|
MRA Lower Ext w/ Contrast
|
Facility
|
IP
|
$4,802.00
|
|
|
Service Code
|
CPT 73725 RT,TC
|
| Hospital Charge Code |
3072655
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$2,447.10 |
| Max. Negotiated Rate |
$4,594.55 |
| Rate for Payer: Aetna Commercial |
$4,494.67
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,294.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,646.86
|
| Rate for Payer: Cash Price |
$1,440.60
|
| Rate for Payer: Cigna Commercial |
$4,594.55
|
| Rate for Payer: Health EOS Commercial |
$4,444.73
|
| Rate for Payer: HFN Commercial |
$4,594.55
|
| Rate for Payer: Multiplan Commercial |
$3,995.26
|
| Rate for Payer: Preferred Network Access Commercial |
$4,594.55
|
| Rate for Payer: Quartz Beloit One Network |
$2,447.10
|
| Rate for Payer: Quartz Commercial |
$2,996.45
|
| Rate for Payer: WEA Trust Commercial |
$2,746.74
|
| Rate for Payer: WPS Commercial |
$3,698.98
|
|
|
MRA Neck/Carotids w/ Contrast
|
Facility
|
IP
|
$5,030.00
|
|
|
Service Code
|
CPT 70548
|
| Hospital Charge Code |
630739
|
| Min. Negotiated Rate |
$2,563.29 |
| Max. Negotiated Rate |
$4,812.70 |
| Rate for Payer: Aetna Commercial |
$4,708.08
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,498.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,772.54
|
| Rate for Payer: Cash Price |
$1,509.00
|
| Rate for Payer: Cigna Commercial |
$4,812.70
|
| Rate for Payer: Health EOS Commercial |
$4,655.77
|
| Rate for Payer: HFN Commercial |
$4,812.70
|
| Rate for Payer: Multiplan Commercial |
$4,184.96
|
| Rate for Payer: Preferred Network Access Commercial |
$4,812.70
|
| Rate for Payer: Quartz Beloit One Network |
$2,563.29
|
| Rate for Payer: Quartz Commercial |
$3,138.72
|
| Rate for Payer: WEA Trust Commercial |
$2,877.16
|
| Rate for Payer: WPS Commercial |
$3,874.61
|
|
|
MRA Neck/Carotids w/ Contrast
|
Facility
|
OP
|
$6,216.00
|
|
|
Service Code
|
CPT 70548 TC
|
| Hospital Charge Code |
1610850
|
|
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 Neck/Carotids w/ Contrast
|
Professional
|
Both
|
$5,030.00
|
|
|
Service Code
|
CPT 70548
|
| Hospital Charge Code |
630739
|
| Min. Negotiated Rate |
$244.24 |
| Max. Negotiated Rate |
$4,969.64 |
| Rate for Payer: Aetna Commercial |
$4,969.64
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,498.83
|
| Rate for Payer: Aetna Managed Medicare |
$244.24
|
| Rate for Payer: Anthem Medicare Advantage |
$244.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$244.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$244.24
|
| Rate for Payer: Cash Price |
$1,509.00
|
| Rate for Payer: Cash Price |
$1,509.00
|
| Rate for Payer: Cash Price |
$1,509.00
|
| Rate for Payer: Cigna Commercial |
$4,969.64
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,615.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$244.24
|
| Rate for Payer: Health EOS Commercial |
$4,760.39
|
| Rate for Payer: HFN Commercial |
$4,969.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$957.82
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$957.82
|
| Rate for Payer: Independent Care Health Plan Medicare |
$244.24
|
| Rate for Payer: Multiplan Commercial |
$4,184.96
|
| Rate for Payer: NAPHCARE Commercial |
$366.37
|
| Rate for Payer: Preferred Network Access Commercial |
$4,969.64
|
| Rate for Payer: Quartz Beloit One Network |
$2,301.73
|
| Rate for Payer: Quartz Commercial |
$2,981.78
|
| Rate for Payer: Quartz Medicare Advantage |
$244.24
|
| Rate for Payer: The Alliance Commercial |
$928.13
|
| Rate for Payer: United Healthcare Medicare Advantage |
$244.24
|
| Rate for Payer: WEA Trust Commercial |
