|
MRI Brain w/ Contrast
|
Professional
|
Both
|
$6,194.00
|
|
|
Service Code
|
CPT 70552 TC
|
| Hospital Charge Code |
1610973
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$728.20 |
| Max. Negotiated Rate |
$5,884.30 |
| Rate for Payer: Aetna Commercial |
$5,884.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,326.84
|
| Rate for Payer: Cash Price |
$1,858.20
|
| Rate for Payer: Cash Price |
$1,858.20
|
| Rate for Payer: Cash Price |
$1,858.20
|
| Rate for Payer: Cigna Commercial |
$5,884.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$3,097.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,716.40
|
| Rate for Payer: Health EOS Commercial |
$5,636.54
|
| Rate for Payer: HFN Commercial |
$5,884.30
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$728.20
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$728.20
|
| Rate for Payer: Multiplan Commercial |
$4,955.20
|
| Rate for Payer: Preferred Network Access Commercial |
$5,884.30
|
| Rate for Payer: Quartz Beloit One Network |
$2,725.36
|
| Rate for Payer: Quartz Commercial |
$3,530.58
|
| Rate for Payer: The Alliance Commercial |
$3,097.00
|
| Rate for Payer: WEA Trust Commercial |
$3,406.70
|
| Rate for Payer: WPS Commercial |
$4,587.90
|
|
|
MRI Brain w/o Contrast
|
Facility
|
OP
|
$5,066.00
|
|
|
Service Code
|
CPT 70551 TC
|
| Hospital Charge Code |
5288677
|
|
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 w/o Contrast
|
Professional
|
Both
|
$5,066.00
|
|
|
Service Code
|
CPT 70551 TC
|
| Hospital Charge Code |
5288677
|
|
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/o Contrast
|
Facility
|
OP
|
$5,066.00
|
|
|
Service Code
|
CPT 70551 TC
|
| Hospital Charge Code |
1610975
|
|
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 w/o Contrast
|
Facility
|
IP
|
$4,359.00
|
|
|
Service Code
|
CPT 70551
|
| Hospital Charge Code |
627684
|
| Min. Negotiated Rate |
$2,135.91 |
| Max. Negotiated Rate |
$4,010.28 |
| Rate for Payer: Aetna Commercial |
$3,923.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,748.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,310.27
|
| Rate for Payer: Cash Price |
$1,307.70
|
| Rate for Payer: Cigna Commercial |
$4,010.28
|
| Rate for Payer: Health EOS Commercial |
$3,879.51
|
| Rate for Payer: HFN Commercial |
$4,010.28
|
| Rate for Payer: Multiplan Commercial |
$3,487.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,615.40
|
| Rate for Payer: Preferred Network Access Commercial |
$4,010.28
|
| Rate for Payer: Quartz Beloit One Network |
$2,135.91
|
| Rate for Payer: Quartz Commercial |
$2,615.40
|
| Rate for Payer: WEA Trust Commercial |
$2,397.45
|
| Rate for Payer: WPS Commercial |
$3,228.71
|
|
|
MRI Brain w/o Contrast
|
Facility
|
OP
|
$4,359.00
|
|
|
Service Code
|
CPT 70551
|
| Hospital Charge Code |
627684
|
| Min. Negotiated Rate |
$242.20 |
| Max. Negotiated Rate |
$4,010.28 |
| Rate for Payer: Aetna Commercial |
$3,923.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,748.74
|
| Rate for Payer: Aetna Managed Medicare |
$242.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,833.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,179.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,092.32
|
| Rate for Payer: Anthem Medicare Advantage |
$242.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,310.27
|
| 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 |
$1,307.70
|
| Rate for Payer: Cash Price |
$1,307.70
|
| Rate for Payer: Cigna Commercial |
$4,010.28
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$242.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,439.30
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$242.20
|
| Rate for Payer: Health EOS Commercial |
$3,879.51
|
| Rate for Payer: HFN Commercial |
$4,010.28
|
| 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 |
$3,487.20
|
| Rate for Payer: NAPHCARE Commercial |
$363.30
|
| Rate for Payer: Preferred Network Access Commercial |
$4,010.28
|
