|
MRI Breast w/ + w/o Contrast Right
|
Professional
|
Both
|
$2,255.00
|
|
|
Service Code
|
CPT 77058 TC,RT
|
| Hospital Charge Code |
2980129
|
|
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/ + w/o Contrast Right
|
Facility
|
IP
|
$2,255.00
|
|
|
Service Code
|
CPT 77048 TC
|
| Hospital Charge Code |
1610990
|
|
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
|
|
|
MRI Breast w/ + w/o Contrast Right
|
Professional
|
Both
|
$2,299.00
|
|
|
Service Code
|
CPT 77058
|
| Hospital Charge Code |
627696
|
| Min. Negotiated Rate |
$1,011.56 |
| Max. Negotiated Rate |
$2,184.05 |
| Rate for Payer: Aetna Commercial |
$2,184.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,977.14
|
| Rate for Payer: Cash Price |
$689.70
|
| Rate for Payer: Cigna Commercial |
$2,184.05
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,149.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,379.40
|
| Rate for Payer: Health EOS Commercial |
$2,092.09
|
| Rate for Payer: HFN Commercial |
$2,184.05
|
| Rate for Payer: Multiplan Commercial |
$1,839.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,184.05
|
| Rate for Payer: Quartz Beloit One Network |
$1,011.56
|
| Rate for Payer: Quartz Commercial |
$1,310.43
|
| Rate for Payer: The Alliance Commercial |
$1,149.50
|
| Rate for Payer: WEA Trust Commercial |
$1,264.45
|
| Rate for Payer: WPS Commercial |
$1,702.87
|
|
|
MRI Breast w/ + w/o Contrast Right
|
Facility
|
OP
|
$2,255.00
|
|
|
Service Code
|
CPT 77048 TC
|
| Hospital Charge Code |
1610990
|
|
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/ + w/o Contrast Right
|
Facility
|
IP
|
$2,299.00
|
|
|
Service Code
|
CPT 77058
|
| Hospital Charge Code |
627696
|
| Min. Negotiated Rate |
$1,126.51 |
| Max. Negotiated Rate |
$2,115.08 |
| Rate for Payer: Aetna Commercial |
$2,069.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,977.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,218.47
|
| Rate for Payer: Cash Price |
$689.70
|
| Rate for Payer: Cigna Commercial |
$2,115.08
|
| Rate for Payer: Health EOS Commercial |
$2,046.11
|
| Rate for Payer: HFN Commercial |
$2,115.08
|
| Rate for Payer: Multiplan Commercial |
$1,839.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,379.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,115.08
|
| Rate for Payer: Quartz Beloit One Network |
$1,126.51
|
| Rate for Payer: Quartz Commercial |
$1,379.40
|
| Rate for Payer: WEA Trust Commercial |
$1,264.45
|
| Rate for Payer: WPS Commercial |
$1,702.87
|
|
|
MRI Breast w/ + w/o Contrast Right
|
Facility
|
OP
|
$2,299.00
|
|
|
Service Code
|
CPT 77058
|
| Hospital Charge Code |
627696
|
| Min. Negotiated Rate |
$643.72 |
| Max. Negotiated Rate |
$9,196.00 |
| Rate for Payer: Aetna Commercial |
$2,069.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,977.14
|
| Rate for Payer: Aetna Managed Medicare |
$643.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,494.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,149.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,103.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,218.47
|
| Rate for Payer: Cash Price |
$689.70
|
| Rate for Payer: Cigna Commercial |
$2,115.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,286.52
|
| Rate for Payer: Health EOS Commercial |
$2,046.11
|
| Rate for Payer: HFN Commercial |
$2,115.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,724.25
|
| Rate for Payer: Multiplan Commercial |
$1,839.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,379.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,115.08
|
| Rate for Payer: Quartz Beloit One Network |
$1,126.51
|
| Rate for Payer: Quartz Commercial |
$1,494.35
|
| Rate for Payer: Quartz Medicare Advantage |
$1,379.40
|
| Rate for Payer: The Alliance Commercial |
$9,196.00
|
| Rate for Payer: WEA Trust Commercial |
$1,264.45
|
| Rate for Payer: WPS Commercial |
$1,702.87
|
|
|
MRI Breast w/ + w/o Contrast Right
|
Professional
|
Both
|
$2,255.00
|
|
|
Service Code
|
CPT 77048 TC
|
| Hospital Charge Code |
1610990
