|
MRA Abdomen w Contrast
|
Facility
|
IP
|
$6,080.00
|
|
| Hospital Charge Code |
675635
|
| Min. Negotiated Rate |
$3,098.37 |
| Max. Negotiated Rate |
$5,817.34 |
| Rate for Payer: Aetna Commercial |
$5,690.88
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,437.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,351.30
|
| Rate for Payer: Cash Price |
$1,824.00
|
| Rate for Payer: Cigna Commercial |
$5,817.34
|
| Rate for Payer: Health EOS Commercial |
$5,627.65
|
| Rate for Payer: HFN Commercial |
$5,817.34
|
| Rate for Payer: Multiplan Commercial |
$5,058.56
|
| Rate for Payer: Preferred Network Access Commercial |
$5,817.34
|
| Rate for Payer: Quartz Beloit One Network |
$3,098.37
|
| Rate for Payer: Quartz Commercial |
$3,793.92
|
| Rate for Payer: WEA Trust Commercial |
$3,477.76
|
| Rate for Payer: WPS Commercial |
$4,683.42
|
|
|
MRA Abdomen w/ Contrast
|
Facility
|
OP
|
$6,194.00
|
|
|
Service Code
|
CPT 74185 TC
|
| Hospital Charge Code |
1610801
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,005.39 |
| Max. Negotiated Rate |
$5,926.42 |
| Rate for Payer: Aetna Commercial |
$5,797.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,539.91
|
| Rate for Payer: Aetna Managed Medicare |
$1,803.69
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,635.84
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,985.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,835.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,414.13
|
| 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 |
$5,926.42
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,604.91
|
| Rate for Payer: Health EOS Commercial |
$5,733.17
|
| Rate for Payer: HFN Commercial |
$5,926.42
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,831.32
|
| Rate for Payer: Multiplan Commercial |
$5,153.41
|
| Rate for Payer: NAPHCARE Commercial |
$3,865.06
|
| Rate for Payer: Preferred Network Access Commercial |
$5,926.42
|
| Rate for Payer: Quartz Beloit One Network |
$3,156.46
|
| Rate for Payer: Quartz Commercial |
$4,187.14
|
| Rate for Payer: Quartz Medicare Advantage |
$3,865.06
|
| Rate for Payer: The Alliance Commercial |
$1,005.39
|
| Rate for Payer: United Healthcare PPO |
$3,142.88
|
| Rate for Payer: WEA Trust Commercial |
$3,542.97
|
| Rate for Payer: WPS Commercial |
$1,759.43
|
|
|
MRA Abdomen w/ Contrast
|
Facility
|
IP
|
$5,965.00
|
|
|
Service Code
|
CPT 74185 TC
|
| Hospital Charge Code |
3072667
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$3,039.76 |
| Max. Negotiated Rate |
$5,707.31 |
| Rate for Payer: Aetna Commercial |
$5,583.24
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,335.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,287.91
|
| Rate for Payer: Cash Price |
$1,789.50
|
| Rate for Payer: Cigna Commercial |
$5,707.31
|
| Rate for Payer: Health EOS Commercial |
$5,521.20
|
| Rate for Payer: HFN Commercial |
$5,707.31
|
| Rate for Payer: Multiplan Commercial |
$4,962.88
|
| Rate for Payer: Preferred Network Access Commercial |
$5,707.31
|
| Rate for Payer: Quartz Beloit One Network |
$3,039.76
|
| Rate for Payer: Quartz Commercial |
$3,722.16
|
| Rate for Payer: WEA Trust Commercial |
$3,411.98
|
| Rate for Payer: WPS Commercial |
$4,594.84
|
|
|
MRA Abdomen w/ Contrast
|
Professional
|
Both
|
$5,965.00
|
|
|
Service Code
|
CPT 74185 TC
|
| Hospital Charge Code |
3072667
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$251.35 |
| Max. Negotiated Rate |
$5,893.42 |
| Rate for Payer: Aetna Commercial |
$5,893.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,335.10
|
| Rate for Payer: Aetna Managed Medicare |
$251.35
|
| Rate for Payer: Anthem Medicare Advantage |
$251.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$251.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$251.35
|
| Rate for Payer: Cash Price |
$1,789.50
|
| Rate for Payer: Cash Price |
$1,789.50
|
| Rate for Payer: Cash Price |
$1,789.50
|
| Rate for Payer: Cigna Commercial |
$5,893.42
