Rate for Payer: WPS Commercial |
$4,915.29
|
|
|
MRI Brain, IAC w + w/o
|
Facility
|
IP
|
$6,385.00
|
|
|
Service Code
|
CPT 70553
|
| Hospital Charge Code |
1608822
|
| Min. Negotiated Rate |
$3,128.65 |
| Max. Negotiated Rate |
$5,874.20 |
| Rate for Payer: Aetna Commercial |
$5,746.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,491.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,384.05
|
| Rate for Payer: Cash Price |
$1,915.50
|
| Rate for Payer: Cigna Commercial |
$5,874.20
|
| Rate for Payer: Health EOS Commercial |
$5,682.65
|
| Rate for Payer: HFN Commercial |
$5,874.20
|
| Rate for Payer: Multiplan Commercial |
$5,108.00
|
| Rate for Payer: NAPHCARE Commercial |
$3,831.00
|
| Rate for Payer: Preferred Network Access Commercial |
$5,874.20
|
| Rate for Payer: Quartz Beloit One Network |
$3,128.65
|
| Rate for Payer: Quartz Commercial |
$3,831.00
|
| Rate for Payer: WEA Trust Commercial |
$3,511.75
|
| Rate for Payer: WPS Commercial |
$4,729.37
|
|
|
MRI Brain, IAC w + w/o
|
Facility
|
OP
|
$6,385.00
|
|
|
Service Code
|
CPT 70553
|
| Hospital Charge Code |
1608822
|
| Min. Negotiated Rate |
$380.12 |
| Max. Negotiated Rate |
$5,874.20 |
| Rate for Payer: Aetna Commercial |
$5,746.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,491.10
|
| Rate for Payer: Aetna Managed Medicare |
$380.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,150.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,192.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,064.80
|
| Rate for Payer: Anthem Medicare Advantage |
$380.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,384.05
|
| 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 |
$1,915.50
|
| Rate for Payer: Cash Price |
$1,915.50
|
| Rate for Payer: Cigna Commercial |
$5,874.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$380.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,573.05
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$380.12
|
| Rate for Payer: Health EOS Commercial |
$5,682.65
|
| Rate for Payer: HFN Commercial |
$5,874.20
|
| 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 |
$5,108.00
|
| Rate for Payer: NAPHCARE Commercial |
$570.18
|
| Rate for Payer: Preferred Network Access Commercial |
$5,874.20
|
| Rate for Payer: Quartz Beloit One Network |
$3,128.65
|
| Rate for Payer: Quartz Commercial |
$4,150.25
|
| 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: WEA Trust Commercial |
$3,511.75
|
| Rate for Payer: Wellcare Medicare |
$380.12
|
| Rate for Payer: WPS Commercial |
$4,729.37
|
|
|
MRI Brain, IAC w + w/o
|
Facility
|
OP
|
$6,717.00
|
|
|
Service Code
|
CPT 70553 TC
|
| Hospital Charge Code |
1610977
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$380.12 |
| Max. Negotiated Rate |
$6,179.64 |
| Rate for Payer: Aetna Commercial |
$6,045.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,776.62
|
| 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 |
$3,560.01
|
| 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 |
$2,015.10
|
| Rate for Payer: Cash Price |
$2,015.10
|
| Rate for Payer: Cash Price |
$2,015.10
|
| Rate for Payer: Cash Price |
$2,015.10
|
| Rate for Payer: Cigna Commercial |
$6,179.64
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$380.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,758.83
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$380.12
|
| Rate for Payer: Health EOS Commercial |
$5,978.13
|
| Rate for Payer: HFN Commercial |
$6,179.64
|
| 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 |
$5,373.60
|
| Rate for Payer: NAPHCARE Commercial |
$570.18
|
| Rate for Payer: Preferred Network Access Commercial |
$6,179.64
|
| Rate for Payer: Quartz Beloit One Network |
$3,291.33
|
| Rate for Payer: Quartz Commercial |
$4,366.05
|
| 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 |
$3,694.35
|
| Rate for Payer: Wellcare Medicare |
$380.12
|
| Rate for Payer: WPS Commercial |
$4,975.28
|
|
|
MRI Brain, IAC w + w/o