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$942.86 |
| 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: Cash Price |
$676.50
|
| 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: Humana Commercial/EPO/HMO/POS/PPO |
$942.86
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$942.86
|
| 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 Cervical Combined
|
Professional
|
Both
|
$6,351.00
|
|
|
Service Code
|
CPT 72156 TC
|
| Hospital Charge Code |
3072663
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$840.78 |
| Max. Negotiated Rate |
$6,033.45 |
| Rate for Payer: Aetna Commercial |
$6,033.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,461.86
|
| Rate for Payer: Cash Price |
$1,905.30
|
| Rate for Payer: Cash Price |
$1,905.30
|
| Rate for Payer: Cash Price |
$1,905.30
|
| Rate for Payer: Cigna Commercial |
$6,033.45
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$3,175.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,810.60
|
| Rate for Payer: Health EOS Commercial |
$5,779.41
|
| Rate for Payer: HFN Commercial |
$6,033.45
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$840.78
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$840.78
|
| Rate for Payer: Multiplan Commercial |
$5,080.80
|
| Rate for Payer: Preferred Network Access Commercial |
$6,033.45
|
| Rate for Payer: Quartz Beloit One Network |
$2,794.44
|
| Rate for Payer: Quartz Commercial |
$3,620.07
|
| Rate for Payer: The Alliance Commercial |
$3,175.50
|
| Rate for Payer: WEA Trust Commercial |
$3,493.05
|
| Rate for Payer: WPS Commercial |
$4,704.19
|
|
|
MRI Cervical Combined
|
Facility
|
IP
|
$6,351.00
|
|
|
Service Code
|
CPT 72156 TC
|
| Hospital Charge Code |
3072663
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$3,111.99 |
| Max. Negotiated Rate |
$5,842.92 |
| Rate for Payer: Aetna Commercial |
$5,715.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,461.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,366.03
|
| Rate for Payer: Cash Price |
$1,905.30
|
| Rate for Payer: Cigna Commercial |
$5,842.92
|
| Rate for Payer: Health EOS Commercial |
$5,652.39
|
| Rate for Payer: HFN Commercial |
$5,842.92
|
| Rate for Payer: Multiplan Commercial |
$5,080.80
|
| Rate for Payer: NAPHCARE Commercial |
$3,810.60
|
| Rate for Payer: Preferred Network Access Commercial |
$5,842.92
|
| Rate for Payer: Quartz Beloit One Network |
$3,111.99
|
| Rate for Payer: Quartz Commercial |
$3,810.60
|
| Rate for Payer: WEA Trust Commercial |
$3,493.05
|
| Rate for Payer: WPS Commercial |
$4,704.19
|
|
|
MRI Cervical Combined
|
Facility
|
OP
|
$6,351.00
|
|
|
Service Code
|
CPT 72156 TC
|
| Hospital Charge Code |
3072663
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$380.12 |
| Max. Negotiated Rate |
$5,842.92 |
| Rate for Payer: Aetna Commercial |
$5,715.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,461.86
|
| 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 |
$3,366.03
|
| 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 |
$1,905.30
|
| Rate for Payer: Cash Price |
$1,905.30
|
| Rate for Payer: Cash Price |
$1,905.30
|
| Rate for Payer: Cash Price |
$1,905.30
|
| Rate for Payer: Cigna Commercial |
$5,842.92
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$380.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,554.02
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$380.12
|
| Rate for Payer: Health EOS Commercial |
$5,652.39
|
| Rate for Payer: HFN Commercial |
$5,842.92
|
| 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 |
$5,080.80
|
| Rate for Payer: NAPHCARE Commercial |
$570.18
|
| Rate for Payer: Preferred Network Access Commercial |
$5,842.92
|
| Rate for Payer: Quartz Beloit One Network |
$3,111.99
|
| Rate for Payer: Quartz Commercial |
$4,128.15
|
| 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 |
$3,493.05
|
| Rate for Payer: Wellcare Medicare |
$380.12
|
| Rate for Payer: WPS Commercial |
$4,704.19
|
|
|
MRI Cervical w/o Contrast
|
Facility
|
IP
|
$4,864.00
|
|
|
Service Code
|
CPT 72141 TC
|
| Hospital Charge Code |
3072662
