|
MRI Ankle w/ + w/o Contrast Right
|
Facility
|
IP
|
$6,080.00
|
|
|
Service Code
|
CPT 73723
|
| Hospital Charge Code |
625702
|
| 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
|
|
|
MRI Ankle w/ + w/o Contrast Right
|
Facility
|
OP
|
$6,080.00
|
|
|
Service Code
|
CPT 73723
|
| Hospital Charge Code |
625702
|
| Min. Negotiated Rate |
$367.15 |
| 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 |
$367.15
|
| 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: Anthem Medicare Advantage |
$367.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,351.30
|
| 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 |
$1,824.00
|
| Rate for Payer: Cash Price |
$1,824.00
|
| Rate for Payer: Cigna Commercial |
$5,817.34
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$367.15
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,538.56
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$367.15
|
| 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 |
$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 |
$5,058.56
|
| Rate for Payer: NAPHCARE Commercial |
$550.73
|
| 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 |
$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 |
$3,477.76
|
| Rate for Payer: Wellcare Medicare |
$367.15
|
| Rate for Payer: WPS Commercial |
$4,683.42
|
|
|
MRI Ankle w/ + w/o Contrast Right
|
Professional
|
Both
|
$6,080.00
|
|
|
Service Code
|
CPT 73723
|
| Hospital Charge Code |
625702
|
| Min. Negotiated Rate |
$379.71 |
| 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 |
$379.71
|
| Rate for Payer: Anthem Medicare Advantage |
$379.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$379.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$379.71
|
| 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 |
$379.71
|
| 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 |
$1,562.68
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,562.68
|
| Rate for Payer: Independent Care Health Plan Medicare |
$379.71
|
| Rate for Payer: Multiplan Commercial |
$5,058.56
|
| Rate for Payer: NAPHCARE Commercial |
$569.57
|
| 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 |
$379.71
|
| Rate for Payer: The Alliance Commercial |
$1,442.91
|
| Rate for Payer: United Healthcare Medicare Advantage |
$379.71
|
| Rate for Payer: WEA Trust Commercial |
$3,477.76
|
| Rate for Payer: WPS Commercial |
$1,898.57
|
|
|
MRI Brachial Plexis w/o Contrast Left
|
Professional
|
Both
|
$4,631.00
|
|
|
Service Code
|
CPT 73218 LT,TC
|
| Hospital Charge Code |
1610962
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,227.83 |
| Max. Negotiated Rate |
$4,575.43 |
| Rate for Payer: Aetna Commercial |
$4,575.43
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,141.97
|
| Rate for Payer: Cash Price |
$1,389.30
|
| Rate for Payer: Cash Price |
$1,389.30
|
| Rate for Payer: Cash Price |
$1,389.30
|
| Rate for Payer: Cigna Commercial |
$4,575.43
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,408.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,889.74
|
| Rate for Payer: Health EOS Commercial |
$4,382.78
|
| Rate for Payer: HFN Commercial |
$4,575.43
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,227.83
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,227.83
|
| Rate for Payer: Multiplan Commercial |
$3,852.99
|
| Rate for Payer: Preferred Network Access Commercial |
$4,575.43
|
| Rate for Payer: Quartz Beloit One Network |
$2,119.15
|
| Rate for Payer: Quartz Commercial |
$2,745.26
|
| Rate for Payer: The Alliance Commercial |
$2,408.12
|
| Rate for Payer: WEA Trust Commercial |
$2,648.93
|
| Rate for Payer: WPS Commercial |
$3,567.26
|
|
|
MRI Brachial Plexis w/o Contrast Left
|
Facility
|
IP
|
$4,721.00
|
|
|
Service Code
|
CPT 73218
|
| Hospital Charge Code |
1608810
|
| Min. Negotiated Rate |
$2,405.82 |