| Rate for Payer: Quartz Beloit One Network |
$2,135.91
|
| Rate for Payer: Quartz Commercial |
$2,833.35
|
| 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 |
$2,397.45
|
| Rate for Payer: Wellcare Medicare |
$242.20
|
| Rate for Payer: WPS Commercial |
$3,228.71
|
|
|
MRI Brain w/o Contrast
|
Professional
|
Both
|
$4,359.00
|
|
|
Service Code
|
CPT 70551
|
| Hospital Charge Code |
627684
|
| Min. Negotiated Rate |
$737.52 |
| Max. Negotiated Rate |
$4,141.05 |
| Rate for Payer: Aetna Commercial |
$4,141.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,748.74
|
| Rate for Payer: Cash Price |
$1,307.70
|
| Rate for Payer: Cash Price |
$1,307.70
|
| Rate for Payer: Cash Price |
$1,307.70
|
| Rate for Payer: Cigna Commercial |
$4,141.05
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,179.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,615.40
|
| Rate for Payer: Health EOS Commercial |
$3,966.69
|
| Rate for Payer: HFN Commercial |
$4,141.05
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$737.52
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$737.52
|
| Rate for Payer: Multiplan Commercial |
$3,487.20
|
| Rate for Payer: Preferred Network Access Commercial |
$4,141.05
|
| Rate for Payer: Quartz Beloit One Network |
$1,917.96
|
| Rate for Payer: Quartz Commercial |
$2,484.63
|
| Rate for Payer: The Alliance Commercial |
$2,179.50
|
| Rate for Payer: WEA Trust Commercial |
$2,397.45
|
| Rate for Payer: WPS Commercial |
$3,228.71
|
|
|
MRI Brain w/o Contrast
|
Facility
|
IP
|
$5,066.00
|
|
|
Service Code
|
CPT 70551 TC
|
| Hospital Charge Code |
1610975
|
|
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 w/o Contrast
|
Facility
|
IP
|
$5,066.00
|
|
|
Service Code
|
CPT 70551 TC
|
| Hospital Charge Code |
5288677
|
|
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 w/o Contrast
|
Professional
|
Both
|
$5,066.00
|
|
|
Service Code
|
CPT 70551 TC
|
| Hospital Charge Code |
1610975
|
|
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 + w/o Contrast
|
Facility
|
OP
|
$6,607.00
|
|
|
Service Code
|
CPT 70553 TC
|
| Hospital Charge Code |
5288675
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$380.12 |
| Max. Negotiated Rate |
$6,078.44 |
| Rate for Payer: Aetna Commercial |
$5,946.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,682.02
|
| 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 |
$3,501.71
|
| 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 |
$1,982.10
|
| Rate for Payer: Cash Price |
$1,982.10
|
| Rate for Payer: Cash Price |
$1,982.10
|
| Rate for Payer: Cash Price |
$1,982.10
|
| Rate for Payer: Cigna Commercial |
$6,078.44
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$380.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,697.28
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$380.12
|
| Rate for Payer: Health EOS Commercial |
$5,880.23
|
| Rate for Payer: HFN Commercial |
$6,078.44
|
| 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 |
$5,285.60
|
| Rate for Payer: NAPHCARE Commercial |
$570.18
|
| Rate for Payer: Preferred Network Access Commercial |
$6,078.44
|
| Rate for Payer: Quartz Beloit One Network |
$3,237.43
|
| Rate for Payer: Quartz Commercial |
$4,294.55
|
| Rate for Payer: Quartz Medicare Advantage |
$380.12
|
| Rate for Payer: The Alliance Commercial |
$1,520.48
|
| Rate for Payer: United Healthcare Medicare Advantage |
$380.12
|
| Rate for Payer: United Healthcare PPO |
$3,022.00
|
| Rate for Payer: WEA Trust Commercial |
$3,633.85
|
| Rate for Payer: Wellcare Medicare |
$380.12
|
| Rate for Payer: WPS Commercial |
$4,893.80
|
|
|
MRI Brain w + w/o Contrast
|
Professional
|
Both
|
$6,607.00
|
|
|
Service Code
|
CPT 70553 TC
|
| Hospital Charge Code |
5288675
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$829.20 |
| Max. Negotiated Rate |
$6,276.65 |
| Rate for Payer: Aetna Commercial |
$6,276.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,682.02
|
| Rate for Payer: Cash Price |