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$3,101.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$251.35
|
| Rate for Payer: Health EOS Commercial |
$5,645.28
|
| Rate for Payer: HFN Commercial |
$5,893.42
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,030.84
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,030.84
|
| Rate for Payer: Independent Care Health Plan Medicare |
$251.35
|
| Rate for Payer: Multiplan Commercial |
$4,962.88
|
| Rate for Payer: NAPHCARE Commercial |
$377.02
|
| Rate for Payer: Preferred Network Access Commercial |
$5,893.42
|
| Rate for Payer: Quartz Beloit One Network |
$2,729.58
|
| Rate for Payer: Quartz Commercial |
$3,536.05
|
| Rate for Payer: Quartz Medicare Advantage |
$251.35
|
| Rate for Payer: The Alliance Commercial |
$955.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$251.35
|
| Rate for Payer: WEA Trust Commercial |
$3,411.98
|
| Rate for Payer: WPS Commercial |
$1,256.74
|
|
|
MRA Abdomen w/ Contrast
|
Facility
|
OP
|
$5,965.00
|
|
|
Service Code
|
CPT 74185 TC
|
| Hospital Charge Code |
3072667
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,005.39 |
| Max. Negotiated Rate |
$5,707.31 |
| Rate for Payer: Aetna Commercial |
$5,583.24
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,335.10
|
| Rate for Payer: Aetna Managed Medicare |
$1,737.01
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,635.84
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,985.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,835.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,287.91
|
| Rate for Payer: Cash Price |
$1,789.50
|
| Rate for Payer: Cash Price |
$1,789.50
|
| Rate for Payer: Cash Price |
$1,789.50
|
| Rate for Payer: Cash Price |
$1,789.50
|
| Rate for Payer: Cigna Commercial |
$5,707.31
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,471.63
|
| Rate for Payer: Health EOS Commercial |
$5,521.20
|
| Rate for Payer: HFN Commercial |
$5,707.31
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,652.70
|
| Rate for Payer: Multiplan Commercial |
$4,962.88
|
| Rate for Payer: NAPHCARE Commercial |
$3,722.16
|
| Rate for Payer: Preferred Network Access Commercial |
$5,707.31
|
| Rate for Payer: Quartz Beloit One Network |
$3,039.76
|
| Rate for Payer: Quartz Commercial |
$4,032.34
|
| Rate for Payer: Quartz Medicare Advantage |
$3,722.16
|
| Rate for Payer: The Alliance Commercial |
$1,005.39
|
| Rate for Payer: United Healthcare PPO |
$3,142.88
|
| Rate for Payer: WEA Trust Commercial |
$3,411.98
|
| Rate for Payer: WPS Commercial |
$1,759.43
|
|
|
MRA Abdomen w/ Contrast
|
Facility
|
IP
|
$6,194.00
|
|
|
Service Code
|
CPT 74185 TC
|
| Hospital Charge Code |
1610801
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$3,156.46 |
| Max. Negotiated Rate |
$5,926.42 |
| Rate for Payer: Aetna Commercial |
$5,797.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,539.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,414.13
|
| Rate for Payer: Cash Price |
$1,858.20
|
| Rate for Payer: Cigna Commercial |
$5,926.42
|
| Rate for Payer: Health EOS Commercial |
$5,733.17
|
| Rate for Payer: HFN Commercial |
$5,926.42
|
| Rate for Payer: Multiplan Commercial |
$5,153.41
|
| Rate for Payer: Preferred Network Access Commercial |
$5,926.42
|
| Rate for Payer: Quartz Beloit One Network |
$3,156.46
|
| Rate for Payer: Quartz Commercial |
$3,865.06
|
| Rate for Payer: WEA Trust Commercial |
$3,542.97
|
| Rate for Payer: WPS Commercial |
$4,771.24
|
|
|
MRA Abdomen w/ Contrast
|
Professional
|
Both
|
$6,194.00
|
|
|
Service Code
|
CPT 74185 TC
|
| Hospital Charge Code |
1610801
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$251.35 |
| Max. Negotiated Rate |
$6,119.67 |
| Rate for Payer: Aetna Commercial |
$6,119.67
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,539.91
|
| Rate for Payer: Aetna Managed Medicare |
$251.35
|
| Rate for Payer: Anthem Medicare Advantage |