| Max. Negotiated Rate |
$4,517.05 |
| Rate for Payer: Aetna Commercial |
$4,418.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,222.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,602.22
|
| Rate for Payer: Cash Price |
$1,416.30
|
| Rate for Payer: Cigna Commercial |
$4,517.05
|
| Rate for Payer: Health EOS Commercial |
$4,369.76
|
| Rate for Payer: HFN Commercial |
$4,517.05
|
| Rate for Payer: Multiplan Commercial |
$3,927.87
|
| Rate for Payer: Preferred Network Access Commercial |
$4,517.05
|
| Rate for Payer: Quartz Beloit One Network |
$2,405.82
|
| Rate for Payer: Quartz Commercial |
$2,945.90
|
| Rate for Payer: WEA Trust Commercial |
$2,700.41
|
| Rate for Payer: WPS Commercial |
$3,636.59
|
|
|
MRI Brachial Plexis w/o Contrast Left
|
Professional
|
Both
|
$4,721.00
|
|
|
Service Code
|
CPT 73218
|
| Hospital Charge Code |
1608810
|
| Min. Negotiated Rate |
$301.83 |
| Max. Negotiated Rate |
$4,664.35 |
| Rate for Payer: Aetna Commercial |
$4,664.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,222.46
|
| Rate for Payer: Aetna Managed Medicare |
$301.83
|
| Rate for Payer: Anthem Medicare Advantage |
$301.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$301.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$301.83
|
| Rate for Payer: Cash Price |
$1,416.30
|
| Rate for Payer: Cash Price |
$1,416.30
|
| Rate for Payer: Cash Price |
$1,416.30
|
| Rate for Payer: Cigna Commercial |
$4,664.35
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,454.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$301.83
|
| Rate for Payer: Health EOS Commercial |
$4,467.95
|
| Rate for Payer: HFN Commercial |
$4,664.35
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,227.83
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,227.83
|
| Rate for Payer: Independent Care Health Plan Medicare |
$301.83
|
| Rate for Payer: Multiplan Commercial |
$3,927.87
|
| Rate for Payer: NAPHCARE Commercial |
$452.74
|
| Rate for Payer: Preferred Network Access Commercial |
$4,664.35
|
| Rate for Payer: Quartz Beloit One Network |
$2,160.33
|
| Rate for Payer: Quartz Commercial |
$2,798.61
|
| Rate for Payer: Quartz Medicare Advantage |
$301.83
|
| Rate for Payer: The Alliance Commercial |
$1,146.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$301.83
|
| Rate for Payer: WEA Trust Commercial |
$2,700.41
|
| Rate for Payer: WPS Commercial |
$1,509.14
|
|
|
MRI Brachial Plexis w/o Contrast Left
|
Facility
|
OP
|
$4,631.00
|
|
|
Service Code
|
CPT 73218 LT,TC
|
| Hospital Charge Code |
1610962
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,348.55 |
| Max. Negotiated Rate |
$4,430.94 |
| Rate for Payer: Aetna Commercial |
$4,334.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,141.97
|
| Rate for Payer: Aetna Managed Medicare |
$1,348.55
|
| 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 |
$2,552.61
|
| Rate for Payer: Cash Price |
$1,389.30
|
| Rate for Payer: Cash Price |
$1,389.30
|
| Rate for Payer: Cash Price |
$1,389.30
|
| Rate for Payer: Cigna Commercial |
$4,430.94
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,695.24
|
| Rate for Payer: Health EOS Commercial |
$4,286.45
|
| Rate for Payer: HFN Commercial |
$4,430.94
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,612.18
|
| Rate for Payer: Multiplan Commercial |
$3,852.99
|
| Rate for Payer: NAPHCARE Commercial |
$2,889.74
|
| Rate for Payer: Preferred Network Access Commercial |
$4,430.94
|
| Rate for Payer: Quartz Beloit One Network |
$2,359.96
|
| Rate for Payer: Quartz Commercial |
$3,130.56
|
| Rate for Payer: Quartz Medicare Advantage |
$2,889.74
|
| Rate for Payer: The Alliance Commercial |
$2,408.12
|
| Rate for Payer: United Healthcare PPO |
$3,142.88
|
| Rate for Payer: WEA Trust Commercial |
$2,648.93
|
| Rate for Payer: WPS Commercial |
$3,567.26
|
|
|