|
Facility
|
IP
|
$6,717.00
|
|
|
Service Code
|
CPT 70553 TC
|
| Hospital Charge Code |
1610977
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$3,291.33 |
| Max. Negotiated Rate |
$6,179.64 |
| Rate for Payer: Aetna Commercial |
$6,045.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,776.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,560.01
|
| Rate for Payer: Cash Price |
$2,015.10
|
| Rate for Payer: Cigna Commercial |
$6,179.64
|
| Rate for Payer: Health EOS Commercial |
$5,978.13
|
| Rate for Payer: HFN Commercial |
$6,179.64
|
| Rate for Payer: Multiplan Commercial |
$5,373.60
|
| Rate for Payer: NAPHCARE Commercial |
$4,030.20
|
| Rate for Payer: Preferred Network Access Commercial |
$6,179.64
|
| Rate for Payer: Quartz Beloit One Network |
$3,291.33
|
| Rate for Payer: Quartz Commercial |
$4,030.20
|
| Rate for Payer: WEA Trust Commercial |
$3,694.35
|
| Rate for Payer: WPS Commercial |
$4,975.28
|
|
|
MRI Brain, IAC w + w/o
|
Professional
|
Both
|
$6,385.00
|
|
|
Service Code
|
CPT 70553
|
| Hospital Charge Code |
1608822
|
| Min. Negotiated Rate |
$1,211.57 |
| Max. Negotiated Rate |
$6,065.75 |
| Rate for Payer: Aetna Commercial |
$6,065.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,491.10
|
| Rate for Payer: Cash Price |
$1,915.50
|
| Rate for Payer: Cash Price |
$1,915.50
|
| Rate for Payer: Cash Price |
$1,915.50
|
| Rate for Payer: Cigna Commercial |
$6,065.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$3,192.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,831.00
|
| Rate for Payer: Health EOS Commercial |
$5,810.35
|
| Rate for Payer: HFN Commercial |
$6,065.75
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,211.57
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,211.57
|
| Rate for Payer: Multiplan Commercial |
$5,108.00
|
| Rate for Payer: Preferred Network Access Commercial |
$6,065.75
|
| Rate for Payer: Quartz Beloit One Network |
$2,809.40
|
| Rate for Payer: Quartz Commercial |
$3,639.45
|
| Rate for Payer: The Alliance Commercial |
$3,192.50
|
| Rate for Payer: WEA Trust Commercial |
$3,511.75
|
| Rate for Payer: WPS Commercial |
$4,729.37
|
|
|
MRI Brain, IAC w + w/o
|
Professional
|
Both
|
$6,717.00
|
|
|
Service Code
|
CPT 70553 TC
|
| Hospital Charge Code |
1610977
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$829.20 |
| Max. Negotiated Rate |
$6,381.15 |
| Rate for Payer: Aetna Commercial |
$6,381.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,776.62
|
| Rate for Payer: Cash Price |
$2,015.10
|
| Rate for Payer: Cash Price |
$2,015.10
|
| Rate for Payer: Cash Price |
$2,015.10
|
| Rate for Payer: Cigna Commercial |
$6,381.15
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$3,358.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,030.20
|
| Rate for Payer: Health EOS Commercial |
$6,112.47
|
| Rate for Payer: HFN Commercial |
$6,381.15
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$829.20
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$829.20
|
| Rate for Payer: Multiplan Commercial |
$5,373.60
|
| Rate for Payer: Preferred Network Access Commercial |
$6,381.15
|
| Rate for Payer: Quartz Beloit One Network |
$2,955.48
|
| Rate for Payer: Quartz Commercial |
$3,828.69
|
| Rate for Payer: The Alliance Commercial |
$3,358.50
|
| Rate for Payer: WEA Trust Commercial |
$3,694.35
|
| Rate for Payer: WPS Commercial |
$4,975.28
|
|
|
MRI Brain Unenhanced
|
Facility
|
OP
|
$5,066.00
|
|
|
Service Code
|
CPT 70551 TC
|
| Hospital Charge Code |
3072668
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$242.20 |
| Max. Negotiated Rate |
$4,660.72 |
| Rate for Payer: Aetna Commercial |
$4,559.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,356.76
|
| 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 |
$2,684.98
|
| 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 |
$1,519.80
|
| Rate for Payer: Cash Price |
$1,519.80
|
| Rate for Payer: Cash Price |
$1,519.80
|