$251.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$251.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$251.35
|
| 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 |
$6,119.67
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$3,220.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$251.35
|
| Rate for Payer: Health EOS Commercial |
$5,862.00
|
| Rate for Payer: HFN Commercial |
$6,119.67
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,030.84
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,030.84
|
| Rate for Payer: Independent Care Health Plan Medicare |
$251.35
|
| Rate for Payer: Multiplan Commercial |
$5,153.41
|
| Rate for Payer: NAPHCARE Commercial |
$377.02
|
| Rate for Payer: Preferred Network Access Commercial |
$6,119.67
|
| Rate for Payer: Quartz Beloit One Network |
$2,834.37
|
| Rate for Payer: Quartz Commercial |
$3,671.80
|
| Rate for Payer: Quartz Medicare Advantage |
$251.35
|
| Rate for Payer: The Alliance Commercial |
$955.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$251.35
|
| Rate for Payer: WEA Trust Commercial |
$3,542.97
|
| Rate for Payer: WPS Commercial |
$1,256.74
|
|
|
MRA Abdomen w/o Contrast
|
Facility
|
IP
|
$5,703.00
|
|
| Hospital Charge Code |
675662
|
| Min. Negotiated Rate |
$2,906.25 |
| Max. Negotiated Rate |
$5,456.63 |
| Rate for Payer: Aetna Commercial |
$5,338.01
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,100.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,143.49
|
| Rate for Payer: Cash Price |
$1,710.90
|
| Rate for Payer: Cigna Commercial |
$5,456.63
|
| Rate for Payer: Health EOS Commercial |
$5,278.70
|
| Rate for Payer: HFN Commercial |
$5,456.63
|
| Rate for Payer: Multiplan Commercial |
$4,744.90
|
| Rate for Payer: Preferred Network Access Commercial |
$5,456.63
|
| Rate for Payer: Quartz Beloit One Network |
$2,906.25
|
| Rate for Payer: Quartz Commercial |
$3,558.67
|
| Rate for Payer: WEA Trust Commercial |
$3,262.12
|
| Rate for Payer: WPS Commercial |
$4,393.02
|
|
|
MRA Abdomen w/o Contrast
|
Professional
|
Both
|
$5,703.00
|
|
| Hospital Charge Code |
675662
|
| Min. Negotiated Rate |
$2,609.69 |
| Max. Negotiated Rate |
$5,634.56 |
| Rate for Payer: Aetna Commercial |
$5,634.56
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,100.76
|
| Rate for Payer: Cash Price |
$1,710.90
|
| Rate for Payer: Cigna Commercial |
$5,634.56
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,965.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,558.67
|
| Rate for Payer: Health EOS Commercial |
$5,397.32
|
| Rate for Payer: HFN Commercial |
$5,634.56
|
| Rate for Payer: Multiplan Commercial |
$4,744.90
|
| Rate for Payer: Preferred Network Access Commercial |
$5,634.56
|
| Rate for Payer: Quartz Beloit One Network |
$2,609.69
|
| Rate for Payer: Quartz Commercial |
$3,380.74
|
| Rate for Payer: The Alliance Commercial |
$2,965.56
|
| Rate for Payer: WEA Trust Commercial |
$3,262.12
|
| Rate for Payer: WPS Commercial |
$4,393.02
|
|
|
MRA Abdomen w/o Contrast
|
Professional
|
Both
|
$5,595.00
|
|
|
Service Code
|
CPT 74185 TC
|
| Hospital Charge Code |
1610803
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$251.35 |
| Max. Negotiated Rate |
$5,527.86 |
| Rate for Payer: Aetna Commercial |
$5,527.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,004.17
|
| Rate for Payer: Aetna Managed Medicare |
$251.35
|
| Rate for Payer: Anthem Medicare Advantage |
$251.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$251.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$251.35
|
| Rate for Payer: Cash Price |
$1,678.50
|
| Rate for Payer: Cash Price |
$1,678.50
|
| Rate for Payer: Cash Price |
$1,678.50
|
| Rate for Payer: Cigna Commercial |
$5,527.86
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,909.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$251.35
|
| Rate for Payer: Health EOS Commercial |
$5,295.11
|
| Rate for Payer: HFN Commercial |
$5,527.86
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,030.84
