|
MRA Brain w/ Contrast
|
Professional
|
Both
|
$4,679.00
|
|
|
Service Code
|
CPT 70545
|
| Hospital Charge Code |
630721
|
| Min. Negotiated Rate |
$225.08 |
| Max. Negotiated Rate |
$4,622.85 |
| Rate for Payer: Aetna Commercial |
$4,622.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,184.90
|
| Rate for Payer: Aetna Managed Medicare |
$225.08
|
| Rate for Payer: Anthem Medicare Advantage |
$225.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$225.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$225.08
|
| Rate for Payer: Cash Price |
$1,403.70
|
| Rate for Payer: Cash Price |
$1,403.70
|
| Rate for Payer: Cash Price |
$1,403.70
|
| Rate for Payer: Cigna Commercial |
$4,622.85
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,433.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$225.08
|
| Rate for Payer: Health EOS Commercial |
$4,428.21
|
| Rate for Payer: HFN Commercial |
$4,622.85
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$890.04
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$890.04
|
| Rate for Payer: Independent Care Health Plan Medicare |
$225.08
|
| Rate for Payer: Multiplan Commercial |
$3,892.93
|
| Rate for Payer: NAPHCARE Commercial |
$337.62
|
| Rate for Payer: Preferred Network Access Commercial |
$4,622.85
|
| Rate for Payer: Quartz Beloit One Network |
$2,141.11
|
| Rate for Payer: Quartz Commercial |
$2,773.71
|
| Rate for Payer: Quartz Medicare Advantage |
$225.08
|
| Rate for Payer: The Alliance Commercial |
$855.29
|
| Rate for Payer: United Healthcare Medicare Advantage |
$225.08
|
| Rate for Payer: WEA Trust Commercial |
$2,676.39
|
| Rate for Payer: WPS Commercial |
$1,125.38
|
|
|
MRA Brain w/ Contrast
|
Facility
|
IP
|
$4,679.00
|
|
|
Service Code
|
CPT 70545
|
| Hospital Charge Code |
630721
|
| Min. Negotiated Rate |
$2,384.42 |
| Max. Negotiated Rate |
$4,476.87 |
| Rate for Payer: Aetna Commercial |
$4,379.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,184.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,579.06
|
| Rate for Payer: Cash Price |
$1,403.70
|
| Rate for Payer: Cigna Commercial |
$4,476.87
|
| Rate for Payer: Health EOS Commercial |
$4,330.88
|
| Rate for Payer: HFN Commercial |
$4,476.87
|
| Rate for Payer: Multiplan Commercial |
$3,892.93
|
| Rate for Payer: Preferred Network Access Commercial |
$4,476.87
|
| Rate for Payer: Quartz Beloit One Network |
$2,384.42
|
| Rate for Payer: Quartz Commercial |
$2,919.70
|
| Rate for Payer: WEA Trust Commercial |
$2,676.39
|
| Rate for Payer: WPS Commercial |
$3,604.23
|
|
|
MRA Brain w/ Contrast
|
Facility
|
OP
|
$4,679.00
|
|
|
Service Code
|
CPT 70545
|
| Hospital Charge Code |
630721
|
| Min. Negotiated Rate |
$367.15 |
| Max. Negotiated Rate |
$4,476.87 |
| Rate for Payer: Aetna Commercial |
$4,379.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,184.90
|
| Rate for Payer: Aetna Managed Medicare |
$367.15
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,163.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,433.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,335.76
|
| Rate for Payer: Anthem Medicare Advantage |
$367.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,579.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$367.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$367.15
|
| Rate for Payer: Cash Price |
$1,403.70
|
| Rate for Payer: Cash Price |
$1,403.70
|
| Rate for Payer: Cigna Commercial |
$4,476.87
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$367.15