$2,877.16
|
| Rate for Payer: WPS Commercial |
$1,221.22
|
|
|
MRA Neck/Carotids w/ Contrast
|
Facility
|
IP
|
$6,216.00
|
|
|
Service Code
|
CPT 70548 TC
|
| Hospital Charge Code |
1610850
|
|
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 Neck/Carotids w/ Contrast
|
Facility
|
OP
|
$5,030.00
|
|
|
Service Code
|
CPT 70548
|
| Hospital Charge Code |
630739
|
| Min. Negotiated Rate |
$367.15 |
| Max. Negotiated Rate |
$4,812.70 |
| Rate for Payer: Aetna Commercial |
$4,708.08
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,498.83
|
| Rate for Payer: Aetna Managed Medicare |
$367.15
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,400.28
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,615.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,510.98
|
| Rate for Payer: Anthem Medicare Advantage |
$367.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,772.54
|
| 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 |
$1,509.00
|
| Rate for Payer: Cash Price |
$1,509.00
|
| Rate for Payer: Cigna Commercial |
$4,812.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$367.15
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,927.46
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$367.15
|
| Rate for Payer: Health EOS Commercial |
$4,655.77
|
| Rate for Payer: HFN Commercial |
$4,812.70
|
| 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 |
$4,184.96
|
| Rate for Payer: NAPHCARE Commercial |
$550.73
|
| Rate for Payer: Preferred Network Access Commercial |
$4,812.70
|
| Rate for Payer: Quartz Beloit One Network |
$2,563.29
|
| Rate for Payer: Quartz Commercial |
$3,400.28
|
| 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 |
$2,877.16
|
| Rate for Payer: Wellcare Medicare |
$367.15
|
| Rate for Payer: WPS Commercial |
$3,874.61
|
|
|
MRA Neck/Carotids w/ Contrast
|
Professional
|
Both
|
$6,216.00
|
|
|
Service Code
|
CPT 70548 TC
|
| Hospital Charge Code |
1610850
|
|
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 Neck/Carotids w/o Contrast
|
Facility
|
OP
|
$5,758.00
|
|
|
Service Code
|
CPT 70547 TC
|
| Hospital Charge Code |
1610852
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$633.57 |
| Max. Negotiated Rate |
$5,509.25 |
| Rate for Payer: Aetna Commercial |
$5,389.49
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,149.96
|
| Rate for Payer: Aetna Managed Medicare |
$1,676.73
|
| 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 |
$3,173.81
|
| Rate for Payer: Cash Price |
$1,727.40
|
| Rate for Payer: Cash Price |
$1,727.40
|
| Rate for Payer: Cash Price |
$1,727.40
|
| Rate for Payer: Cash Price |
$1,727.40
|
| Rate for Payer: Cigna Commercial |
$5,509.25
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,351.16
|
| Rate for Payer: Health EOS Commercial |
$5,329.60
|
| Rate for Payer: HFN Commercial |
$5,509.25
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,491.24
|
| Rate for Payer: Multiplan Commercial |
$4,790.66
|
| Rate for Payer: NAPHCARE Commercial |
$3,592.99
|
| Rate for Payer: Preferred Network Access Commercial |
$5,509.25
|
| Rate for Payer: Quartz Beloit One Network |
$2,934.28
|
| Rate for Payer: Quartz Commercial |
$3,892.41
|
| Rate for Payer: Quartz Medicare Advantage |
$3,592.99
|
| Rate for Payer: The Alliance Commercial |
$633.57
|
| Rate for Payer: United Healthcare PPO |
$3,142.88
|
| Rate for Payer: WEA Trust Commercial |
$3,293.58
|
| Rate for Payer: WPS Commercial |
$1,108.74
|
|
|
MRA Neck/Carotids w/o Contrast
|
Facility
|
IP
|
$5,758.00
|
|
|
Service Code
|
CPT 70547 TC
|
| Hospital Charge Code |
1610852