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,030.84
|
| Rate for Payer: Independent Care Health Plan Medicare |
$251.35
|
| Rate for Payer: Multiplan Commercial |
$4,655.04
|
| Rate for Payer: NAPHCARE Commercial |
$377.02
|
| Rate for Payer: Preferred Network Access Commercial |
$5,527.86
|
| Rate for Payer: Quartz Beloit One Network |
$2,560.27
|
| Rate for Payer: Quartz Commercial |
$3,316.72
|
| Rate for Payer: Quartz Medicare Advantage |
$251.35
|
| Rate for Payer: The Alliance Commercial |
$955.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$251.35
|
| Rate for Payer: WEA Trust Commercial |
$3,200.34
|
| Rate for Payer: WPS Commercial |
$1,256.74
|
|
|
MRA Abdomen w/o Contrast
|
Facility
|
OP
|
$5,595.00
|
|
|
Service Code
|
CPT 74185 TC
|
| Hospital Charge Code |
1610803
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,005.39 |
| Max. Negotiated Rate |
$5,353.30 |
| Rate for Payer: Aetna Commercial |
$5,236.92
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,004.17
|
| Rate for Payer: Aetna Managed Medicare |
$1,629.26
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,635.84
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,985.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,835.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,083.96
|
| Rate for Payer: Cash Price |
$1,678.50
|
| Rate for Payer: Cash Price |
$1,678.50
|
| Rate for Payer: Cash Price |
$1,678.50
|
| Rate for Payer: Cash Price |
$1,678.50
|
| Rate for Payer: Cigna Commercial |
$5,353.30
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,256.29
|
| Rate for Payer: Health EOS Commercial |
$5,178.73
|
| Rate for Payer: HFN Commercial |
$5,353.30
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,364.10
|
| Rate for Payer: Multiplan Commercial |
$4,655.04
|
| Rate for Payer: NAPHCARE Commercial |
$3,491.28
|
| Rate for Payer: Preferred Network Access Commercial |
$5,353.30
|
| Rate for Payer: Quartz Beloit One Network |
$2,851.21
|
| Rate for Payer: Quartz Commercial |
$3,782.22
|
| Rate for Payer: Quartz Medicare Advantage |
$3,491.28
|
| Rate for Payer: The Alliance Commercial |
$1,005.39
|
| Rate for Payer: United Healthcare PPO |
$3,142.88
|
| Rate for Payer: WEA Trust Commercial |
$3,200.34
|
| Rate for Payer: WPS Commercial |
$1,759.43
|
|
|
MRA Abdomen w/o Contrast
|
Facility
|
OP
|
$5,703.00
|
|
| Hospital Charge Code |
675662
|
| Min. Negotiated Rate |
$1,660.71 |
| Max. Negotiated Rate |
$5,456.63 |
| Rate for Payer: Aetna Commercial |
$5,338.01
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,100.76
|
| Rate for Payer: Aetna Managed Medicare |
$1,660.71
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,855.23
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,965.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,846.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,143.49
|
| Rate for Payer: Cash Price |
$1,710.90
|
| Rate for Payer: Cigna Commercial |
$5,456.63
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,319.15
|
| Rate for Payer: Health EOS Commercial |
$5,278.70
|
| Rate for Payer: HFN Commercial |
$5,456.63
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,448.34
|
| Rate for Payer: Multiplan Commercial |
$4,744.90
|
| Rate for Payer: NAPHCARE Commercial |
$3,558.67
|
| Rate for Payer: Preferred Network Access Commercial |
$5,456.63
|
| Rate for Payer: Quartz Beloit One Network |
$2,906.25
|
| Rate for Payer: Quartz Commercial |
$3,855.23
|
| Rate for Payer: Quartz Medicare Advantage |
$3,558.67
|
| Rate for Payer: The Alliance Commercial |
$2,965.56
|
| Rate for Payer: WEA Trust Commercial |
$3,262.12
|
| Rate for Payer: WPS Commercial |
$4,393.02
|
|
|
MRA Abdomen w/o Contrast
|
Facility
|
IP
|
$5,595.00
|
|
|
Service Code
|
CPT 74185 TC
|
| Hospital Charge Code |
1610803
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$2,851.21 |
| Max. Negotiated Rate |
$5,353.30 |
| Rate for Payer: Aetna Commercial |
$5,236.92