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,723.18
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$367.15
|
| Rate for Payer: Health EOS Commercial |
$4,330.88
|
| Rate for Payer: HFN Commercial |
$4,476.87
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,365.80
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$367.15
|
| Rate for Payer: Independent Care Health Plan Medicare |
$367.15
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$367.15
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$367.15
|
| Rate for Payer: Multiplan Commercial |
$3,892.93
|
| Rate for Payer: NAPHCARE Commercial |
$550.73
|
| Rate for Payer: Preferred Network Access Commercial |
$4,476.87
|
| Rate for Payer: Quartz Beloit One Network |
$2,384.42
|
| Rate for Payer: Quartz Commercial |
$3,163.00
|
| Rate for Payer: Quartz Medicare Advantage |
$367.15
|
| Rate for Payer: The Alliance Commercial |
$1,468.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$367.15
|
| Rate for Payer: WEA Trust Commercial |
$2,676.39
|
| Rate for Payer: Wellcare Medicare |
$367.15
|
| Rate for Payer: WPS Commercial |
$3,604.23
|
|
|
MRA Carotids w/ Contrast
|
Professional
|
Both
|
$6,216.00
|
|
|
Service Code
|
CPT 70548 TC
|
| Hospital Charge Code |
5965680
|
|
Hospital Revenue Code
|
615
|
| Min. Negotiated Rate |
$175.36 |
| Max. Negotiated Rate |
$6,141.41 |
| Rate for Payer: Aetna Commercial |
$6,141.41
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,559.59
|
| Rate for Payer: Aetna Managed Medicare |
$175.36
|
| Rate for Payer: Anthem Medicare Advantage |
$175.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$175.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$175.36
|
| Rate for Payer: Cash Price |
$1,864.80
|
| Rate for Payer: Cash Price |
$1,864.80
|
| Rate for Payer: Cash Price |
$1,864.80
|
| Rate for Payer: Cigna Commercial |
$6,141.41
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$3,232.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$175.36
|
| Rate for Payer: Health EOS Commercial |
$5,882.82
|
| Rate for Payer: HFN Commercial |
$6,141.41
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$698.22
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$698.22
|
| Rate for Payer: Independent Care Health Plan Medicare |
$175.36
|
| Rate for Payer: Multiplan Commercial |
$5,171.71
|
| Rate for Payer: NAPHCARE Commercial |
$263.05
|
| Rate for Payer: Preferred Network Access Commercial |
$6,141.41
|
| Rate for Payer: Quartz Beloit One Network |
$2,844.44
|
| Rate for Payer: Quartz Commercial |
$3,684.84
|
| Rate for Payer: Quartz Medicare Advantage |
$175.36
|
| Rate for Payer: The Alliance Commercial |
$666.39
|
| Rate for Payer: United Healthcare Medicare Advantage |
$175.36
|
| Rate for Payer: WEA Trust Commercial |
$3,555.55
|
| Rate for Payer: WPS Commercial |
$876.82
|
|
|
MRA Carotids w/ Contrast
|
Facility
|
IP
|
$6,216.00
|
|
|
Service Code
|
CPT 70548 TC
|
| Hospital Charge Code |
5965680
|
|
Hospital Revenue Code
|
615
|
| Min. Negotiated Rate |
$3,167.67 |
| Max. Negotiated Rate |
$5,947.47 |
| Rate for Payer: Aetna Commercial |
$5,818.18
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,559.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,426.26
|
| Rate for Payer: Cash Price |
$1,864.80
|
| Rate for Payer: Cigna Commercial |
$5,947.47
|
| Rate for Payer: Health EOS Commercial |
$5,753.53
|
| Rate for Payer: HFN Commercial |
$5,947.47
|
| Rate for Payer: Multiplan Commercial |
$5,171.71
|
