|
MRA Pelvis w/ Contrast
|
Professional
|
Both
|
$5,965.00
|
|
|
Service Code
|
CPT 72198 TC
|
| Hospital Charge Code |
1610858
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$252.35 |
| 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 |
$252.35
|
| Rate for Payer: Anthem Medicare Advantage |
$252.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$252.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$252.35
|
| 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 |
$252.35
|
| 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 |
$1,029.62
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,029.62
|
| Rate for Payer: Independent Care Health Plan Medicare |
$252.35
|
| Rate for Payer: Multiplan Commercial |
$4,962.88
|
| Rate for Payer: NAPHCARE Commercial |
$378.52
|
| 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 |
$252.35
|
| Rate for Payer: The Alliance Commercial |
$958.91
|
| Rate for Payer: United Healthcare Medicare Advantage |
$252.35
|
| Rate for Payer: WEA Trust Commercial |
$3,411.98
|
| Rate for Payer: WPS Commercial |
$1,261.73
|
|
|
MRA Pelvis w/ Contrast
|
Facility
|
IP
|
$6,080.00
|
|
| Hospital Charge Code |
675685
|
| 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 Pelvis w/ Contrast
|
Facility
|
OP
|
$6,080.00
|
|
| Hospital Charge Code |
675685
|
| 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 Pelvis w/o Contrast
|
Professional
|
Both
|
$5,640.00
|
|
| Hospital Charge Code |
675683
|
| Min. Negotiated Rate |
$2,580.86 |
| Max. Negotiated Rate |
$5,572.32 |
| Rate for Payer: Aetna Commercial |
$5,572.32
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,044.42
|
| Rate for Payer: Cash Price |
$1,692.00
|
| Rate for Payer: Cigna Commercial |
$5,572.32
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,932.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,519.36
|
| Rate for Payer: Health EOS Commercial |
$5,337.70
|
| Rate for Payer: HFN Commercial |
$5,572.32
|
| Rate for Payer: Multiplan Commercial |
$4,692.48
|
| Rate for Payer: Preferred Network Access Commercial |
$5,572.32
|
| Rate for Payer: Quartz Beloit One Network |
$2,580.86
|
| Rate for Payer: Quartz Commercial |
$3,343.39
|
| Rate for Payer: The Alliance Commercial |
$2,932.80
|
| Rate for Payer: WEA Trust Commercial |
$3,226.08
|
| Rate for Payer: WPS Commercial |
$4,344.49
|
|
|
MRA Pelvis w/o Contrast
|
Facility
|
IP
|
$5,533.00
|
|
|
Service Code
|
CPT 72198 TC
|
| Hospital Charge Code |
1610860
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$2,819.62 |
| Max. Negotiated Rate |
$5,293.97 |
| Rate for Payer: Aetna Commercial |
$5,178.89
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,948.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,049.79
|
| Rate for Payer: Cash Price |
$1,659.90
|
| Rate for Payer: Cigna Commercial |
$5,293.97
|
| Rate for Payer: Health EOS Commercial |
$5,121.34
|
| Rate for Payer: HFN Commercial |
$5,293.97
|
| Rate for Payer: Multiplan Commercial |
$4,603.46
|
| Rate for Payer: Preferred Network Access Commercial |
$5,293.97
|
| Rate for Payer: Quartz Beloit One Network |
$2,819.62
|
| Rate for Payer: Quartz Commercial |
$3,452.59
|
| Rate for Payer: WEA Trust Commercial |
$3,164.88
|
| Rate for Payer: WPS Commercial |
$4,262.07
|
|
|
MRA Pelvis w/o Contrast
|
Facility
|
OP
|
$5,533.00
|
|
|
Service Code
|
CPT 72198 TC
|
| Hospital Charge Code |
1610860
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,009.38 |
| Max. Negotiated Rate |
$5,293.97 |
| Rate for Payer: Aetna Commercial |
$5,178.89
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,948.72
|
| Rate for Payer: Aetna Managed Medicare |
$1,611.21
|
| 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 |
$3,049.79
|
| Rate for Payer: Cash Price |
$1,659.90
|
| Rate for Payer: Cash Price |