$1,982.10
|
| Rate for Payer: Cash Price |
$1,982.10
|
| Rate for Payer: Cash Price |
$1,982.10
|
| Rate for Payer: Cigna Commercial |
$6,276.65
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$3,303.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,964.20
|
| Rate for Payer: Health EOS Commercial |
$6,012.37
|
| Rate for Payer: HFN Commercial |
$6,276.65
|
| 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 |
$5,285.60
|
| Rate for Payer: Preferred Network Access Commercial |
$6,276.65
|
| Rate for Payer: Quartz Beloit One Network |
$2,907.08
|
| Rate for Payer: Quartz Commercial |
$3,765.99
|
| Rate for Payer: The Alliance Commercial |
$3,303.50
|
| Rate for Payer: WEA Trust Commercial |
$3,633.85
|
| Rate for Payer: WPS Commercial |
$4,893.80
|
|
|
MRI Brain w + w/o Contrast
|
Facility
|
IP
|
$6,607.00
|
|
|
Service Code
|
CPT 70553 TC
|
| Hospital Charge Code |
5288675
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$3,237.43 |
| Max. Negotiated Rate |
$6,078.44 |
| Rate for Payer: Aetna Commercial |
$5,946.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,682.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,501.71
|
| Rate for Payer: Cash Price |
$1,982.10
|
| Rate for Payer: Cigna Commercial |
$6,078.44
|
| Rate for Payer: Health EOS Commercial |
$5,880.23
|
| Rate for Payer: HFN Commercial |
$6,078.44
|
| Rate for Payer: Multiplan Commercial |
$5,285.60
|
| Rate for Payer: NAPHCARE Commercial |
$3,964.20
|
| Rate for Payer: Preferred Network Access Commercial |
$6,078.44
|
| Rate for Payer: Quartz Beloit One Network |
$3,237.43
|
| Rate for Payer: Quartz Commercial |
$3,964.20
|
| Rate for Payer: WEA Trust Commercial |
$3,633.85
|
| Rate for Payer: WPS Commercial |
$4,893.80
|
|
|
MRI Brain w/ + w/o Contrast
|
Facility
|
IP
|
$6,280.00
|
|
|
Service Code
|
CPT 70553
|
| Hospital Charge Code |
627680
|
| Min. Negotiated Rate |
$3,077.20 |
| Max. Negotiated Rate |
$5,777.60 |
| Rate for Payer: Aetna Commercial |
$5,652.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,400.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,328.40
|
| Rate for Payer: Cash Price |
$1,884.00
|
| Rate for Payer: Cigna Commercial |
$5,777.60
|
| Rate for Payer: Health EOS Commercial |
$5,589.20
|
| Rate for Payer: HFN Commercial |
$5,777.60
|
| Rate for Payer: Multiplan Commercial |
$5,024.00
|
| Rate for Payer: NAPHCARE Commercial |
$3,768.00
|
| Rate for Payer: Preferred Network Access Commercial |
$5,777.60
|
| Rate for Payer: Quartz Beloit One Network |
$3,077.20
|
| Rate for Payer: Quartz Commercial |
$3,768.00
|
| Rate for Payer: WEA Trust Commercial |
$3,454.00
|
| Rate for Payer: WPS Commercial |
$4,651.60
|
|
|
MRI Brain w/ + w/o Contrast
|
Professional
|
Both
|
$6,607.00
|
|
|
Service Code
|
CPT 70553 TC
|
| Hospital Charge Code |
1610971
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$829.20 |
| Max. Negotiated Rate |
$6,276.65 |
| Rate for Payer: Aetna Commercial |
$6,276.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,682.02
|
| Rate for Payer: Cash Price |
$1,982.10
|
| Rate for Payer: Cash Price |
$1,982.10
|
| Rate for Payer: Cash Price |
$1,982.10
|
| Rate for Payer: Cigna Commercial |
$6,276.65
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$3,303.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,964.20
|
| Rate for Payer: Health EOS Commercial |
$6,012.37
|
| Rate for Payer: HFN Commercial |
$6,276.65
|
| 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 |
$5,285.60
|
| Rate for Payer: Preferred Network Access Commercial |
$6,276.65
|
| Rate for Payer: Quartz Beloit One Network |
$2,907.08
|
| Rate for Payer: Quartz Commercial |
$3,765.99
|
| Rate for Payer: The Alliance Commercial |
$3,303.50
|
| Rate for Payer: WEA Trust Commercial |
$3,633.85
|
| Rate for Payer: WPS Commercial |
$4,893.80
|
|
|
MRI Brain w/ + w/o Contrast
|
Facility
|
OP
|
$6,280.00
|
|
|
Service Code
|
CPT 70553
|
| Hospital Charge Code |
627680