| Rate for Payer: Preferred Network Access Commercial |
$5,947.47
|
| Rate for Payer: Quartz Beloit One Network |
$3,167.67
|
| Rate for Payer: Quartz Commercial |
$3,878.78
|
| Rate for Payer: WEA Trust Commercial |
$3,555.55
|
| Rate for Payer: WPS Commercial |
$4,788.18
|
|
|
MRA Carotids w/ Contrast
|
Facility
|
OP
|
$6,216.00
|
|
|
Service Code
|
CPT 70548 TC
|
| Hospital Charge Code |
5965680
|
|
Hospital Revenue Code
|
615
|
| Min. Negotiated Rate |
$701.46 |
| Max. Negotiated Rate |
$5,947.47 |
| Rate for Payer: Aetna Commercial |
$5,818.18
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,559.59
|
| Rate for Payer: Aetna Managed Medicare |
$1,810.10
|
| 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 |
$3,426.26
|
| Rate for Payer: Cash Price |
$1,864.80
|
| Rate for Payer: Cash Price |
$1,864.80
|
| Rate for Payer: Cash Price |
$1,864.80
|
| Rate for Payer: Cash Price |
$1,864.80
|
| Rate for Payer: Cigna Commercial |
$5,947.47
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,617.71
|
| Rate for Payer: Health EOS Commercial |
$5,753.53
|
| Rate for Payer: HFN Commercial |
$5,947.47
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,848.48
|
| Rate for Payer: Multiplan Commercial |
$5,171.71
|
| Rate for Payer: NAPHCARE Commercial |
$3,878.78
|
| Rate for Payer: Preferred Network Access Commercial |
$5,947.47
|
| Rate for Payer: Quartz Beloit One Network |
$3,167.67
|
| Rate for Payer: Quartz Commercial |
$4,202.02
|
| Rate for Payer: Quartz Medicare Advantage |
$3,878.78
|
| Rate for Payer: The Alliance Commercial |
$701.46
|
| Rate for Payer: United Healthcare PPO |
$3,142.88
|
| Rate for Payer: WEA Trust Commercial |
$3,555.55
|
| Rate for Payer: WPS Commercial |
$1,227.55
|
|
|
MRA Chest w Contrast
|
Professional
|
Both
|
$6,520.00
|
|
| Hospital Charge Code |
675638
|
| Min. Negotiated Rate |
$2,983.55 |
| Max. Negotiated Rate |
$6,441.76 |
| Rate for Payer: Aetna Commercial |
$6,441.76
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,831.49
|
| Rate for Payer: Cash Price |
$1,956.00
|
| Rate for Payer: Cigna Commercial |
$6,441.76
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$3,390.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,068.48
|
| Rate for Payer: Health EOS Commercial |
$6,170.53
|
| Rate for Payer: HFN Commercial |
$6,441.76
|
| Rate for Payer: Multiplan Commercial |
$5,424.64
|
| Rate for Payer: Preferred Network Access Commercial |
$6,441.76
|
| Rate for Payer: Quartz Beloit One Network |
$2,983.55
|
| Rate for Payer: Quartz Commercial |
$3,865.06
|
| Rate for Payer: The Alliance Commercial |
$3,390.40
|
| Rate for Payer: WEA Trust Commercial |
$3,729.44
|
| Rate for Payer: WPS Commercial |
$5,022.36
|
|
|
MRA Chest w Contrast
|
Facility
|
OP
|
$6,520.00
|
|
| Hospital Charge Code |
675638
|
| Min. Negotiated Rate |
$1,898.62 |
| Max. Negotiated Rate |
$6,238.34 |
| Rate for Payer: Aetna Commercial |
$6,102.72
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,831.49
|
| Rate for Payer: Aetna Managed Medicare |
$1,898.62
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,407.52
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,390.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,254.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,593.82
|
| Rate for Payer: Cash Price |
$1,956.00
|
| Rate for Payer: Cigna Commercial |
$6,238.34
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,794.64
|
| Rate for Payer: Health EOS Commercial |
$6,034.91
|
| Rate for Payer: HFN Commercial |