$1,659.90
|
| Rate for Payer: Cash Price |
$1,659.90
|
| Rate for Payer: Cash Price |
$1,659.90
|
| Rate for Payer: Cigna Commercial |
$5,293.97
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,220.21
|
| Rate for Payer: Health EOS Commercial |
$5,121.34
|
| Rate for Payer: HFN Commercial |
$5,293.97
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,315.74
|
| Rate for Payer: Multiplan Commercial |
$4,603.46
|
| Rate for Payer: NAPHCARE Commercial |
$3,452.59
|
| Rate for Payer: Preferred Network Access Commercial |
$5,293.97
|
| Rate for Payer: Quartz Beloit One Network |
$2,819.62
|
| Rate for Payer: Quartz Commercial |
$3,740.31
|
| Rate for Payer: Quartz Medicare Advantage |
$3,452.59
|
| Rate for Payer: The Alliance Commercial |
$1,009.38
|
| Rate for Payer: United Healthcare PPO |
$3,142.88
|
| Rate for Payer: WEA Trust Commercial |
$3,164.88
|
| Rate for Payer: WPS Commercial |
$1,766.42
|
|
|
MRA Pelvis w/o Contrast
|
Professional
|
Both
|
$5,533.00
|
|
|
Service Code
|
CPT 72198 TC
|
| Hospital Charge Code |
1610860
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$252.35 |
| Max. Negotiated Rate |
$5,466.60 |
| Rate for Payer: Aetna Commercial |
$5,466.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,948.72
|
| Rate for Payer: Aetna Managed Medicare |
$252.35
|
| Rate for Payer: Anthem Medicare Advantage |
$252.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$252.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$252.35
|
| Rate for Payer: Cash Price |
$1,659.90
|
| Rate for Payer: Cash Price |
$1,659.90
|
| Rate for Payer: Cash Price |
$1,659.90
|
| Rate for Payer: Cigna Commercial |
$5,466.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,877.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$252.35
|
| Rate for Payer: Health EOS Commercial |
$5,236.43
|
| Rate for Payer: HFN Commercial |
$5,466.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,029.62
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,029.62
|
| Rate for Payer: Independent Care Health Plan Medicare |
$252.35
|
| Rate for Payer: Multiplan Commercial |
$4,603.46
|
| Rate for Payer: NAPHCARE Commercial |
$378.52
|
| Rate for Payer: Preferred Network Access Commercial |
$5,466.60
|
| Rate for Payer: Quartz Beloit One Network |
$2,531.90
|
| Rate for Payer: Quartz Commercial |
$3,279.96
|
| Rate for Payer: Quartz Medicare Advantage |
$252.35
|
| Rate for Payer: The Alliance Commercial |
$958.91
|
| Rate for Payer: United Healthcare Medicare Advantage |
$252.35
|
| Rate for Payer: WEA Trust Commercial |
$3,164.88
|
| Rate for Payer: WPS Commercial |
$1,261.73
|
|
|
MRA Pelvis w/o Contrast
|
Facility
|
IP
|
$5,640.00
|
|
| Hospital Charge Code |
675683
|
| Min. Negotiated Rate |
$2,874.14 |
| Max. Negotiated Rate |
$5,396.35 |
| Rate for Payer: Aetna Commercial |
$5,279.04
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,044.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,108.77
|
| Rate for Payer: Cash Price |
$1,692.00
|
| Rate for Payer: Cigna Commercial |
$5,396.35
|
| Rate for Payer: Health EOS Commercial |
$5,220.38
|
| Rate for Payer: HFN Commercial |
$5,396.35
|
| Rate for Payer: Multiplan Commercial |
$4,692.48
|
| Rate for Payer: Preferred Network Access Commercial |
$5,396.35
|
| Rate for Payer: Quartz Beloit One Network |
$2,874.14
|
| Rate for Payer: Quartz Commercial |
$3,519.36
|
| Rate for Payer: WEA Trust Commercial |
$3,226.08
|
| Rate for Payer: WPS Commercial |
$4,344.49
|
|
|
MRA Pelvis w/o Contrast
|
Facility
|
OP
|
$5,640.00
|
|
| Hospital Charge Code |
675683
|
| Min. Negotiated Rate |
$1,642.37 |
| Max. Negotiated Rate |
$5,396.35 |
| Rate for Payer: Aetna Commercial |
$5,279.04
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,044.42
|
| Rate for Payer: Aetna Managed Medicare |