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$2,383.36 |
| Max. Negotiated Rate |
$4,474.88 |
| Rate for Payer: Aetna Commercial |
$4,377.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,183.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,577.92
|
| Rate for Payer: Cash Price |
$1,459.20
|
| Rate for Payer: Cigna Commercial |
$4,474.88
|
| Rate for Payer: Health EOS Commercial |
$4,328.96
|
| Rate for Payer: HFN Commercial |
$4,474.88
|
| Rate for Payer: Multiplan Commercial |
$3,891.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,918.40
|
| Rate for Payer: Preferred Network Access Commercial |
$4,474.88
|
| Rate for Payer: Quartz Beloit One Network |
$2,383.36
|
| Rate for Payer: Quartz Commercial |
$2,918.40
|
| Rate for Payer: WEA Trust Commercial |
$2,675.20
|
| Rate for Payer: WPS Commercial |
$3,602.76
|
|
|
MRI Cervical w/o Contrast
|
Professional
|
Both
|
$4,864.00
|
|
|
Service Code
|
CPT 72141 TC
|
| Hospital Charge Code |
3072662
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$474.93 |
| Max. Negotiated Rate |
$4,620.80 |
| Rate for Payer: Aetna Commercial |
$4,620.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,183.04
|
| Rate for Payer: Cash Price |
$1,459.20
|
| Rate for Payer: Cash Price |
$1,459.20
|
| Rate for Payer: Cash Price |
$1,459.20
|
| Rate for Payer: Cigna Commercial |
$4,620.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,432.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,918.40
|
| Rate for Payer: Health EOS Commercial |
$4,426.24
|
| Rate for Payer: HFN Commercial |
$4,620.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$474.93
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$474.93
|
| Rate for Payer: Multiplan Commercial |
$3,891.20
|
| Rate for Payer: Preferred Network Access Commercial |
$4,620.80
|
| Rate for Payer: Quartz Beloit One Network |
$2,140.16
|
| Rate for Payer: Quartz Commercial |
$2,772.48
|
| Rate for Payer: The Alliance Commercial |
$2,432.00
|
| Rate for Payer: WEA Trust Commercial |
$2,675.20
|
| Rate for Payer: WPS Commercial |
$3,602.76
|
|
|
MRI Cervical w/o Contrast
|
Facility
|
OP
|
$4,864.00
|
|
|
Service Code
|
CPT 72141 TC
|
| Hospital Charge Code |
3072662
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$242.20 |
| Max. Negotiated Rate |
$4,474.88 |
| Rate for Payer: Aetna Commercial |
$4,377.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,183.04
|
| 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 |
$2,577.92
|
| 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 |
$1,459.20
|
| Rate for Payer: Cash Price |
$1,459.20
|
| Rate for Payer: Cash Price |
$1,459.20
|
| Rate for Payer: Cash Price |
$1,459.20
|
| Rate for Payer: Cigna Commercial |
$4,474.88
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$242.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,721.89
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$242.20
|
| Rate for Payer: Health EOS Commercial |
$4,328.96
|
| Rate for Payer: HFN Commercial |
$4,474.88
|
| 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 |
$3,891.20
|
| Rate for Payer: NAPHCARE Commercial |
$363.30
|
| Rate for Payer: Preferred Network Access Commercial |
$4,474.88
|
| Rate for Payer: Quartz Beloit One Network |
$2,383.36
|
| Rate for Payer: Quartz Commercial |
$3,161.60
|
| 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 |
$2,675.20
|
| Rate for Payer: Wellcare Medicare |
$242.20
|
| Rate for Payer: WPS Commercial |
$3,602.76
|
|
|
MRI Chest w/ Contrast
|
Professional
|
Both
|
$7,316.00
|
|
|
Service Code
|
CPT 71551 TC
|
| Hospital Charge Code |
1611027
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,164.09 |
| Max. Negotiated Rate |
$6,950.20 |
| Rate for Payer: Aetna Commercial |
$6,950.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,291.76
|
| Rate for Payer: Cash Price |
$2,194.80
|
| Rate for Payer: Cash Price |
$2,194.80
|
| Rate for Payer: Cash Price |
$2,194.80
|
| Rate for Payer: Cigna Commercial |
$6,950.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$3,658.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,389.60