$6,238.34
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,085.60
|
| Rate for Payer: Multiplan Commercial |
$5,424.64
|
| Rate for Payer: NAPHCARE Commercial |
$4,068.48
|
| Rate for Payer: Preferred Network Access Commercial |
$6,238.34
|
| Rate for Payer: Quartz Beloit One Network |
$3,322.59
|
| Rate for Payer: Quartz Commercial |
$4,407.52
|
| Rate for Payer: Quartz Medicare Advantage |
$4,068.48
|
| Rate for Payer: The Alliance Commercial |
$3,390.40
|
| Rate for Payer: WEA Trust Commercial |
$3,729.44
|
| Rate for Payer: WPS Commercial |
$5,022.36
|
|
|
MRA Chest w Contrast
|
Facility
|
IP
|
$6,520.00
|
|
| Hospital Charge Code |
675638
|
| Min. Negotiated Rate |
$3,322.59 |
| Max. Negotiated Rate |
$6,238.34 |
| Rate for Payer: Aetna Commercial |
$6,102.72
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,831.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,593.82
|
| Rate for Payer: Cash Price |
$1,956.00
|
| Rate for Payer: Cigna Commercial |
$6,238.34
|
| Rate for Payer: Health EOS Commercial |
$6,034.91
|
| Rate for Payer: HFN Commercial |
$6,238.34
|
| Rate for Payer: Multiplan Commercial |
$5,424.64
|
| Rate for Payer: Preferred Network Access Commercial |
$6,238.34
|
| Rate for Payer: Quartz Beloit One Network |
$3,322.59
|
| Rate for Payer: Quartz Commercial |
$4,068.48
|
| Rate for Payer: WEA Trust Commercial |
$3,729.44
|
| Rate for Payer: WPS Commercial |
$5,022.36
|
|
|
MRA Chest w/ Contrast
|
Facility
|
OP
|
$6,642.00
|
|
|
Service Code
|
CPT 71555 TC
|
| Hospital Charge Code |
1610819
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,000.06 |
| Max. Negotiated Rate |
$6,355.07 |
| Rate for Payer: Aetna Commercial |
$6,216.91
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,940.60
|
| Rate for Payer: Aetna Managed Medicare |
$1,934.15
|
| 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 |
$3,661.07
|
| Rate for Payer: Cash Price |
$1,992.60
|
| Rate for Payer: Cash Price |
$1,992.60
|
| Rate for Payer: Cash Price |
$1,992.60
|
| Rate for Payer: Cash Price |
$1,992.60
|
| Rate for Payer: Cigna Commercial |
$6,355.07
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,865.64
|
| Rate for Payer: Health EOS Commercial |
$6,147.84
|
| Rate for Payer: HFN Commercial |
$6,355.07
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,180.76
|
| Rate for Payer: Multiplan Commercial |
$5,526.14
|
| Rate for Payer: NAPHCARE Commercial |
$4,144.61
|
| Rate for Payer: Preferred Network Access Commercial |
$6,355.07
|
| Rate for Payer: Quartz Beloit One Network |
$3,384.76
|
| Rate for Payer: Quartz Commercial |
$4,489.99
|
| Rate for Payer: Quartz Medicare Advantage |
$4,144.61
|
| Rate for Payer: The Alliance Commercial |
$1,000.06
|
| Rate for Payer: United Healthcare PPO |
$3,142.88
|
| Rate for Payer: WEA Trust Commercial |
$3,799.22
|
| Rate for Payer: WPS Commercial |
$1,750.11
|
|
|
MRA Chest w/ Contrast
|
Facility
|
IP
|
$6,642.00
|
|
|
Service Code
|
CPT 71555 TC
|
| Hospital Charge Code |
1610819
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$3,384.76 |
| Max. Negotiated Rate |
$6,355.07 |
| Rate for Payer: Aetna Commercial |
$6,216.91
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,940.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,661.07
|
| Rate for Payer: Cash Price |
$1,992.60
|
| Rate for Payer: Cigna Commercial |
$6,355.07
|
| Rate for Payer: Health EOS Commercial |
$6,147.84
|
| Rate for Payer: HFN Commercial |
$6,355.07
|
| Rate for Payer: Multiplan Commercial |
$5,526.14