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,004.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,083.96
|
| Rate for Payer: Cash Price |
$1,678.50
|
| Rate for Payer: Cigna Commercial |
$5,353.30
|
| Rate for Payer: Health EOS Commercial |
$5,178.73
|
| Rate for Payer: HFN Commercial |
$5,353.30
|
| Rate for Payer: Multiplan Commercial |
$4,655.04
|
| Rate for Payer: Preferred Network Access Commercial |
$5,353.30
|
| Rate for Payer: Quartz Beloit One Network |
$2,851.21
|
| Rate for Payer: Quartz Commercial |
$3,491.28
|
| Rate for Payer: WEA Trust Commercial |
$3,200.34
|
| Rate for Payer: WPS Commercial |
$4,309.83
|
|
|
MRA Abdomen w or w/o Contrast
|
Facility
|
OP
|
$6,327.00
|
|
|
Service Code
|
CPT 74185 TC
|
| Hospital Charge Code |
4054123
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,005.39 |
| Max. Negotiated Rate |
$6,053.67 |
| Rate for Payer: Aetna Commercial |
$5,922.07
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,658.87
|
| Rate for Payer: Aetna Managed Medicare |
$1,842.42
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,635.84
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,985.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,835.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,487.44
|
| Rate for Payer: Cash Price |
$1,898.10
|
| Rate for Payer: Cash Price |
$1,898.10
|
| Rate for Payer: Cash Price |
$1,898.10
|
| Rate for Payer: Cash Price |
$1,898.10
|
| Rate for Payer: Cigna Commercial |
$6,053.67
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,682.31
|
| Rate for Payer: Health EOS Commercial |
$5,856.27
|
| Rate for Payer: HFN Commercial |
$6,053.67
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,935.06
|
| Rate for Payer: Multiplan Commercial |
$5,264.06
|
| Rate for Payer: NAPHCARE Commercial |
$3,948.05
|
| Rate for Payer: Preferred Network Access Commercial |
$6,053.67
|
| Rate for Payer: Quartz Beloit One Network |
$3,224.24
|
| Rate for Payer: Quartz Commercial |
$4,277.05
|
| Rate for Payer: Quartz Medicare Advantage |
$3,948.05
|
| Rate for Payer: The Alliance Commercial |
$1,005.39
|
| Rate for Payer: United Healthcare PPO |
$3,142.88
|
| Rate for Payer: WEA Trust Commercial |
$3,619.04
|
| Rate for Payer: WPS Commercial |
$1,759.43
|
|
|
MRA Abdomen w or w/o Contrast
|
Facility
|
IP
|
$6,327.00
|
|
|
Service Code
|
CPT 74185 TC
|
| Hospital Charge Code |
4054123
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$3,224.24 |
| Max. Negotiated Rate |
$6,053.67 |
| Rate for Payer: Aetna Commercial |
$5,922.07
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,658.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,487.44
|
| Rate for Payer: Cash Price |
$1,898.10
|
| Rate for Payer: Cigna Commercial |
$6,053.67
|
| Rate for Payer: Health EOS Commercial |
$5,856.27
|
| Rate for Payer: HFN Commercial |
$6,053.67
|
| Rate for Payer: Multiplan Commercial |
$5,264.06
|
| Rate for Payer: Preferred Network Access Commercial |
$6,053.67
|
| Rate for Payer: Quartz Beloit One Network |
$3,224.24
|
| Rate for Payer: Quartz Commercial |
$3,948.05
|
| Rate for Payer: WEA Trust Commercial |
$3,619.04
|
| Rate for Payer: WPS Commercial |
$4,873.69
|
|
|
MRA Abdomen w or w/o Contrast
|
Professional
|
Both
|
$6,327.00
|
|
|
Service Code
|
CPT 74185 TC
|
| Hospital Charge Code |
4054123
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$251.35 |
| Max. Negotiated Rate |
$6,251.08 |
| Rate for Payer: Aetna Commercial |
$6,251.08
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,658.87
|
| Rate for Payer: Aetna Managed Medicare |
$251.35
|
| Rate for Payer: Anthem Medicare Advantage |
$251.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$251.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$251.35
|
| Rate for Payer: Cash Price |
$1,898.10
|
| Rate for Payer: Cash Price |
$1,898.10
|
| Rate for Payer: Cash Price |
$1,898.10
|
| Rate for Payer: Cigna Commercial |
$6,251.08