MRI Brachial Plexis w/o Contrast Left
|
Facility
|
IP
|
$4,631.00
|
|
|
Service Code
|
CPT 73218 LT,TC
|
| Hospital Charge Code |
1610962
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$2,359.96 |
| Max. Negotiated Rate |
$4,430.94 |
| Rate for Payer: Aetna Commercial |
$4,334.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,141.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,552.61
|
| Rate for Payer: Cash Price |
$1,389.30
|
| Rate for Payer: Cigna Commercial |
$4,430.94
|
| Rate for Payer: Health EOS Commercial |
$4,286.45
|
| Rate for Payer: HFN Commercial |
$4,430.94
|
| Rate for Payer: Multiplan Commercial |
$3,852.99
|
| Rate for Payer: Preferred Network Access Commercial |
$4,430.94
|
| Rate for Payer: Quartz Beloit One Network |
$2,359.96
|
| Rate for Payer: Quartz Commercial |
$2,889.74
|
| Rate for Payer: WEA Trust Commercial |
$2,648.93
|
| Rate for Payer: WPS Commercial |
$3,567.26
|
|
|
MRI Brachial Plexis w/o Contrast Left
|
Facility
|
OP
|
$4,721.00
|
|
|
Service Code
|
CPT 73218
|
| Hospital Charge Code |
1608810
|
| Min. Negotiated Rate |
$251.10 |
| Max. Negotiated Rate |
$4,517.05 |
| Rate for Payer: Aetna Commercial |
$4,418.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,222.46
|
| Rate for Payer: Aetna Managed Medicare |
$251.10
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,191.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,454.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,356.72
|
| Rate for Payer: Anthem Medicare Advantage |
$251.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,602.22
|
| 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 |
$1,416.30
|
| Rate for Payer: Cash Price |
$1,416.30
|
| Rate for Payer: Cigna Commercial |
$4,517.05
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$251.10
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,747.62
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$251.10
|
| Rate for Payer: Health EOS Commercial |
$4,369.76
|
| Rate for Payer: HFN Commercial |
$4,517.05
|
| 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 |
$3,927.87
|
| Rate for Payer: NAPHCARE Commercial |
$376.65
|
| Rate for Payer: Preferred Network Access Commercial |
$4,517.05
|
| Rate for Payer: Quartz Beloit One Network |
$2,405.82
|
| Rate for Payer: Quartz Commercial |
$3,191.40
|
| 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 |
$2,700.41
|
| Rate for Payer: Wellcare Medicare |
$251.10
|
| Rate for Payer: WPS Commercial |
$3,636.59
|
|
|
MRI Brachial Plexis w/o Contrast Right
|
Professional
|
Both
|
$4,721.00
|
|
|
Service Code
|
CPT 73218
|
| Hospital Charge Code |
1608811
|
| Min. Negotiated Rate |
$301.83 |
| Max. Negotiated Rate |
$4,664.35 |
| Rate for Payer: Aetna Commercial |
$4,664.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,222.46
|
| Rate for Payer: Aetna Managed Medicare |
$301.83
|
| Rate for Payer: Anthem Medicare Advantage |
$301.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$301.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$301.83
|
| Rate for Payer: Cash Price |
$1,416.30
|
| Rate for Payer: Cash Price |
$1,416.30
|
| Rate for Payer: Cash Price |
$1,416.30
|
| Rate for Payer: Cigna Commercial |
$4,664.35
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,454.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$301.83
|
| Rate for Payer: Health EOS Commercial |
$4,467.95
|
| Rate for Payer: HFN Commercial |
$4,664.35
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,227.83
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,227.83
|
| Rate for Payer: Independent Care Health Plan Medicare |
$301.83
|
| Rate for Payer: Multiplan Commercial |
$3,927.87
|
| Rate for Payer: NAPHCARE Commercial |
$452.74
|
| Rate for Payer: Preferred Network Access Commercial |
$4,664.35
|
| Rate for Payer: Quartz Beloit One Network |