|
| Min. Negotiated Rate |
$380.12 |
| Max. Negotiated Rate |
$5,777.60 |
| Rate for Payer: Aetna Commercial |
$5,652.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,400.80
|
| Rate for Payer: Aetna Managed Medicare |
$380.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,082.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,140.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,014.40
|
| Rate for Payer: Anthem Medicare Advantage |
$380.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,328.40
|
| 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 |
$1,884.00
|
| Rate for Payer: Cash Price |
$1,884.00
|
| Rate for Payer: Cigna Commercial |
$5,777.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$380.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,514.29
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$380.12
|
| Rate for Payer: Health EOS Commercial |
$5,589.20
|
| Rate for Payer: HFN Commercial |
$5,777.60
|
| 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 |
$5,024.00
|
| Rate for Payer: NAPHCARE Commercial |
$570.18
|
| Rate for Payer: Preferred Network Access Commercial |
$5,777.60
|
| Rate for Payer: Quartz Beloit One Network |
$3,077.20
|
| Rate for Payer: Quartz Commercial |
$4,082.00
|
| 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 |
$3,454.00
|
| Rate for Payer: Wellcare Medicare |
$380.12
|
| Rate for Payer: WPS Commercial |
$4,651.60
|
|
|
MRI Brain w/ + w/o Contrast
|
Facility
|
IP
|
$6,607.00
|
|
|
Service Code
|
CPT 70553 TC
|
| Hospital Charge Code |
1610971
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$3,237.43 |
| Max. Negotiated Rate |
$6,078.44 |
| Rate for Payer: Aetna Commercial |
$5,946.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,682.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,501.71
|
| Rate for Payer: Cash Price |
$1,982.10
|
| Rate for Payer: Cigna Commercial |
$6,078.44
|
| Rate for Payer: Health EOS Commercial |
$5,880.23
|
| Rate for Payer: HFN Commercial |
$6,078.44
|
| Rate for Payer: Multiplan Commercial |
$5,285.60
|
| Rate for Payer: NAPHCARE Commercial |
$3,964.20
|
| Rate for Payer: Preferred Network Access Commercial |
$6,078.44
|
| Rate for Payer: Quartz Beloit One Network |
$3,237.43
|
| Rate for Payer: Quartz Commercial |
$3,964.20
|
| Rate for Payer: WEA Trust Commercial |
$3,633.85
|
| Rate for Payer: WPS Commercial |
$4,893.80
|
|
|
MRI Brain w/ + w/o Contrast
|
Professional
|
Both
|
$6,280.00
|
|
|
Service Code
|
CPT 70553
|
| Hospital Charge Code |
627680
|
| Min. Negotiated Rate |
$1,211.57 |
| Max. Negotiated Rate |
$5,966.00 |
| Rate for Payer: Aetna Commercial |
$5,966.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,400.80
|
| Rate for Payer: Cash Price |
$1,884.00
|
| Rate for Payer: Cash Price |
$1,884.00
|
| Rate for Payer: Cash Price |
$1,884.00
|
| Rate for Payer: Cigna Commercial |
$5,966.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$3,140.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,768.00
|
| Rate for Payer: Health EOS Commercial |
$5,714.80
|
| Rate for Payer: HFN Commercial |
$5,966.00
|
| 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 |
$5,024.00
|
| Rate for Payer: Preferred Network Access Commercial |
$5,966.00
|
| Rate for Payer: Quartz Beloit One Network |
$2,763.20
|
| Rate for Payer: Quartz Commercial |
$3,579.60
|
| Rate for Payer: The Alliance Commercial |
$3,140.00
|
| Rate for Payer: WEA Trust Commercial |
$3,454.00
|
| Rate for Payer: WPS Commercial |
$4,651.60
|
|
|
MRI Brain w/ + w/o Contrast
|
Facility
|
OP
|
$6,607.00
|
|
|
Service Code
|
CPT 70553 TC
|
| Hospital Charge Code |
1610971
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$380.12 |
| Max. Negotiated Rate |
$6,078.44 |
| Rate for Payer: Aetna Commercial |
$5,946.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,682.02
|
| 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 |
$3,501.71
|
| 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 |