| Rate for Payer: Cash Price |
$1,519.80
|
| Rate for Payer: Cigna Commercial |
$4,660.72
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$242.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,834.93
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$242.20
|
| Rate for Payer: Health EOS Commercial |
$4,508.74
|
| Rate for Payer: HFN Commercial |
$4,660.72
|
| 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 |
$4,052.80
|
| Rate for Payer: NAPHCARE Commercial |
$363.30
|
| Rate for Payer: Preferred Network Access Commercial |
$4,660.72
|
| Rate for Payer: Quartz Beloit One Network |
$2,482.34
|
| Rate for Payer: Quartz Commercial |
$3,292.90
|
| 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 |
$2,786.30
|
| Rate for Payer: Wellcare Medicare |
$242.20
|
| Rate for Payer: WPS Commercial |
$3,752.39
|
|
|
MRI Brain Unenhanced
|
Facility
|
IP
|
$5,066.00
|
|
|
Service Code
|
CPT 70551 TC
|
| Hospital Charge Code |
3072668
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$2,482.34 |
| Max. Negotiated Rate |
$4,660.72 |
| Rate for Payer: Aetna Commercial |
$4,559.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,356.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,684.98
|
| Rate for Payer: Cash Price |
$1,519.80
|
| Rate for Payer: Cigna Commercial |
$4,660.72
|
| Rate for Payer: Health EOS Commercial |
$4,508.74
|
| Rate for Payer: HFN Commercial |
$4,660.72
|
| Rate for Payer: Multiplan Commercial |
$4,052.80
|
| Rate for Payer: NAPHCARE Commercial |
$3,039.60
|
| Rate for Payer: Preferred Network Access Commercial |
$4,660.72
|
| Rate for Payer: Quartz Beloit One Network |
$2,482.34
|
| Rate for Payer: Quartz Commercial |
$3,039.60
|
| Rate for Payer: WEA Trust Commercial |
$2,786.30
|
| Rate for Payer: WPS Commercial |
$3,752.39
|
|
|
MRI Brain Unenhanced
|
Professional
|
Both
|
$5,066.00
|
|
|
Service Code
|
CPT 70551 TC
|
| Hospital Charge Code |
3072668
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$491.55 |
| Max. Negotiated Rate |
$4,812.70 |
| Rate for Payer: Aetna Commercial |
$4,812.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,356.76
|
| Rate for Payer: Cash Price |
$1,519.80
|
| Rate for Payer: Cash Price |
$1,519.80
|
| Rate for Payer: Cash Price |
$1,519.80
|
| Rate for Payer: Cigna Commercial |
$4,812.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,533.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,039.60
|
| Rate for Payer: Health EOS Commercial |
$4,610.06
|
| Rate for Payer: HFN Commercial |
$4,812.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$491.55
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$491.55
|
| Rate for Payer: Multiplan Commercial |
$4,052.80
|
| Rate for Payer: Preferred Network Access Commercial |
$4,812.70
|
| Rate for Payer: Quartz Beloit One Network |
$2,229.04
|
| Rate for Payer: Quartz Commercial |
$2,887.62
|
| Rate for Payer: The Alliance Commercial |
$2,533.00
|
| Rate for Payer: WEA Trust Commercial |
$2,786.30
|
| Rate for Payer: WPS Commercial |
$3,752.39
|
|
|
MRI Brain w/ Contrast
|
Professional
|
Both
|
$6,080.00
|
|
|
Service Code
|
CPT 70552
|
| Hospital Charge Code |
627682
|
| Min. Negotiated Rate |
$1,025.01 |
| 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 |
$1,025.01
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,025.01
|
| 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
|
|
|
MRI Brain w/ Contrast
|
Facility
|
OP
|
$6,080.00
|
|
|
Service Code
|
CPT 70552
|
| Hospital Charge Code |
627682
|
| Min. Negotiated Rate |
$380.12 |
| 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: Aetna Managed Medicare |
$380.12
|
| 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: Anthem Medicare Advantage |
$380.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,222.40
|
| 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 |
$1,824.00
|
| Rate for Payer: Cash Price |
$1,824.00
|
| Rate for Payer: Cigna Commercial |