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$3,290.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$251.35
|
| Rate for Payer: Health EOS Commercial |
$5,987.87
|
| Rate for Payer: HFN Commercial |
$6,251.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,030.84
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,030.84
|
| Rate for Payer: Independent Care Health Plan Medicare |
$251.35
|
| Rate for Payer: Multiplan Commercial |
$5,264.06
|
| Rate for Payer: NAPHCARE Commercial |
$377.02
|
| Rate for Payer: Preferred Network Access Commercial |
$6,251.08
|
| Rate for Payer: Quartz Beloit One Network |
$2,895.24
|
| Rate for Payer: Quartz Commercial |
$3,750.65
|
| Rate for Payer: Quartz Medicare Advantage |
$251.35
|
| Rate for Payer: The Alliance Commercial |
$955.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$251.35
|
| Rate for Payer: WEA Trust Commercial |
$3,619.04
|
| Rate for Payer: WPS Commercial |
$1,256.74
|
|
|
MRA Abdomen w + w/o Contrast
|
Professional
|
Both
|
$6,450.00
|
|
| Hospital Charge Code |
675636
|
| Min. Negotiated Rate |
$2,951.52 |
| Max. Negotiated Rate |
$6,372.60 |
| Rate for Payer: Aetna Commercial |
$6,372.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,768.88
|
| Rate for Payer: Cash Price |
$1,935.00
|
| Rate for Payer: Cigna Commercial |
$6,372.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$3,354.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,024.80
|
| Rate for Payer: Health EOS Commercial |
$6,104.28
|
| Rate for Payer: HFN Commercial |
$6,372.60
|
| Rate for Payer: Multiplan Commercial |
$5,366.40
|
| Rate for Payer: Preferred Network Access Commercial |
$6,372.60
|
| Rate for Payer: Quartz Beloit One Network |
$2,951.52
|
| Rate for Payer: Quartz Commercial |
$3,823.56
|
| Rate for Payer: The Alliance Commercial |
$3,354.00
|
| Rate for Payer: WEA Trust Commercial |
$3,689.40
|
| Rate for Payer: WPS Commercial |
$4,968.44
|
|
|
MRA Abdomen w + w/o Contrast
|
Facility
|
IP
|
$6,450.00
|
|
| Hospital Charge Code |
675636
|
| Min. Negotiated Rate |
$3,286.92 |
| Max. Negotiated Rate |
$6,171.36 |
| Rate for Payer: Aetna Commercial |
$6,037.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,768.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,555.24
|
| Rate for Payer: Cash Price |
$1,935.00
|
| Rate for Payer: Cigna Commercial |
$6,171.36
|
| Rate for Payer: Health EOS Commercial |
$5,970.12
|
| Rate for Payer: HFN Commercial |
$6,171.36
|
| Rate for Payer: Multiplan Commercial |
$5,366.40
|
| Rate for Payer: Preferred Network Access Commercial |
$6,171.36
|
| Rate for Payer: Quartz Beloit One Network |
$3,286.92
|
| Rate for Payer: Quartz Commercial |
$4,024.80
|
| Rate for Payer: WEA Trust Commercial |
$3,689.40
|
| Rate for Payer: WPS Commercial |
$4,968.44
|
|
|
MRA Abdomen w + w/o Contrast
|
Facility
|
OP
|
$6,450.00
|
|
| Hospital Charge Code |
675636
|
| Min. Negotiated Rate |
$1,878.24 |
| Max. Negotiated Rate |
$6,171.36 |
| Rate for Payer: Aetna Commercial |
$6,037.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,768.88
|
| Rate for Payer: Aetna Managed Medicare |
$1,878.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,360.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,354.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,219.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,555.24
|
| Rate for Payer: Cash Price |
$1,935.00
|
| Rate for Payer: Cigna Commercial |
$6,171.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,753.90
|
| Rate for Payer: Health EOS Commercial |
$5,970.12
|
| Rate for Payer: HFN Commercial |
$6,171.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,031.00
|
| Rate for Payer: Multiplan Commercial |
$5,366.40
|
| Rate for Payer: NAPHCARE Commercial |
$4,024.80
|
| Rate for Payer: Preferred Network Access Commercial |
$6,171.36
|
| Rate for Payer: Quartz Beloit One Network |
$3,286.92
|
| Rate for Payer: Quartz Commercial |
$4,360.20
|
| Rate for Payer: Quartz Medicare Advantage |
$4,024.80
|