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$2,934.28 |
| Max. Negotiated Rate |
$5,509.25 |
| Rate for Payer: Aetna Commercial |
$5,389.49
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,149.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,173.81
|
| Rate for Payer: Cash Price |
$1,727.40
|
| Rate for Payer: Cigna Commercial |
$5,509.25
|
| Rate for Payer: Health EOS Commercial |
$5,329.60
|
| Rate for Payer: HFN Commercial |
$5,509.25
|
| Rate for Payer: Multiplan Commercial |
$4,790.66
|
| Rate for Payer: Preferred Network Access Commercial |
$5,509.25
|
| Rate for Payer: Quartz Beloit One Network |
$2,934.28
|
| Rate for Payer: Quartz Commercial |
$3,592.99
|
| Rate for Payer: WEA Trust Commercial |
$3,293.58
|
| Rate for Payer: WPS Commercial |
$4,435.39
|
|
|
MRA Neck/Carotids w/o Contrast
|
Professional
|
Both
|
$5,758.00
|
|
|
Service Code
|
CPT 70547 TC
|
| Hospital Charge Code |
1610852
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$158.39 |
| Max. Negotiated Rate |
$5,688.90 |
| Rate for Payer: Aetna Commercial |
$5,688.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,149.96
|
| Rate for Payer: Aetna Managed Medicare |
$158.39
|
| Rate for Payer: Anthem Medicare Advantage |
$158.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$158.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$158.39
|
| Rate for Payer: Cash Price |
$1,727.40
|
| Rate for Payer: Cash Price |
$1,727.40
|
| Rate for Payer: Cash Price |
$1,727.40
|
| Rate for Payer: Cigna Commercial |
$5,688.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,994.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$158.39
|
| Rate for Payer: Health EOS Commercial |
$5,449.37
|
| Rate for Payer: HFN Commercial |
$5,688.90
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$640.30
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$640.30
|
| Rate for Payer: Independent Care Health Plan Medicare |
$158.39
|
| Rate for Payer: Multiplan Commercial |
$4,790.66
|
| Rate for Payer: NAPHCARE Commercial |
$237.59
|
| Rate for Payer: Preferred Network Access Commercial |
$5,688.90
|
| Rate for Payer: Quartz Beloit One Network |
$2,634.86
|
| Rate for Payer: Quartz Commercial |
$3,413.34
|
| Rate for Payer: Quartz Medicare Advantage |
$158.39
|
| Rate for Payer: The Alliance Commercial |
$601.89
|
| Rate for Payer: United Healthcare Medicare Advantage |
$158.39
|
| Rate for Payer: WEA Trust Commercial |
$3,293.58
|
| Rate for Payer: WPS Commercial |
$791.96
|
|
|
MRA Neck/Carotids w/o Contrast
|
Facility
|
IP
|
$4,679.00
|
|
|
Service Code
|
CPT 70547
|
| Hospital Charge Code |
630743
|
| 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 Neck/Carotids w/o Contrast
|
Professional
|
Both
|
$4,679.00
|
|
|
Service Code
|
CPT 70547
|
| Hospital Charge Code |
630743
|
| Min. Negotiated Rate |
$213.43 |
| 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 |
$213.43
|
| Rate for Payer: Anthem Medicare Advantage |
$213.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$213.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$213.43
|
| 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 |
$213.43
|
| 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 |
$849.00
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$849.00
|
| Rate for Payer: Independent Care Health Plan Medicare |
$213.43
|
| Rate for Payer: Multiplan Commercial |
$3,892.93
|
| Rate for Payer: NAPHCARE Commercial |
$320.14
|
| 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 |
$213.43
|
| Rate for Payer: The Alliance Commercial |
$811.03
|