|
| Rate for Payer: Preferred Network Access Commercial |
$6,355.07
|
| Rate for Payer: Quartz Beloit One Network |
$3,384.76
|
| Rate for Payer: Quartz Commercial |
$4,144.61
|
| Rate for Payer: WEA Trust Commercial |
$3,799.22
|
| Rate for Payer: WPS Commercial |
$5,116.33
|
|
|
MRA Chest w/ Contrast
|
Professional
|
Both
|
$6,642.00
|
|
|
Service Code
|
CPT 71555 TC
|
| Hospital Charge Code |
1610819
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$250.02 |
| Max. Negotiated Rate |
$6,562.30 |
| Rate for Payer: Aetna Commercial |
$6,562.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,940.60
|
| Rate for Payer: Aetna Managed Medicare |
$250.02
|
| Rate for Payer: Anthem Medicare Advantage |
$250.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$250.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$250.02
|
| Rate for Payer: Cash Price |
$1,992.60
|
| Rate for Payer: Cash Price |
$1,992.60
|
| Rate for Payer: Cash Price |
$1,992.60
|
| Rate for Payer: Cigna Commercial |
$6,562.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$3,453.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$250.02
|
| Rate for Payer: Health EOS Commercial |
$6,285.99
|
| Rate for Payer: HFN Commercial |
$6,562.30
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,019.97
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,019.97
|
| Rate for Payer: Independent Care Health Plan Medicare |
$250.02
|
| Rate for Payer: Multiplan Commercial |
$5,526.14
|
| Rate for Payer: NAPHCARE Commercial |
$375.02
|
| Rate for Payer: Preferred Network Access Commercial |
$6,562.30
|
| Rate for Payer: Quartz Beloit One Network |
$3,039.38
|
| Rate for Payer: Quartz Commercial |
$3,937.38
|
| Rate for Payer: Quartz Medicare Advantage |
$250.02
|
| Rate for Payer: The Alliance Commercial |
$950.06
|
| Rate for Payer: United Healthcare Medicare Advantage |
$250.02
|
| Rate for Payer: WEA Trust Commercial |
$3,799.22
|
| Rate for Payer: WPS Commercial |
$1,250.08
|
|
|
MRA Chest w/o Contrast
|
Facility
|
IP
|
$6,080.00
|
|
| Hospital Charge Code |
675664
|
| 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 Chest w/o Contrast
|
Facility
|
IP
|
$5,965.00
|
|
|
Service Code
|
CPT 71555 TC
|
| Hospital Charge Code |
1610821
|
|
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 Chest w/o Contrast
|
Professional
|
Both
|
$6,080.00
|
|
| Hospital Charge Code |
675664
|
| Min. Negotiated Rate |
$2,782.21 |
| Max. Negotiated Rate |
$6,007.04 |
| Rate for Payer: Aetna Commercial |
$6,007.04
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,437.95
|
| Rate for Payer: Cash Price |
$1,824.00
|
| Rate for Payer: Cigna Commercial |
$6,007.04
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$3,161.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,793.92
|
| Rate for Payer: Health EOS Commercial |
$5,754.11
|
| Rate for Payer: HFN Commercial |
$6,007.04
|
| Rate for Payer: Multiplan Commercial |
$5,058.56
|
| Rate for Payer: Preferred Network Access Commercial |
$6,007.04
|
| Rate for Payer: Quartz Beloit One Network |
$2,782.21
|
| Rate for Payer: Quartz Commercial |
$3,604.22
|
| Rate for Payer: The Alliance Commercial |
$3,161.60
|
| Rate for Payer: WEA Trust Commercial |
$3,477.76
|
| Rate for Payer: WPS Commercial |
$4,683.42
|
|
|
MRA Chest w/o Contrast
|
Facility
|
OP
|
$5,965.00
|
|
|
Service Code
|
CPT 71555 TC
|
| Hospital Charge Code |
1610821
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,000.06 |
| 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 |