$1,642.37
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,812.64
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,932.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,815.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,108.77
|
| Rate for Payer: Cash Price |
$1,692.00
|
| Rate for Payer: Cigna Commercial |
$5,396.35
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,282.48
|
| Rate for Payer: Health EOS Commercial |
$5,220.38
|
| Rate for Payer: HFN Commercial |
$5,396.35
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,399.20
|
| Rate for Payer: Multiplan Commercial |
$4,692.48
|
| Rate for Payer: NAPHCARE Commercial |
$3,519.36
|
| Rate for Payer: Preferred Network Access Commercial |
$5,396.35
|
| Rate for Payer: Quartz Beloit One Network |
$2,874.14
|
| Rate for Payer: Quartz Commercial |
$3,812.64
|
| Rate for Payer: Quartz Medicare Advantage |
$3,519.36
|
| Rate for Payer: The Alliance Commercial |
$2,932.80
|
| Rate for Payer: WEA Trust Commercial |
$3,226.08
|
| Rate for Payer: WPS Commercial |
$4,344.49
|
|
|
MRA Upper Extremity w/ Contrast Bilat
|
Professional
|
Both
|
$12,159.00
|
|
|
Service Code
|
CPT 73225
|
| Hospital Charge Code |
711766
|
| Min. Negotiated Rate |
$321.55 |
| Max. Negotiated Rate |
$12,013.09 |
| Rate for Payer: Aetna Commercial |
$12,013.09
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,875.01
|
| Rate for Payer: Aetna Managed Medicare |
$321.55
|
| Rate for Payer: Anthem Medicare Advantage |
$321.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$321.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$321.55
|
| Rate for Payer: Cash Price |
$3,647.70
|
| Rate for Payer: Cash Price |
$3,647.70
|
| Rate for Payer: Cash Price |
$3,647.70
|
| Rate for Payer: Cigna Commercial |
$12,013.09
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$6,322.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$321.55
|
| Rate for Payer: Health EOS Commercial |
$11,507.28
|
| Rate for Payer: HFN Commercial |
$12,013.09
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,363.26
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,363.26
|
| Rate for Payer: Independent Care Health Plan Medicare |
$321.55
|
| Rate for Payer: Multiplan Commercial |
$10,116.29
|
| Rate for Payer: NAPHCARE Commercial |
$482.32
|
| Rate for Payer: Preferred Network Access Commercial |
$12,013.09
|
| Rate for Payer: Quartz Beloit One Network |
$5,563.96
|
| Rate for Payer: Quartz Commercial |
$7,207.86
|
| Rate for Payer: Quartz Medicare Advantage |
$321.55
|
| Rate for Payer: The Alliance Commercial |
$1,221.88
|
| Rate for Payer: United Healthcare Medicare Advantage |
$321.55
|
| Rate for Payer: WEA Trust Commercial |
$6,954.95
|
| Rate for Payer: WPS Commercial |
$1,607.74
|
|
|
MRA Upper Extremity w/ Contrast Bilat
|
Facility
|
IP
|
$12,159.00
|
|
|
Service Code
|
CPT 73225
|
| Hospital Charge Code |
711766
|
| Min. Negotiated Rate |
$6,196.23 |
| Max. Negotiated Rate |
$11,633.73 |
| Rate for Payer: Aetna Commercial |
$11,380.82
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,875.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,702.04
|
| Rate for Payer: Cash Price |
$3,647.70
|
| Rate for Payer: Cigna Commercial |
$11,633.73
|
| Rate for Payer: Health EOS Commercial |
$11,254.37
|
| Rate for Payer: HFN Commercial |
$11,633.73
|
| Rate for Payer: Multiplan Commercial |
$10,116.29
|
| Rate for Payer: Preferred Network Access Commercial |
$11,633.73
|
| Rate for Payer: Quartz Beloit One Network |
$6,196.23
|
| Rate for Payer: Quartz Commercial |
$7,587.22
|
| Rate for Payer: WEA Trust Commercial |
$6,954.95
|
| Rate for Payer: WPS Commercial |
$9,366.08
|
|
|
MRA Upper Extremity w/ Contrast Bilat
|
Professional
|
Both
|
$5,965.00
|
|
|
Service Code
|
CPT 73225 LT,TC
|