| Rate for Payer: United Healthcare Medicare Advantage |
$213.43
|
| Rate for Payer: WEA Trust Commercial |
$2,676.39
|
| Rate for Payer: WPS Commercial |
$1,067.14
|
|
|
MRA Neck/Carotids w/o Contrast
|
Facility
|
OP
|
$4,679.00
|
|
|
Service Code
|
CPT 70547
|
| Hospital Charge Code |
630743
|
| Min. Negotiated Rate |
$251.10 |
| 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 |
$251.10
|
| 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 |
$251.10
|
| 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 |
$251.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$251.10
|
| 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 |
$251.10
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,723.18
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$251.10
|
| 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 |
$934.08
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$251.10
|
| Rate for Payer: Independent Care Health Plan Medicare |
$251.10
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$251.10
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$251.10
|
| Rate for Payer: Multiplan Commercial |
$3,892.93
|
| Rate for Payer: NAPHCARE Commercial |
$376.65
|
| 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 |
$251.10
|
| Rate for Payer: The Alliance Commercial |
$1,004.39
|
| Rate for Payer: United Healthcare Medicare Advantage |
$251.10
|
| Rate for Payer: WEA Trust Commercial |
$2,676.39
|
| Rate for Payer: Wellcare Medicare |
$251.10
|
| Rate for Payer: WPS Commercial |
$3,604.23
|
|
|
MRA Neck/Carotids w/ + w/o Contrast
|
Facility
|
OP
|
$7,316.00
|
|
|
Service Code
|
CPT 70549 TC
|
| Hospital Charge Code |
1610848
|
|
Hospital Revenue Code
|
615
|
| Min. Negotiated Rate |
$1,036.01 |
| Max. Negotiated Rate |
$6,999.95 |
| Rate for Payer: Aetna Commercial |
$6,847.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,543.43
|
| Rate for Payer: Aetna Managed Medicare |
$2,130.42
|
| 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 |
$4,032.58
|
| 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 |
$6,999.95
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,257.91
|
| Rate for Payer: Health EOS Commercial |
$6,771.69
|
| Rate for Payer: HFN Commercial |
$6,999.95
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,706.48
|
| Rate for Payer: Multiplan Commercial |
$6,086.91
|
| Rate for Payer: NAPHCARE Commercial |
$4,565.18
|
| Rate for Payer: Preferred Network Access Commercial |
$6,999.95
|
| Rate for Payer: Quartz Beloit One Network |
$3,728.23
|
| Rate for Payer: Quartz Commercial |
$4,945.62
|
| Rate for Payer: Quartz Medicare Advantage |
$4,565.18
|
| Rate for Payer: The Alliance Commercial |
$1,036.01
|
| Rate for Payer: United Healthcare PPO |
$3,142.88
|
| Rate for Payer: WEA Trust Commercial |
$4,184.75
|
| Rate for Payer: WPS Commercial |
$1,813.01
|
|
|
MRA Neck/Carotids w/ + w/o Contrast
|
Professional
|
Both
|
$5,491.00
|
|
|
Service Code
|
CPT 70549
|
| Hospital Charge Code |
630737
|
| Min. Negotiated Rate |
$341.73 |
| Max. Negotiated Rate |
$5,425.11 |
| Rate for Payer: Aetna Commercial |
$5,425.11
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,911.15
|
| Rate for Payer: Aetna Managed Medicare |
$341.73
|
| Rate for Payer: Anthem Medicare Advantage |
$341.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$341.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$341.73
|
| Rate for Payer: Cash Price |
$1,647.30
|
| Rate for Payer: Cash Price |
$1,647.30
|
| Rate for Payer: Cash Price |
$1,647.30
|
| Rate for Payer: Cigna Commercial |
$5,425.11