$1,000.06
|
| Rate for Payer: United Healthcare PPO |
$3,142.88
|
| Rate for Payer: WEA Trust Commercial |
$3,411.98
|
| Rate for Payer: WPS Commercial |
$1,750.11
|
|
|
MRA Chest w/o Contrast
|
Professional
|
Both
|
$5,965.00
|
|
|
Service Code
|
CPT 71555 TC
|
| Hospital Charge Code |
1610821
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$250.02 |
| 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 |
$250.02
|
| Rate for Payer: Anthem Medicare Advantage |
$250.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$250.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$250.02
|
| 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 |
$250.02
|
| 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 |
$1,019.97
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,019.97
|
| Rate for Payer: Independent Care Health Plan Medicare |
$250.02
|
| Rate for Payer: Multiplan Commercial |
$4,962.88
|
| Rate for Payer: NAPHCARE Commercial |
$375.02
|
| 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 |
$250.02
|
| Rate for Payer: The Alliance Commercial |
$950.06
|
| Rate for Payer: United Healthcare Medicare Advantage |
$250.02
|
| Rate for Payer: WEA Trust Commercial |
$3,411.98
|
| Rate for Payer: WPS Commercial |
$1,250.08
|
|
|
MRA Chest w/o Contrast
|
Facility
|
OP
|
$6,080.00
|
|
| Hospital Charge Code |
675664
|
| Min. Negotiated Rate |
$1,770.50 |
| 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: Aetna Managed Medicare |
$1,770.50
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,110.08
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,161.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,035.14
|
| 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: Dean Health DHI/DHP/ASO |
$3,538.56
|
| Rate for Payer: Health EOS Commercial |
$5,627.65
|
| Rate for Payer: HFN Commercial |
$5,817.34
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,742.40
|
| Rate for Payer: Multiplan Commercial |
$5,058.56
|
| Rate for Payer: NAPHCARE Commercial |
$3,793.92
|
| 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 |
$4,110.08
|
| Rate for Payer: Quartz Medicare Advantage |
$3,793.92
|
| Rate for Payer: The Alliance Commercial |
$3,161.60
|
| Rate for Payer: WEA Trust Commercial |
$3,477.76
|
| Rate for Payer: WPS Commercial |
$4,683.42
|
|
|
MRA Chest w + w/o Contrast
|
Professional
|
Both
|
$7,771.00
|
|
| Hospital Charge Code |
675637
|
| Min. Negotiated Rate |
$3,556.01 |
| Max. Negotiated Rate |
$7,677.75 |
| Rate for Payer: Aetna Commercial |
$7,677.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,950.38
|
| Rate for Payer: Cash Price |
$2,331.30
|
| Rate for Payer: Cigna Commercial |
$7,677.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$4,040.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,849.10
|
| Rate for Payer: Health EOS Commercial |
$7,354.47
|
| Rate for Payer: HFN Commercial |
$7,677.75
|
| Rate for Payer: Multiplan Commercial |
$6,465.47
|
| Rate for Payer: Preferred Network Access Commercial |
$7,677.75
|
| Rate for Payer: Quartz Beloit One Network |
$3,556.01
|
| Rate for Payer: Quartz Commercial |
$4,606.65
|
| Rate for Payer: The Alliance Commercial |
$4,040.92
|
| Rate for Payer: WEA Trust Commercial |
$4,445.01
|
| Rate for Payer: WPS Commercial |
$5,986.00
|
|
|
MRA Chest w + w/o Contrast
|
Facility
|
OP
|
$7,771.00
|
|
| Hospital Charge Code |
675637
|
| Min. Negotiated Rate |
$2,262.92 |
| Max. Negotiated Rate |
$7,435.29 |
| Rate for Payer: Aetna Commercial |