$1,982.10
|
| Rate for Payer: Cash Price |
$1,982.10
|
| Rate for Payer: Cash Price |
$1,982.10
|
| Rate for Payer: Cash Price |
$1,982.10
|
| Rate for Payer: Cigna Commercial |
$6,078.44
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$380.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,697.28
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$380.12
|
| Rate for Payer: Health EOS Commercial |
$5,880.23
|
| Rate for Payer: HFN Commercial |
$6,078.44
|
| 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 |
$5,285.60
|
| Rate for Payer: NAPHCARE Commercial |
$570.18
|
| Rate for Payer: Preferred Network Access Commercial |
$6,078.44
|
| Rate for Payer: Quartz Beloit One Network |
$3,237.43
|
| Rate for Payer: Quartz Commercial |
$4,294.55
|
| Rate for Payer: Quartz Medicare Advantage |
$380.12
|
| Rate for Payer: The Alliance Commercial |
$1,520.48
|
| Rate for Payer: United Healthcare Medicare Advantage |
$380.12
|
| Rate for Payer: United Healthcare PPO |
$3,022.00
|
| Rate for Payer: WEA Trust Commercial |
$3,633.85
|
| Rate for Payer: Wellcare Medicare |
$380.12
|
| Rate for Payer: WPS Commercial |
$4,893.80
|
|
|
MRI Breast w/ Contrast Bilateral
|
Facility
|
OP
|
$4,597.00
|
|
|
Service Code
|
CPT 77059
|
| Hospital Charge Code |
627698
|
| Min. Negotiated Rate |
$1,287.16 |
| Max. Negotiated Rate |
$18,388.00 |
| Rate for Payer: Aetna Commercial |
$4,137.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,953.42
|
| Rate for Payer: Aetna Managed Medicare |
$1,287.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,988.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,298.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,206.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,436.41
|
| Rate for Payer: Cash Price |
$1,379.10
|
| Rate for Payer: Cigna Commercial |
$4,229.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,572.48
|
| Rate for Payer: Health EOS Commercial |
$4,091.33
|
| Rate for Payer: HFN Commercial |
$4,229.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,447.75
|
| Rate for Payer: Multiplan Commercial |
$3,677.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,758.20
|
| Rate for Payer: Preferred Network Access Commercial |
$4,229.24
|
| Rate for Payer: Quartz Beloit One Network |
$2,252.53
|
| Rate for Payer: Quartz Commercial |
$2,988.05
|
| Rate for Payer: Quartz Medicare Advantage |
$2,758.20
|
| Rate for Payer: The Alliance Commercial |
$18,388.00
|
| Rate for Payer: WEA Trust Commercial |
$2,528.35
|
| Rate for Payer: WPS Commercial |
$3,405.00
|
|
|
MRI Breast w/ Contrast Bilateral
|
Facility
|
IP
|
$4,597.00
|
|
|
Service Code
|
CPT 77059
|
| Hospital Charge Code |
627698
|
| Min. Negotiated Rate |
$2,252.53 |
| Max. Negotiated Rate |
$4,229.24 |
| Rate for Payer: Aetna Commercial |
$4,137.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,953.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,436.41
|
| Rate for Payer: Cash Price |
$1,379.10
|
| Rate for Payer: Cigna Commercial |
$4,229.24
|
| Rate for Payer: Health EOS Commercial |
$4,091.33
|
| Rate for Payer: HFN Commercial |
$4,229.24
|
| Rate for Payer: Multiplan Commercial |
$3,677.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,758.20
|
| Rate for Payer: Preferred Network Access Commercial |
$4,229.24
|
| Rate for Payer: Quartz Beloit One Network |
$2,252.53
|
| Rate for Payer: Quartz Commercial |
$2,758.20
|
| Rate for Payer: WEA Trust Commercial |
$2,528.35
|
| Rate for Payer: WPS Commercial |
$3,405.00
|
|
|
MRI Breast w/ Contrast Bilateral
|
Facility
|
OP
|
$2,255.00
|
|
|
Service Code
|
CPT 77059 TC
|
| Hospital Charge Code |
1610992
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$380.12 |
| Max. Negotiated Rate |
$3,496.00 |
| Rate for Payer: Aetna Commercial |
$2,029.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,939.30
|
| 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 |
$1,195.15
|
| 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 |