|
| Rate for Payer: Health EOS Commercial |
$6,657.56
|
| Rate for Payer: HFN Commercial |
$6,950.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,164.09
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,164.09
|
| Rate for Payer: Multiplan Commercial |
$5,852.80
|
| Rate for Payer: Preferred Network Access Commercial |
$6,950.20
|
| Rate for Payer: Quartz Beloit One Network |
$3,219.04
|
| Rate for Payer: Quartz Commercial |
$4,170.12
|
| Rate for Payer: The Alliance Commercial |
$3,658.00
|
| Rate for Payer: WEA Trust Commercial |
$4,023.80
|
| Rate for Payer: WPS Commercial |
$5,418.96
|
|
|
MRI Chest w/ Contrast
|
Professional
|
Both
|
$7,457.00
|
|
|
Service Code
|
CPT 71551
|
| Hospital Charge Code |
629710
|
| Min. Negotiated Rate |
$1,452.38 |
| Max. Negotiated Rate |
$7,084.15 |
| Rate for Payer: Aetna Commercial |
$7,084.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,413.02
|
| Rate for Payer: Cash Price |
$2,237.10
|
| Rate for Payer: Cash Price |
$2,237.10
|
| Rate for Payer: Cash Price |
$2,237.10
|
| Rate for Payer: Cigna Commercial |
$7,084.15
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$3,728.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,474.20
|
| Rate for Payer: Health EOS Commercial |
$6,785.87
|
| Rate for Payer: HFN Commercial |
$7,084.15
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,452.38
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,452.38
|
| Rate for Payer: Multiplan Commercial |
$5,965.60
|
| Rate for Payer: Preferred Network Access Commercial |
$7,084.15
|
| Rate for Payer: Quartz Beloit One Network |
$3,281.08
|
| Rate for Payer: Quartz Commercial |
$4,250.49
|
| Rate for Payer: The Alliance Commercial |
$3,728.50
|
| Rate for Payer: WEA Trust Commercial |
$4,101.35
|
| Rate for Payer: WPS Commercial |
$5,523.40
|
|
|
MRI Chest w/ Contrast
|
Facility
|
OP
|
$7,457.00
|
|
|
Service Code
|
CPT 71551
|
| Hospital Charge Code |
629710
|
| Min. Negotiated Rate |
$791.40 |
| Max. Negotiated Rate |
$6,860.44 |
| Rate for Payer: Aetna Commercial |
$6,711.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,413.02
|
| Rate for Payer: Aetna Managed Medicare |
$791.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,847.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,728.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,579.36
|
| Rate for Payer: Anthem Medicare Advantage |
$791.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,952.21
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$791.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$791.40
|
| Rate for Payer: Cash Price |
$2,237.10
|
| Rate for Payer: Cash Price |
$2,237.10
|
| Rate for Payer: Cigna Commercial |
$6,860.44
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$791.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,172.94
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$791.40
|
| Rate for Payer: Health EOS Commercial |
$6,636.73
|
| Rate for Payer: HFN Commercial |
$6,860.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,944.01
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$791.40
|
| Rate for Payer: Independent Care Health Plan Medicare |
$791.40
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$791.40
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$791.40
|
| Rate for Payer: Multiplan Commercial |
$5,965.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,187.10
|
| Rate for Payer: Preferred Network Access Commercial |
$6,860.44
|
| Rate for Payer: Quartz Beloit One Network |
$3,653.93
|
| Rate for Payer: Quartz Commercial |
$4,847.05
|
| Rate for Payer: Quartz Medicare Advantage |
$791.40
|
| Rate for Payer: The Alliance Commercial |
$3,165.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$791.40
|
| Rate for Payer: WEA Trust Commercial |
$4,101.35
|
| Rate for Payer: Wellcare Medicare |
$791.40
|
| Rate for Payer: WPS Commercial |
$5,523.40
|
|
|
MRI Chest w/ Contrast
|
Facility
|
IP
|
$7,457.00
|
|
|
Service Code
|
CPT 71551
|
| Hospital Charge Code |
629710
|