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,855.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$341.73
|
| Rate for Payer: Health EOS Commercial |
$5,196.68
|
| Rate for Payer: HFN Commercial |
$5,425.11
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,354.12
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,354.12
|
| Rate for Payer: Independent Care Health Plan Medicare |
$341.73
|
| Rate for Payer: Multiplan Commercial |
$4,568.51
|
| Rate for Payer: NAPHCARE Commercial |
$512.60
|
| Rate for Payer: Preferred Network Access Commercial |
$5,425.11
|
| Rate for Payer: Quartz Beloit One Network |
$2,512.68
|
| Rate for Payer: Quartz Commercial |
$3,255.06
|
| Rate for Payer: Quartz Medicare Advantage |
$341.73
|
| Rate for Payer: The Alliance Commercial |
$1,298.59
|
| Rate for Payer: United Healthcare Medicare Advantage |
$341.73
|
| Rate for Payer: WEA Trust Commercial |
$3,140.85
|
| Rate for Payer: WPS Commercial |
$1,708.67
|
|
|
MRA Neck/Carotids w/ + w/o Contrast
|
Facility
|
IP
|
$5,491.00
|
|
|
Service Code
|
CPT 70549
|
| Hospital Charge Code |
630737
|
| Min. Negotiated Rate |
$2,798.21 |
| Max. Negotiated Rate |
$5,253.79 |
| Rate for Payer: Aetna Commercial |
$5,139.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,911.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,026.64
|
| Rate for Payer: Cash Price |
$1,647.30
|
| Rate for Payer: Cigna Commercial |
$5,253.79
|
| Rate for Payer: Health EOS Commercial |
$5,082.47
|
| Rate for Payer: HFN Commercial |
$5,253.79
|
| Rate for Payer: Multiplan Commercial |
$4,568.51
|
| Rate for Payer: Preferred Network Access Commercial |
$5,253.79
|
| Rate for Payer: Quartz Beloit One Network |
$2,798.21
|
| Rate for Payer: Quartz Commercial |
$3,426.38
|
| Rate for Payer: WEA Trust Commercial |
$3,140.85
|
| Rate for Payer: WPS Commercial |
$4,229.72
|
|
|
MRA Neck/Carotids w/ + w/o Contrast
|
Facility
|
OP
|
$5,491.00
|
|
|
Service Code
|
CPT 70549
|
| Hospital Charge Code |
630737
|
| Min. Negotiated Rate |
$367.15 |
| Max. Negotiated Rate |
$5,253.79 |
| Rate for Payer: Aetna Commercial |
$5,139.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,911.15
|
| Rate for Payer: Aetna Managed Medicare |
$367.15
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,711.92
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,855.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,741.11
|
| Rate for Payer: Anthem Medicare Advantage |
$367.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,026.64
|
| 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 |
$1,647.30
|
| Rate for Payer: Cash Price |
$1,647.30
|
| Rate for Payer: Cigna Commercial |
$5,253.79
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$367.15
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,195.76
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$367.15
|
| Rate for Payer: Health EOS Commercial |
$5,082.47
|
| Rate for Payer: HFN Commercial |
$5,253.79
|
| 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 |
$4,568.51
|
| Rate for Payer: NAPHCARE Commercial |
$550.73
|
| Rate for Payer: Preferred Network Access Commercial |
$5,253.79
|
| Rate for Payer: Quartz Beloit One Network |
$2,798.21
|
| Rate for Payer: Quartz Commercial |
$3,711.92
|
| 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 |
$3,140.85
|
| Rate for Payer: Wellcare Medicare |
$367.15
|
| Rate for Payer: WPS Commercial |
$4,229.72
|
|
|
MRA Neck/Carotids w/ + w/o Contrast
|
Facility
|
IP
|
$7,316.00
|
|
|
Service Code
|
CPT 70549 TC
|
| Hospital Charge Code |
1610848
|
|
Hospital Revenue Code
|
615
|
| Min. Negotiated Rate |