$676.50
|
| Rate for Payer: Cash Price |
$676.50
|
| Rate for Payer: Cash Price |
$676.50
|
| Rate for Payer: Cash Price |
$676.50
|
| Rate for Payer: Cigna Commercial |
$2,074.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$380.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,261.90
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$380.12
|
| Rate for Payer: Health EOS Commercial |
$2,006.95
|
| Rate for Payer: HFN Commercial |
$2,074.60
|
| 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 |
$1,804.00
|
| Rate for Payer: NAPHCARE Commercial |
$570.18
|
| Rate for Payer: Preferred Network Access Commercial |
$2,074.60
|
| Rate for Payer: Quartz Beloit One Network |
$1,104.95
|
| Rate for Payer: Quartz Commercial |
$1,465.75
|
| 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 |
$1,240.25
|
| Rate for Payer: Wellcare Medicare |
$380.12
|
| Rate for Payer: WPS Commercial |
$1,670.28
|
|
|
MRI Breast w/ Contrast Bilateral
|
Professional
|
Both
|
$4,597.00
|
|
|
Service Code
|
CPT 77059
|
| Hospital Charge Code |
627698
|
| Min. Negotiated Rate |
$2,022.68 |
| Max. Negotiated Rate |
$4,367.15 |
| Rate for Payer: Aetna Commercial |
$4,367.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,953.42
|
| Rate for Payer: Cash Price |
$1,379.10
|
| Rate for Payer: Cigna Commercial |
$4,367.15
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,298.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,758.20
|
| Rate for Payer: Health EOS Commercial |
$4,183.27
|
| Rate for Payer: HFN Commercial |
$4,367.15
|
| Rate for Payer: Multiplan Commercial |
$3,677.60
|
| Rate for Payer: Preferred Network Access Commercial |
$4,367.15
|
| Rate for Payer: Quartz Beloit One Network |
$2,022.68
|
| Rate for Payer: Quartz Commercial |
$2,620.29
|
| Rate for Payer: The Alliance Commercial |
$2,298.50
|
| Rate for Payer: WEA Trust Commercial |
$2,528.35
|
| Rate for Payer: WPS Commercial |
$3,405.00
|
|
|
MRI Breast w/ Contrast Bilateral
|
Professional
|
Both
|
$2,255.00
|
|
|
Service Code
|
CPT 77059 TC
|
| Hospital Charge Code |
1610992
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$992.20 |
| Max. Negotiated Rate |
$2,142.25 |
| Rate for Payer: Aetna Commercial |
$2,142.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,939.30
|
| Rate for Payer: Cash Price |
$676.50
|
| Rate for Payer: Cigna Commercial |
$2,142.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,127.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,353.00
|
| Rate for Payer: Health EOS Commercial |
$2,052.05
|
| Rate for Payer: HFN Commercial |
$2,142.25
|
| Rate for Payer: Multiplan Commercial |
$1,804.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,142.25
|
| Rate for Payer: Quartz Beloit One Network |
$992.20
|
| Rate for Payer: Quartz Commercial |
$1,285.35
|
| Rate for Payer: The Alliance Commercial |
$1,127.50
|
| Rate for Payer: WEA Trust Commercial |
$1,240.25
|
| Rate for Payer: WPS Commercial |
$1,670.28
|
|
|
MRI Breast w/ Contrast Bilateral
|
Facility
|
IP
|
$2,255.00
|
|
|
Service Code
|
CPT 77059 TC
|
| Hospital Charge Code |
1610992
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,104.95 |
| Max. Negotiated Rate |
$2,074.60 |
| Rate for Payer: Aetna Commercial |
$2,029.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,939.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,195.15
|
| Rate for Payer: Cash Price |
$676.50
|
| Rate for Payer: Cigna Commercial |
$2,074.60
|
| Rate for Payer: Health EOS Commercial |
$2,006.95
|
| Rate for Payer: HFN Commercial |
$2,074.60
|
| Rate for Payer: Multiplan Commercial |
$1,804.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,353.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,074.60
|
| Rate for Payer: Quartz Beloit One Network |
$1,104.95
|
| Rate for Payer: Quartz Commercial |
$1,353.00
|
| Rate for Payer: WEA Trust Commercial |
$1,240.25
|
| Rate for Payer: WPS Commercial |
$1,670.28
|
|