| Min. Negotiated Rate |
$3,653.93 |
| Max. Negotiated Rate |
$6,860.44 |
| Rate for Payer: Aetna Commercial |
$6,711.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,413.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,952.21
|
| Rate for Payer: Cash Price |
$2,237.10
|
| Rate for Payer: Cigna Commercial |
$6,860.44
|
| Rate for Payer: Health EOS Commercial |
$6,636.73
|
| Rate for Payer: HFN Commercial |
$6,860.44
|
| Rate for Payer: Multiplan Commercial |
$5,965.60
|
| Rate for Payer: NAPHCARE Commercial |
$4,474.20
|
| Rate for Payer: Preferred Network Access Commercial |
$6,860.44
|
| Rate for Payer: Quartz Beloit One Network |
$3,653.93
|
| Rate for Payer: Quartz Commercial |
$4,474.20
|
| Rate for Payer: WEA Trust Commercial |
$4,101.35
|
| Rate for Payer: WPS Commercial |
$5,523.40
|
|
|
MRI Chest w/ Contrast
|
Facility
|
OP
|
$7,316.00
|
|
|
Service Code
|
CPT 71551 TC
|
| Hospital Charge Code |
1611027
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$791.40 |
| Max. Negotiated Rate |
$6,730.72 |
| Rate for Payer: Aetna Commercial |
$6,584.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,291.76
|
| Rate for Payer: Aetna Managed Medicare |
$791.40
|
| 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 |
$791.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,877.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$791.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$791.40
|
| Rate for Payer: Cash Price |
$2,194.80
|
| Rate for Payer: Cash Price |
$2,194.80
|
| Rate for Payer: Cash Price |
$2,194.80
|
| Rate for Payer: Cash Price |
$2,194.80
|
| Rate for Payer: Cigna Commercial |
$6,730.72
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$791.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,094.03
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$791.40
|
| Rate for Payer: Health EOS Commercial |
$6,511.24
|
| Rate for Payer: HFN Commercial |
$6,730.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,944.01
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$791.40
|
| Rate for Payer: Independent Care Health Plan Medicare |
$791.40
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$791.40
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$791.40
|
| Rate for Payer: Multiplan Commercial |
$5,852.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,187.10
|
| Rate for Payer: Preferred Network Access Commercial |
$6,730.72
|
| Rate for Payer: Quartz Beloit One Network |
$3,584.84
|
| Rate for Payer: Quartz Commercial |
$4,755.40
|
| Rate for Payer: Quartz Medicare Advantage |
$791.40
|
| Rate for Payer: The Alliance Commercial |
$3,165.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$791.40
|
| Rate for Payer: United Healthcare PPO |
$3,022.00
|
| Rate for Payer: WEA Trust Commercial |
$4,023.80
|
| Rate for Payer: Wellcare Medicare |
$791.40
|
| Rate for Payer: WPS Commercial |
$5,418.96
|
|
|
MRI Chest w/ Contrast
|
Facility
|
IP
|
$7,316.00
|
|
|
Service Code
|
CPT 71551 TC
|
| Hospital Charge Code |
1611027
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$3,584.84 |
| Max. Negotiated Rate |
$6,730.72 |
| Rate for Payer: Aetna Commercial |
$6,584.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,291.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,877.48
|
| Rate for Payer: Cash Price |
$2,194.80
|
| Rate for Payer: Cigna Commercial |
$6,730.72
|
| Rate for Payer: Health EOS Commercial |
$6,511.24
|
| Rate for Payer: HFN Commercial |
$6,730.72
|
| Rate for Payer: Multiplan Commercial |
$5,852.80
|
| Rate for Payer: NAPHCARE Commercial |
$4,389.60
|
| Rate for Payer: Preferred Network Access Commercial |
$6,730.72
|
| Rate for Payer: Quartz Beloit One Network |
$3,584.84
|
| Rate for Payer: Quartz Commercial |
$4,389.60
|
| Rate for Payer: WEA Trust Commercial |
$4,023.80
|
| Rate for Payer: WPS Commercial |
$5,418.96
|
|
|
MRI Chest w/o Contrast
|
Facility
|
IP
|
$6,780.00
|
|
|
Service Code
|
CPT 71550
|
| Hospital Charge Code |
629712
|
| Min. Negotiated Rate |
$3,322.20 |
| Max. Negotiated Rate |
$6,237.60 |