$3,728.23 |
| Max. Negotiated Rate |
$6,999.95 |
| Rate for Payer: Aetna Commercial |
$6,847.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,543.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,032.58
|
| Rate for Payer: Cash Price |
$2,194.80
|
| Rate for Payer: Cigna Commercial |
$6,999.95
|
| Rate for Payer: Health EOS Commercial |
$6,771.69
|
| Rate for Payer: HFN Commercial |
$6,999.95
|
| Rate for Payer: Multiplan Commercial |
$6,086.91
|
| Rate for Payer: Preferred Network Access Commercial |
$6,999.95
|
| Rate for Payer: Quartz Beloit One Network |
$3,728.23
|
| Rate for Payer: Quartz Commercial |
$4,565.18
|
| Rate for Payer: WEA Trust Commercial |
$4,184.75
|
| Rate for Payer: WPS Commercial |
$5,635.51
|
|
|
MRA Neck/Carotids w/ + w/o Contrast
|
Professional
|
Both
|
$7,316.00
|
|
|
Service Code
|
CPT 70549 TC
|
| Hospital Charge Code |
1610848
|
|
Hospital Revenue Code
|
615
|
| Min. Negotiated Rate |
$259.00 |
| Max. Negotiated Rate |
$7,228.21 |
| Rate for Payer: Aetna Commercial |
$7,228.21
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,543.43
|
| Rate for Payer: Aetna Managed Medicare |
$259.00
|
| Rate for Payer: Anthem Medicare Advantage |
$259.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$259.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$259.00
|
| 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 |
$7,228.21
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$3,804.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$259.00
|
| Rate for Payer: Health EOS Commercial |
$6,923.86
|
| Rate for Payer: HFN Commercial |
$7,228.21
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,041.71
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,041.71
|
| Rate for Payer: Independent Care Health Plan Medicare |
$259.00
|
| Rate for Payer: Multiplan Commercial |
$6,086.91
|
| Rate for Payer: NAPHCARE Commercial |
$388.50
|
| Rate for Payer: Preferred Network Access Commercial |
$7,228.21
|
| Rate for Payer: Quartz Beloit One Network |
$3,347.80
|
| Rate for Payer: Quartz Commercial |
$4,336.92
|
| Rate for Payer: Quartz Medicare Advantage |
$259.00
|
| Rate for Payer: The Alliance Commercial |
$984.21
|
| Rate for Payer: United Healthcare Medicare Advantage |
$259.00
|
| Rate for Payer: WEA Trust Commercial |
$4,184.75
|
| Rate for Payer: WPS Commercial |
$1,295.01
|
|
|
MRA Neck w/ w/o Contrast
|
Facility
|
OP
|
$5,875.00
|
|
|
Service Code
|
CPT 70549 TC
|
| Hospital Charge Code |
3072664
|
|
Hospital Revenue Code
|
615
|
| Min. Negotiated Rate |
$1,036.01 |
| Max. Negotiated Rate |
$5,621.20 |
| Rate for Payer: Aetna Commercial |
$5,499.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,254.60
|
| Rate for Payer: Aetna Managed Medicare |
$1,710.80
|
| 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 |
$3,238.30
|
| Rate for Payer: Cash Price |
$1,762.50
|
| Rate for Payer: Cash Price |
$1,762.50
|
| Rate for Payer: Cash Price |
$1,762.50
|
| Rate for Payer: Cash Price |
$1,762.50
|
| Rate for Payer: Cigna Commercial |
$5,621.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,419.25
|
| Rate for Payer: Health EOS Commercial |
$5,437.90
|
| Rate for Payer: HFN Commercial |
$5,621.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,582.50
|
| Rate for Payer: Multiplan Commercial |
$4,888.00
|
| Rate for Payer: NAPHCARE Commercial |
$3,666.00
|
| Rate for Payer: Preferred Network Access Commercial |
$5,621.20
|
| Rate for Payer: Quartz Beloit One Network |
$2,993.90
|
| Rate for Payer: Quartz Commercial |
$3,971.50
|
| Rate for Payer: Quartz Medicare Advantage |