$5,593.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$380.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,402.37
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$380.12
|
| 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 |
$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 |
$4,864.00
|
| Rate for Payer: NAPHCARE Commercial |
$570.18
|
| 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 |
$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 |
$3,344.00
|
| Rate for Payer: Wellcare Medicare |
$380.12
|
| Rate for Payer: WPS Commercial |
$4,503.46
|
|
|
MRI Brain w/ Contrast
|
Facility
|
OP
|
$6,194.00
|
|
|
Service Code
|
CPT 70552 TC
|
| Hospital Charge Code |
1610973
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$380.12 |
| Max. Negotiated Rate |
$5,698.48 |
| Rate for Payer: Aetna Commercial |
$5,574.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,326.84
|
| Rate for Payer: Aetna Managed Medicare |
$380.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,496.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,871.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,726.00
|
| Rate for Payer: Anthem Medicare Advantage |
$380.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,282.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$380.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$380.12
|
| Rate for Payer: Cash Price |
$1,858.20
|
| Rate for Payer: Cash Price |
$1,858.20
|
| Rate for Payer: Cash Price |
$1,858.20
|
| Rate for Payer: Cash Price |
$1,858.20
|
| Rate for Payer: Cigna Commercial |
$5,698.48
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$380.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,466.16
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$380.12
|
| Rate for Payer: Health EOS Commercial |
$5,512.66
|
| Rate for Payer: HFN Commercial |
$5,698.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,414.05
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$380.12
|
| Rate for Payer: Independent Care Health Plan Medicare |
$380.12
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$380.12
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$380.12
|
| Rate for Payer: Multiplan Commercial |
$4,955.20
|
| Rate for Payer: NAPHCARE Commercial |
$570.18
|
| Rate for Payer: Preferred Network Access Commercial |
$5,698.48
|
| Rate for Payer: Quartz Beloit One Network |
$3,035.06
|
| Rate for Payer: Quartz Commercial |
$4,026.10
|
| Rate for Payer: Quartz Medicare Advantage |
$380.12
|
| Rate for Payer: The Alliance Commercial |
$1,520.48
|
| Rate for Payer: United Healthcare Medicare Advantage |
$380.12
|
| Rate for Payer: United Healthcare PPO |
$3,022.00
|
| Rate for Payer: WEA Trust Commercial |
$3,406.70
|
| Rate for Payer: Wellcare Medicare |
$380.12
|
| Rate for Payer: WPS Commercial |
$4,587.90
|
|
|
MRI Brain w/ Contrast
|
Facility
|
IP
|
$6,080.00
|
|
|
Service Code
|
CPT 70552
|
| Hospital Charge Code |
627682
|
| 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
|
|
|
MRI Brain w/ Contrast
|
Facility
|
IP
|
$6,194.00
|
|
|
Service Code
|
CPT 70552 TC
|
| Hospital Charge Code |
1610973
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$3,035.06 |
| Max. Negotiated Rate |
$5,698.48 |
| Rate for Payer: Aetna Commercial |
$5,574.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,326.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,282.82
|
| Rate for Payer: Cash Price |
$1,858.20
|
| Rate for Payer: Cigna Commercial |
$5,698.48
|
| Rate for Payer: Health EOS Commercial |
$5,512.66
|
| Rate for Payer: HFN Commercial |
$5,698.48
|
| Rate for Payer: Multiplan Commercial |
$4,955.20
|
| Rate for Payer: NAPHCARE Commercial |
$3,716.40
|
| Rate for Payer: Preferred Network Access Commercial |
$5,698.48
|
| Rate for Payer: Quartz Beloit One Network |
$3,035.06
|
| Rate for Payer: Quartz Commercial |
$3,716.40
|
| Rate for Payer: WEA Trust Commercial |
$3,406.70
|
| Rate for Payer: WPS Commercial |
$4,587.90
|
|