| Hospital Charge Code |
1610879
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,363.26 |
| 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: 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 |
$3,722.16
|
| 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 |
$1,363.26
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,363.26
|
| Rate for Payer: Multiplan Commercial |
$4,962.88
|
| 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: The Alliance Commercial |
$3,101.80
|
| Rate for Payer: WEA Trust Commercial |
$3,411.98
|
| Rate for Payer: WPS Commercial |
$4,594.84
|
|
|
MRA Upper Extremity w/ Contrast Bilat
|
Facility
|
OP
|
$12,159.00
|
|
|
Service Code
|
CPT 73225
|
| Hospital Charge Code |
711766
|
| Min. Negotiated Rate |
$1,286.19 |
| Max. Negotiated Rate |
$11,633.73 |
| Rate for Payer: Aetna Commercial |
$11,380.82
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,875.01
|
| Rate for Payer: Aetna Managed Medicare |
$3,540.70
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$8,219.48
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$6,322.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$6,069.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,702.04
|
| Rate for Payer: Cash Price |
$3,647.70
|
| Rate for Payer: Cash Price |
$3,647.70
|
| Rate for Payer: Cigna Commercial |
$11,633.73
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$7,076.54
|
| Rate for Payer: Health EOS Commercial |
$11,254.37
|
| Rate for Payer: HFN Commercial |
$11,633.73
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$9,484.02
|
| Rate for Payer: Multiplan Commercial |
$10,116.29
|
| Rate for Payer: NAPHCARE Commercial |
$7,587.22
|
| Rate for Payer: Preferred Network Access Commercial |
$11,633.73
|
| Rate for Payer: Quartz Beloit One Network |
$6,196.23
|
| Rate for Payer: Quartz Commercial |
$8,219.48
|
| Rate for Payer: Quartz Medicare Advantage |
$7,587.22
|
| Rate for Payer: The Alliance Commercial |
$1,286.19
|
| Rate for Payer: WEA Trust Commercial |
$6,954.95
|
| Rate for Payer: WPS Commercial |
$9,366.08
|
|
|
MRA Upper Extremity w/ Contrast Bilat
|
Facility
|
IP
|
$5,965.00
|
|
|
Service Code
|
CPT 73225 LT,TC
|
| Hospital Charge Code |
1610879
|
|
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 Upper Extremity w/ Contrast Bilat
|
Facility
|
OP
|
$5,965.00
|
|
|
Service Code
|
CPT 73225 LT,TC
|
| Hospital Charge Code |
1610879
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,737.01 |
| 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: 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 |
$3,101.80
|
| Rate for Payer: United Healthcare PPO |
$3,142.88
|
| Rate for Payer: WEA Trust Commercial |
$3,411.98
|
| Rate for Payer: WPS Commercial |
$4,594.84
|
|
|
MRA Upper Extremity w/ Contrast Left
|
Facility
|
IP
|
$5,965.00
|
|
|
Service Code
|
CPT 73225 LT,TC
|
| Hospital Charge Code |
1610882
|
|
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 Upper Extremity w/ Contrast Left
|
Professional
|
Both
|
$5,965.00
|
|
|
Service Code
|
CPT 73225 LT,TC
|
| Hospital Charge Code |
1610882
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,363.26 |
| 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: 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 |
$3,722.16
|
| 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 |
$1,363.26
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,363.26
|
| Rate for Payer: Multiplan Commercial |
$4,962.88
|
| 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: The Alliance Commercial |
$3,101.80
|
| Rate for Payer: WEA Trust Commercial |
$3,411.98
|
| Rate for Payer: WPS Commercial |
$4,594.84
|
|
|
MRA Upper Extremity w/ Contrast Left
|
Facility
|
OP
|
$5,965.00
|
|
|
Service Code
|
CPT 73225 LT,TC
|
| Hospital Charge Code |
1610882