| Rate for Payer: Aetna Commercial |
$6,102.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,830.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,593.40
|
| Rate for Payer: Cash Price |
$2,034.00
|
| Rate for Payer: Cigna Commercial |
$6,237.60
|
| Rate for Payer: Health EOS Commercial |
$6,034.20
|
| Rate for Payer: HFN Commercial |
$6,237.60
|
| Rate for Payer: Multiplan Commercial |
$5,424.00
|
| Rate for Payer: NAPHCARE Commercial |
$4,068.00
|
| Rate for Payer: Preferred Network Access Commercial |
$6,237.60
|
| Rate for Payer: Quartz Beloit One Network |
$3,322.20
|
| Rate for Payer: Quartz Commercial |
$4,068.00
|
| Rate for Payer: WEA Trust Commercial |
$3,729.00
|
| Rate for Payer: WPS Commercial |
$5,021.95
|
|
|
MRI Chest w/o Contrast
|
Professional
|
Both
|
$6,652.00
|
|
|
Service Code
|
CPT 71550 TC
|
| Hospital Charge Code |
1611029
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,075.17 |
| Max. Negotiated Rate |
$6,319.40 |
| Rate for Payer: Aetna Commercial |
$6,319.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,720.72
|
| Rate for Payer: Cash Price |
$1,995.60
|
| Rate for Payer: Cash Price |
$1,995.60
|
| Rate for Payer: Cash Price |
$1,995.60
|
| Rate for Payer: Cigna Commercial |
$6,319.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$3,326.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,991.20
|
| Rate for Payer: Health EOS Commercial |
$6,053.32
|
| Rate for Payer: HFN Commercial |
$6,319.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,075.17
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,075.17
|
| Rate for Payer: Multiplan Commercial |
$5,321.60
|
| Rate for Payer: Preferred Network Access Commercial |
$6,319.40
|
| Rate for Payer: Quartz Beloit One Network |
$2,926.88
|
| Rate for Payer: Quartz Commercial |
$3,791.64
|
| Rate for Payer: The Alliance Commercial |
$3,326.00
|
| Rate for Payer: WEA Trust Commercial |
$3,658.60
|
| Rate for Payer: WPS Commercial |
$4,927.14
|
|
|
MRI Chest w/o Contrast
|
Facility
|
IP
|
$6,652.00
|
|
|
Service Code
|
CPT 71550 TC
|
| Hospital Charge Code |
1611029
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$3,259.48 |
| Max. Negotiated Rate |
$6,119.84 |
| Rate for Payer: Aetna Commercial |
$5,986.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,720.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,525.56
|
| Rate for Payer: Cash Price |
$1,995.60
|
| Rate for Payer: Cigna Commercial |
$6,119.84
|
| Rate for Payer: Health EOS Commercial |
$5,920.28
|
| Rate for Payer: HFN Commercial |
$6,119.84
|
| Rate for Payer: Multiplan Commercial |
$5,321.60
|
| Rate for Payer: NAPHCARE Commercial |
$3,991.20
|
| Rate for Payer: Preferred Network Access Commercial |
$6,119.84
|
| Rate for Payer: Quartz Beloit One Network |
$3,259.48
|
| Rate for Payer: Quartz Commercial |
$3,991.20
|
| Rate for Payer: WEA Trust Commercial |
$3,658.60
|
| Rate for Payer: WPS Commercial |
$4,927.14
|
|
|
MRI Chest w/o Contrast
|
Facility
|
OP
|
$6,780.00
|
|
|
Service Code
|
CPT 71550
|
| Hospital Charge Code |
629712
|
| Min. Negotiated Rate |
$242.20 |
| Max. Negotiated Rate |
$6,237.60 |
| Rate for Payer: Aetna Commercial |
$6,102.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,830.80
|
| Rate for Payer: Aetna Managed Medicare |
$242.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,407.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,390.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,254.40
|
| Rate for Payer: Anthem Medicare Advantage |
$242.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,593.40
|
| 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 |
$2,034.00
|
| Rate for Payer: Cash Price |
$2,034.00
|
| Rate for Payer: Cigna Commercial |
$6,237.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$242.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,794.09
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$242.20
|
| Rate for Payer: Health EOS Commercial |
$6,034.20
|
| Rate for Payer: HFN Commercial |
$6,237.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$900.98