$7,273.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,950.38
|
| Rate for Payer: Aetna Managed Medicare |
$2,262.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,253.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,040.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,879.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,283.38
|
| Rate for Payer: Cash Price |
$2,331.30
|
| Rate for Payer: Cigna Commercial |
$7,435.29
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,522.72
|
| Rate for Payer: Health EOS Commercial |
$7,192.84
|
| Rate for Payer: HFN Commercial |
$7,435.29
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,061.38
|
| Rate for Payer: Multiplan Commercial |
$6,465.47
|
| Rate for Payer: NAPHCARE Commercial |
$4,849.10
|
| Rate for Payer: Preferred Network Access Commercial |
$7,435.29
|
| Rate for Payer: Quartz Beloit One Network |
$3,960.10
|
| Rate for Payer: Quartz Commercial |
$5,253.20
|
| Rate for Payer: Quartz Medicare Advantage |
$4,849.10
|
| Rate for Payer: The Alliance Commercial |
$4,040.92
|
| Rate for Payer: WEA Trust Commercial |
$4,445.01
|
| Rate for Payer: WPS Commercial |
$5,986.00
|
|
|
MRA Chest w + w/o Contrast
|
Facility
|
IP
|
$7,771.00
|
|
| Hospital Charge Code |
675637
|
| Min. Negotiated Rate |
$3,960.10 |
| Max. Negotiated Rate |
$7,435.29 |
| Rate for Payer: Aetna Commercial |
$7,273.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,950.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,283.38
|
| Rate for Payer: Cash Price |
$2,331.30
|
| Rate for Payer: Cigna Commercial |
$7,435.29
|
| Rate for Payer: Health EOS Commercial |
$7,192.84
|
| Rate for Payer: HFN Commercial |
$7,435.29
|
| Rate for Payer: Multiplan Commercial |
$6,465.47
|
| Rate for Payer: Preferred Network Access Commercial |
$7,435.29
|
| Rate for Payer: Quartz Beloit One Network |
$3,960.10
|
| Rate for Payer: Quartz Commercial |
$4,849.10
|
| Rate for Payer: WEA Trust Commercial |
$4,445.01
|
| Rate for Payer: WPS Commercial |
$5,986.00
|
|
|
MRA Chest w/ + w/o Contrast
|
Professional
|
Both
|
$7,625.00
|
|
|
Service Code
|
CPT 71555 TC
|
| Hospital Charge Code |
1610817
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$250.02 |
| Max. Negotiated Rate |
$7,533.50 |
| Rate for Payer: Aetna Commercial |
$7,533.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,819.80
|
| Rate for Payer: Aetna Managed Medicare |
$250.02
|
| Rate for Payer: Anthem Medicare Advantage |
$250.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$250.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$250.02
|
| Rate for Payer: Cash Price |
$2,287.50
|
| Rate for Payer: Cash Price |
$2,287.50
|
| Rate for Payer: Cash Price |
$2,287.50
|
| Rate for Payer: Cigna Commercial |
$7,533.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$3,965.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$250.02
|
| Rate for Payer: Health EOS Commercial |
$7,216.30
|
| Rate for Payer: HFN Commercial |
$7,533.50
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,019.97
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,019.97
|
| Rate for Payer: Independent Care Health Plan Medicare |
$250.02
|
| Rate for Payer: Multiplan Commercial |
$6,344.00
|
| Rate for Payer: NAPHCARE Commercial |
$375.02
|
| Rate for Payer: Preferred Network Access Commercial |
$7,533.50
|
| Rate for Payer: Quartz Beloit One Network |
$3,489.20
|
| Rate for Payer: Quartz Commercial |
$4,520.10
|
| Rate for Payer: Quartz Medicare Advantage |
$250.02