| Rate for Payer: The Alliance Commercial |
$3,354.00
|
| Rate for Payer: WEA Trust Commercial |
$3,689.40
|
| Rate for Payer: WPS Commercial |
$4,968.44
|
|
|
MRA Abdomen w/ + w/o Contrast
|
Professional
|
Both
|
$6,327.00
|
|
|
Service Code
|
CPT 74185 TC
|
| Hospital Charge Code |
1610799
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$251.35 |
| Max. Negotiated Rate |
$6,251.08 |
| Rate for Payer: Aetna Commercial |
$6,251.08
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,658.87
|
| Rate for Payer: Aetna Managed Medicare |
$251.35
|
| Rate for Payer: Anthem Medicare Advantage |
$251.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$251.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$251.35
|
| Rate for Payer: Cash Price |
$1,898.10
|
| Rate for Payer: Cash Price |
$1,898.10
|
| Rate for Payer: Cash Price |
$1,898.10
|
| Rate for Payer: Cigna Commercial |
$6,251.08
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$3,290.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$251.35
|
| Rate for Payer: Health EOS Commercial |
$5,987.87
|
| Rate for Payer: HFN Commercial |
$6,251.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,030.84
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,030.84
|
| Rate for Payer: Independent Care Health Plan Medicare |
$251.35
|
| Rate for Payer: Multiplan Commercial |
$5,264.06
|
| Rate for Payer: NAPHCARE Commercial |
$377.02
|
| Rate for Payer: Preferred Network Access Commercial |
$6,251.08
|
| Rate for Payer: Quartz Beloit One Network |
$2,895.24
|
| Rate for Payer: Quartz Commercial |
$3,750.65
|
| Rate for Payer: Quartz Medicare Advantage |
$251.35
|
| Rate for Payer: The Alliance Commercial |
$955.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$251.35
|
| Rate for Payer: WEA Trust Commercial |
$3,619.04
|
| Rate for Payer: WPS Commercial |
$1,256.74
|
|
|
MRA Abdomen w/ + w/o Contrast
|
Facility
|
OP
|
$6,327.00
|
|
|
Service Code
|
CPT 74185 TC
|
| Hospital Charge Code |
1610799
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,005.39 |
| Max. Negotiated Rate |
$6,053.67 |
| Rate for Payer: Aetna Commercial |
$5,922.07
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,658.87
|
| Rate for Payer: Aetna Managed Medicare |
$1,842.42
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,635.84
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,985.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,835.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,487.44
|
| Rate for Payer: Cash Price |
$1,898.10
|
| Rate for Payer: Cash Price |
$1,898.10
|
| Rate for Payer: Cash Price |
$1,898.10
|
| Rate for Payer: Cash Price |
$1,898.10
|
| Rate for Payer: Cigna Commercial |
$6,053.67
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,682.31
|
| Rate for Payer: Health EOS Commercial |
$5,856.27
|
| Rate for Payer: HFN Commercial |
$6,053.67
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,935.06
|
| Rate for Payer: Multiplan Commercial |
$5,264.06
|
| Rate for Payer: NAPHCARE Commercial |
$3,948.05
|
| Rate for Payer: Preferred Network Access Commercial |
$6,053.67
|
| Rate for Payer: Quartz Beloit One Network |
$3,224.24
|
| Rate for Payer: Quartz Commercial |
$4,277.05
|
| Rate for Payer: Quartz Medicare Advantage |
$3,948.05
|
| Rate for Payer: The Alliance Commercial |
$1,005.39
|
| Rate for Payer: United Healthcare PPO |
$3,142.88
|
| Rate for Payer: WEA Trust Commercial |
$3,619.04
|
| Rate for Payer: WPS Commercial |
$1,759.43
|
|
|
MRA Abdomen w/ + w/o Contrast
|
Facility
|
IP
|
$6,327.00
|
|
|
Service Code
|
CPT 74185 TC
|
| Hospital Charge Code |
1610799
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$3,224.24 |
| Max. Negotiated Rate |
$6,053.67 |
| Rate for Payer: Aetna Commercial |
$5,922.07
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,658.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,487.44
|
| Rate for Payer: Cash Price |
$1,898.10
|
| Rate for Payer: Cigna Commercial |
$6,053.67
|