$3,666.00
|
| Rate for Payer: The Alliance Commercial |
$1,036.01
|
| Rate for Payer: United Healthcare PPO |
$3,142.88
|
| Rate for Payer: WEA Trust Commercial |
$3,360.50
|
| Rate for Payer: WPS Commercial |
$1,813.01
|
|
|
MRA Neck w/ w/o Contrast
|
Facility
|
IP
|
$5,875.00
|
|
|
Service Code
|
CPT 70549 TC
|
| Hospital Charge Code |
3072664
|
|
Hospital Revenue Code
|
615
|
| Min. Negotiated Rate |
$2,993.90 |
| Max. Negotiated Rate |
$5,621.20 |
| Rate for Payer: Aetna Commercial |
$5,499.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,254.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,238.30
|
| Rate for Payer: Cash Price |
$1,762.50
|
| Rate for Payer: Cigna Commercial |
$5,621.20
|
| Rate for Payer: Health EOS Commercial |
$5,437.90
|
| Rate for Payer: HFN Commercial |
$5,621.20
|
| Rate for Payer: Multiplan Commercial |
$4,888.00
|
| Rate for Payer: Preferred Network Access Commercial |
$5,621.20
|
| Rate for Payer: Quartz Beloit One Network |
$2,993.90
|
| Rate for Payer: Quartz Commercial |
$3,666.00
|
| Rate for Payer: WEA Trust Commercial |
$3,360.50
|
| Rate for Payer: WPS Commercial |
$4,525.51
|
|
|
MRA Neck w/ w/o Contrast
|
Professional
|
Both
|
$5,875.00
|
|
|
Service Code
|
CPT 70549 TC
|
| Hospital Charge Code |
3072664
|
|
Hospital Revenue Code
|
615
|
| Min. Negotiated Rate |
$259.00 |
| Max. Negotiated Rate |
$5,804.50 |
| Rate for Payer: Aetna Commercial |
$5,804.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,254.60
|
| Rate for Payer: Aetna Managed Medicare |
$259.00
|
| Rate for Payer: Anthem Medicare Advantage |
$259.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$259.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$259.00
|
| Rate for Payer: Cash Price |
$1,762.50
|
| Rate for Payer: Cash Price |
$1,762.50
|
| Rate for Payer: Cash Price |
$1,762.50
|
| Rate for Payer: Cigna Commercial |
$5,804.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$3,055.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$259.00
|
| Rate for Payer: Health EOS Commercial |
$5,560.10
|
| Rate for Payer: HFN Commercial |
$5,804.50
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,041.71
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,041.71
|
| Rate for Payer: Independent Care Health Plan Medicare |
$259.00
|
| Rate for Payer: Multiplan Commercial |
$4,888.00
|
| Rate for Payer: NAPHCARE Commercial |
$388.50
|
| Rate for Payer: Preferred Network Access Commercial |
$5,804.50
|
| Rate for Payer: Quartz Beloit One Network |
$2,688.40
|
| Rate for Payer: Quartz Commercial |
$3,482.70
|
| Rate for Payer: Quartz Medicare Advantage |
$259.00
|
| Rate for Payer: The Alliance Commercial |
$984.21
|
| Rate for Payer: United Healthcare Medicare Advantage |
$259.00
|
| Rate for Payer: WEA Trust Commercial |
$3,360.50
|
| Rate for Payer: WPS Commercial |
$1,295.01
|
|
|
MRA Pelvis w/ Contrast
|
Facility
|
OP
|
$5,965.00
|
|
|
Service Code
|
CPT 72198 TC
|
| Hospital Charge Code |
1610858
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,009.38 |
| 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 |
$1,009.38
|
| Rate for Payer: United Healthcare PPO |
$3,142.88
|
| Rate for Payer: WEA Trust Commercial |
$3,411.98
|
| Rate for Payer: WPS Commercial |
$1,766.42
|
|
|
MRA Pelvis w/ Contrast
|
Professional
|
Both
|
$6,080.00
|
|
| Hospital Charge Code |
675685
|
| 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 Pelvis w/ Contrast
|
Facility
|
IP
|
$5,965.00
|
|
|
Service Code
|
CPT 72198 TC
|
| Hospital Charge Code |
1610858
|
|
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
|
|