|
| Rate for Payer: The Alliance Commercial |
$950.06
|
| Rate for Payer: United Healthcare Medicare Advantage |
$250.02
|
| Rate for Payer: WEA Trust Commercial |
$4,361.50
|
| Rate for Payer: WPS Commercial |
$1,250.08
|
|
|
MRA Chest w/ + w/o Contrast
|
Facility
|
OP
|
$7,625.00
|
|
|
Service Code
|
CPT 71555 TC
|
| Hospital Charge Code |
1610817
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,000.06 |
| Max. Negotiated Rate |
$7,295.60 |
| Rate for Payer: Aetna Commercial |
$7,137.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,819.80
|
| Rate for Payer: Aetna Managed Medicare |
$2,220.40
|
| 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 |
$4,202.90
|
| Rate for Payer: Cash Price |
$2,287.50
|
| Rate for Payer: Cash Price |
$2,287.50
|
| Rate for Payer: Cash Price |
$2,287.50
|
| Rate for Payer: Cash Price |
$2,287.50
|
| Rate for Payer: Cigna Commercial |
$7,295.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,437.75
|
| Rate for Payer: Health EOS Commercial |
$7,057.70
|
| Rate for Payer: HFN Commercial |
$7,295.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,947.50
|
| Rate for Payer: Multiplan Commercial |
$6,344.00
|
| Rate for Payer: NAPHCARE Commercial |
$4,758.00
|
| Rate for Payer: Preferred Network Access Commercial |
$7,295.60
|
| Rate for Payer: Quartz Beloit One Network |
$3,885.70
|
| Rate for Payer: Quartz Commercial |
$5,154.50
|
| Rate for Payer: Quartz Medicare Advantage |
$4,758.00
|
| Rate for Payer: The Alliance Commercial |
$1,000.06
|
| Rate for Payer: United Healthcare PPO |
$3,142.88
|
| Rate for Payer: WEA Trust Commercial |
$4,361.50
|
| Rate for Payer: WPS Commercial |
$1,750.11
|
|
|
MRA Chest w/ + w/o Contrast
|
Facility
|
IP
|
$7,625.00
|
|
|
Service Code
|
CPT 71555 TC
|
| Hospital Charge Code |
1610817
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$3,885.70 |
| Max. Negotiated Rate |
$7,295.60 |
| Rate for Payer: Aetna Commercial |
$7,137.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,819.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,202.90
|
| Rate for Payer: Cash Price |
$2,287.50
|
| Rate for Payer: Cigna Commercial |
$7,295.60
|
| Rate for Payer: Health EOS Commercial |
$7,057.70
|
| Rate for Payer: HFN Commercial |
$7,295.60
|
| Rate for Payer: Multiplan Commercial |
$6,344.00
|
| Rate for Payer: Preferred Network Access Commercial |
$7,295.60
|
| Rate for Payer: Quartz Beloit One Network |
$3,885.70
|
| Rate for Payer: Quartz Commercial |
$4,758.00
|
| Rate for Payer: WEA Trust Commercial |
$4,361.50
|
| Rate for Payer: WPS Commercial |
$5,873.54
|
|
|
MRA Head w/ Contrast
|
Facility
|
IP
|
$6,015.00
|
|
|
Service Code
|
CPT 70545 TC
|
| Hospital Charge Code |
1610825
|
|
Hospital Revenue Code
|
615
|
| Min. Negotiated Rate |
$3,065.24 |
| Max. Negotiated Rate |
$5,755.15 |
| Rate for Payer: Aetna Commercial |
$5,630.04
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,379.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,315.47
|
| Rate for Payer: Cash Price |
$1,804.50
|
| Rate for Payer: Cigna Commercial |
$5,755.15
|
| Rate for Payer: Health EOS Commercial |
$5,567.48
|
| Rate for Payer: HFN Commercial |
$5,755.15
|
| Rate for Payer: Multiplan Commercial |
$5,004.48
|
| Rate for Payer: Preferred Network Access Commercial |
$5,755.15
|
| Rate for Payer: Quartz Beloit One Network |
$3,065.24
|
| Rate for Payer: Quartz Commercial |
$3,753.36
|
| Rate for Payer: WEA Trust Commercial |
$3,440.58
|
| Rate for Payer: WPS Commercial |
$4,633.35
|
|