| Rate for Payer: Health EOS Commercial |
$5,856.27
|
| Rate for Payer: HFN Commercial |
$6,053.67
|
| Rate for Payer: Multiplan Commercial |
$5,264.06
|
| Rate for Payer: Preferred Network Access Commercial |
$6,053.67
|
| Rate for Payer: Quartz Beloit One Network |
$3,224.24
|
| Rate for Payer: Quartz Commercial |
$3,948.05
|
| Rate for Payer: WEA Trust Commercial |
$3,619.04
|
| Rate for Payer: WPS Commercial |
$4,873.69
|
|
|
MRA Abdomen w/ + w/o Contrast
|
Professional
|
Both
|
$6,327.00
|
|
|
Service Code
|
HCPCS C8902 TC
|
| Hospital Charge Code |
3072690
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$2,895.24 |
| Max. Negotiated Rate |
$6,251.08 |
| Rate for Payer: Aetna Commercial |
$6,251.08
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,658.87
|
| Rate for Payer: Cash Price |
$1,898.10
|
| Rate for Payer: Cigna Commercial |
$6,251.08
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$3,290.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,948.05
|
| Rate for Payer: Health EOS Commercial |
$5,987.87
|
| Rate for Payer: HFN Commercial |
$6,251.08
|
| Rate for Payer: Multiplan Commercial |
$5,264.06
|
| Rate for Payer: Preferred Network Access Commercial |
$6,251.08
|
| Rate for Payer: Quartz Beloit One Network |
$2,895.24
|
| Rate for Payer: Quartz Commercial |
$3,750.65
|
| Rate for Payer: The Alliance Commercial |
$3,290.04
|
| Rate for Payer: WEA Trust Commercial |
$3,619.04
|
| Rate for Payer: WPS Commercial |
$4,873.69
|
|
|
MRA Abdomen w/ + w/o Contrast
|
Facility
|
OP
|
$6,327.00
|
|
|
Service Code
|
HCPCS C8902 TC
|
| Hospital Charge Code |
3072690
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,842.42 |
| Max. Negotiated Rate |
$6,053.67 |
| Rate for Payer: Aetna Commercial |
$5,922.07
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,658.87
|
| Rate for Payer: Aetna Managed Medicare |
$1,842.42
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,635.84
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,985.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,835.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,487.44
|
| Rate for Payer: Cash Price |
$1,898.10
|
| Rate for Payer: Cash Price |
$1,898.10
|
| Rate for Payer: Cash Price |
$1,898.10
|
| Rate for Payer: Cigna Commercial |
$6,053.67
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,682.31
|
| Rate for Payer: Health EOS Commercial |
$5,856.27
|
| Rate for Payer: HFN Commercial |
$6,053.67
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,935.06
|
| Rate for Payer: Multiplan Commercial |
$5,264.06
|
| Rate for Payer: NAPHCARE Commercial |
$3,948.05
|
| Rate for Payer: Preferred Network Access Commercial |
$6,053.67
|
| Rate for Payer: Quartz Beloit One Network |
$3,224.24
|
| Rate for Payer: Quartz Commercial |
$4,277.05
|
| Rate for Payer: Quartz Medicare Advantage |
$3,948.05
|
| Rate for Payer: The Alliance Commercial |
$3,290.04
|
| Rate for Payer: United Healthcare PPO |
$3,142.88
|
| Rate for Payer: WEA Trust Commercial |
$3,619.04
|
| Rate for Payer: WPS Commercial |
$4,873.69
|
|
|
MRA Abdomen w/ + w/o Contrast
|
Facility
|
IP
|
$6,327.00
|
|
|
Service Code
|
HCPCS C8902 TC
|
| Hospital Charge Code |
3072690
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$3,224.24 |
| Max. Negotiated Rate |
$6,053.67 |
| Rate for Payer: Aetna Commercial |
$5,922.07
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,658.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,487.44
|
| Rate for Payer: Cash Price |
$1,898.10
|
| Rate for Payer: Cigna Commercial |
$6,053.67
|
| Rate for Payer: Health EOS Commercial |
$5,856.27
|
| Rate for Payer: HFN Commercial |
$6,053.67
|
| Rate for Payer: Multiplan Commercial |
$5,264.06
|
| Rate for Payer: Preferred Network Access Commercial |
$6,053.67
|
| Rate for Payer: Quartz Beloit One Network |
$3,224.24
|
| Rate for Payer: Quartz Commercial |
$3,948.05
|
| Rate for Payer: WEA Trust Commercial |
$3,619.04
|
| Rate for Payer: WPS Commercial |
$4,873.69
|
|