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,737.01 |
| 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: 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 |
$3,101.80
|
| Rate for Payer: United Healthcare PPO |
$3,142.88
|
| Rate for Payer: WEA Trust Commercial |
$3,411.98
|
| Rate for Payer: WPS Commercial |
$4,594.84
|
|
|
MRA Upper Extremity w/ Contrast Left
|
Professional
|
Both
|
$6,080.00
|
|
|
Service Code
|
CPT 73225
|
| Hospital Charge Code |
711767
|
| Min. Negotiated Rate |
$321.55 |
| 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: Aetna Managed Medicare |
$321.55
|
| Rate for Payer: Anthem Medicare Advantage |
$321.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$321.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$321.55
|
| Rate for Payer: Cash Price |
$1,824.00
|
| Rate for Payer: Cash Price |
$1,824.00
|
| 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 |
$321.55
|
| Rate for Payer: Health EOS Commercial |
$5,754.11
|
| Rate for Payer: HFN Commercial |
$6,007.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,363.26
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,363.26
|
| Rate for Payer: Independent Care Health Plan Medicare |
$321.55
|
| Rate for Payer: Multiplan Commercial |
$5,058.56
|
| Rate for Payer: NAPHCARE Commercial |
$482.32
|
| 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: Quartz Medicare Advantage |
$321.55
|
| Rate for Payer: The Alliance Commercial |
$1,221.88
|
| Rate for Payer: United Healthcare Medicare Advantage |
$321.55
|
| Rate for Payer: WEA Trust Commercial |
$3,477.76
|
| Rate for Payer: WPS Commercial |
$1,607.74
|
|
|
MRA Upper Extremity w/ Contrast Left
|
Facility
|
OP
|
$6,080.00
|
|
|
Service Code
|
CPT 73225
|
| Hospital Charge Code |
711767
|
| Min. Negotiated Rate |
$1,286.19 |
| 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: 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 |
$1,286.19
|
| Rate for Payer: WEA Trust Commercial |
$3,477.76
|
| Rate for Payer: WPS Commercial |
$4,683.42
|
|
|
MRA Upper Extremity w/ Contrast Left
|
Facility
|
IP
|
$6,080.00
|
|
|
Service Code
|
CPT 73225
|
| Hospital Charge Code |
711767
|
| 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 Upper Extremity w/ Contrast Right
|
Facility
|
IP
|
$5,965.00
|
|
|
Service Code
|
CPT 73225 TC,RT
|
| Hospital Charge Code |
2980052
|
|
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 Upper Extremity w/ Contrast Right
|
Professional
|
Both
|
$5,965.00
|
|
|
Service Code
|
CPT 73225 RT,TC
|
| Hospital Charge Code |
1610885
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,363.26 |
| 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: 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 |
$3,722.16
|
| 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 |
$1,363.26
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,363.26
|
| Rate for Payer: Multiplan Commercial |
$4,962.88
|
| 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: The Alliance Commercial |
$3,101.80
|
| Rate for Payer: WEA Trust Commercial |
$3,411.98
|
| Rate for Payer: WPS Commercial |
$4,594.84
|
|
|
MRA Upper Extremity w/ Contrast Right
|
Facility
|
IP
|
$6,080.00
|
|
|
Service Code
|
CPT 73225
|
| Hospital Charge Code |
711768
|
| 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 Upper Extremity w/ Contrast Right
|
Facility
|
OP
|
$5,965.00
|
|
|
Service Code
|
CPT 73225 RT,TC
|
| Hospital Charge Code |
1610885
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,737.01 |
| 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: 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 |
$3,101.80
|
| Rate for Payer: United Healthcare PPO |
$3,142.88
|
| Rate for Payer: WEA Trust Commercial |
$3,411.98
|
| Rate for Payer: WPS Commercial |
$4,594.84
|
|