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$242.20
|
| Rate for Payer: Independent Care Health Plan Medicare |
$242.20
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$242.20
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$242.20
|
| Rate for Payer: Multiplan Commercial |
$5,424.00
|
| Rate for Payer: NAPHCARE Commercial |
$363.30
|
| Rate for Payer: Preferred Network Access Commercial |
$6,237.60
|
| Rate for Payer: Quartz Beloit One Network |
$3,322.20
|
| Rate for Payer: Quartz Commercial |
$4,407.00
|
| 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 |
$3,729.00
|
| Rate for Payer: Wellcare Medicare |
$242.20
|
| Rate for Payer: WPS Commercial |
$5,021.95
|
|
|
MRI Chest w/o Contrast
|
Facility
|
OP
|
$6,652.00
|
|
|
Service Code
|
CPT 71550 TC
|
| Hospital Charge Code |
1611029
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$242.20 |
| Max. Negotiated Rate |
$6,119.84 |
| Rate for Payer: Aetna Commercial |
$5,986.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,720.72
|
| Rate for Payer: Aetna Managed Medicare |
$242.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,496.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,871.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,726.00
|
| Rate for Payer: Anthem Medicare Advantage |
$242.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,525.56
|
| 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 |
$1,995.60
|
| Rate for Payer: Cash Price |
$1,995.60
|
| Rate for Payer: Cash Price |
$1,995.60
|
| Rate for Payer: Cash Price |
$1,995.60
|
| Rate for Payer: Cigna Commercial |
$6,119.84
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$242.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,722.46
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$242.20
|
| Rate for Payer: Health EOS Commercial |
$5,920.28
|
| Rate for Payer: HFN Commercial |
$6,119.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$900.98
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$242.20
|
| Rate for Payer: Independent Care Health Plan Medicare |
$242.20
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$242.20
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$242.20
|
| Rate for Payer: Multiplan Commercial |
$5,321.60
|
| Rate for Payer: NAPHCARE Commercial |
$363.30
|
| Rate for Payer: Preferred Network Access Commercial |
$6,119.84
|
| Rate for Payer: Quartz Beloit One Network |
$3,259.48
|
| Rate for Payer: Quartz Commercial |
$4,323.80
|
| Rate for Payer: Quartz Medicare Advantage |
$242.20
|
| Rate for Payer: The Alliance Commercial |
$968.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$242.20
|
| Rate for Payer: United Healthcare PPO |
$3,022.00
|
| Rate for Payer: WEA Trust Commercial |
$3,658.60
|
| Rate for Payer: Wellcare Medicare |
$242.20
|
| Rate for Payer: WPS Commercial |
$4,927.14
|
|
|
MRI Chest w/o Contrast
|
Professional
|
Both
|
$6,780.00
|
|
|
Service Code
|
CPT 71550
|
| Hospital Charge Code |
629712
|
| Min. Negotiated Rate |
$1,318.67 |
| Max. Negotiated Rate |
$6,441.00 |
| Rate for Payer: Aetna Commercial |
$6,441.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,830.80
|
| Rate for Payer: Cash Price |
$2,034.00
|
| Rate for Payer: Cash Price |
$2,034.00
|
| Rate for Payer: Cash Price |
$2,034.00
|
| Rate for Payer: Cigna Commercial |
$6,441.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$3,390.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,068.00
|
| Rate for Payer: Health EOS Commercial |
$6,169.80
|
| Rate for Payer: HFN Commercial |
$6,441.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,318.67
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,318.67
|
| Rate for Payer: Multiplan Commercial |
$5,424.00
|
| Rate for Payer: Preferred Network Access Commercial |
$6,441.00
|
| Rate for Payer: Quartz Beloit One Network |
$2,983.20
|
| Rate for Payer: Quartz Commercial |
$3,864.60
|
| Rate for Payer: The Alliance Commercial |
$3,390.00
|
| Rate for Payer: WEA Trust Commercial |
$3,729.00
|
| Rate for Payer: WPS Commercial |
$5,021.95
|
|