$2,160.33
|
| Rate for Payer: Quartz Commercial |
$2,798.61
|
| Rate for Payer: Quartz Medicare Advantage |
$301.83
|
| Rate for Payer: The Alliance Commercial |
$1,146.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$301.83
|
| Rate for Payer: WEA Trust Commercial |
$2,700.41
|
| Rate for Payer: WPS Commercial |
$1,509.14
|
|
|
MRI Brachial Plexis w/o Contrast Right
|
Facility
|
IP
|
$4,721.00
|
|
|
Service Code
|
CPT 73218
|
| Hospital Charge Code |
1608811
|
| Min. Negotiated Rate |
$2,405.82 |
| Max. Negotiated Rate |
$4,517.05 |
| Rate for Payer: Aetna Commercial |
$4,418.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,222.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,602.22
|
| Rate for Payer: Cash Price |
$1,416.30
|
| Rate for Payer: Cigna Commercial |
$4,517.05
|
| Rate for Payer: Health EOS Commercial |
$4,369.76
|
| Rate for Payer: HFN Commercial |
$4,517.05
|
| Rate for Payer: Multiplan Commercial |
$3,927.87
|
| Rate for Payer: Preferred Network Access Commercial |
$4,517.05
|
| Rate for Payer: Quartz Beloit One Network |
$2,405.82
|
| Rate for Payer: Quartz Commercial |
$2,945.90
|
| Rate for Payer: WEA Trust Commercial |
$2,700.41
|
| Rate for Payer: WPS Commercial |
$3,636.59
|
|
|
MRI Brachial Plexis w/o Contrast Right
|
Facility
|
OP
|
$4,721.00
|
|
|
Service Code
|
CPT 73218
|
| Hospital Charge Code |
1608811
|
| Min. Negotiated Rate |
$251.10 |
| Max. Negotiated Rate |
$4,517.05 |
| Rate for Payer: Aetna Commercial |
$4,418.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,222.46
|
| Rate for Payer: Aetna Managed Medicare |
$251.10
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,191.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,454.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,356.72
|
| Rate for Payer: Anthem Medicare Advantage |
$251.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,602.22
|
| 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 |
$1,416.30
|
| Rate for Payer: Cash Price |
$1,416.30
|
| Rate for Payer: Cigna Commercial |
$4,517.05
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$251.10
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,747.62
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$251.10
|
| Rate for Payer: Health EOS Commercial |
$4,369.76
|
| Rate for Payer: HFN Commercial |
$4,517.05
|
| 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 |
$3,927.87
|
| Rate for Payer: NAPHCARE Commercial |
$376.65
|
| Rate for Payer: Preferred Network Access Commercial |
$4,517.05
|
| Rate for Payer: Quartz Beloit One Network |
$2,405.82
|
| Rate for Payer: Quartz Commercial |
$3,191.40
|
| 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 |
$2,700.41
|
| Rate for Payer: Wellcare Medicare |
$251.10
|
| Rate for Payer: WPS Commercial |
$3,636.59
|
|
|
MRI Brachial Plexis w/o Contrast Right
|
Professional
|
Both
|
$4,810.00
|
|
|
Service Code
|
CPT 73218 RT,TC
|
| Hospital Charge Code |
1610965
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,227.83 |
| Max. Negotiated Rate |
$4,752.28 |
| Rate for Payer: Aetna Commercial |
$4,752.28
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,302.06
|
| Rate for Payer: Cash Price |
$1,443.00
|
| Rate for Payer: Cash Price |
$1,443.00
|
| Rate for Payer: Cash Price |
$1,443.00
|
| Rate for Payer: Cigna Commercial |
$4,752.28
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,501.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,001.44
|
| Rate for Payer: Health EOS Commercial |
$4,552.18
|
| Rate for Payer: HFN Commercial |
$4,752.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,227.83
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,227.83
|
| Rate for Payer: Multiplan Commercial |
$4,001.92
|
| Rate for Payer: Preferred Network Access Commercial |
$4,752.28
|
| Rate for Payer: Quartz Beloit One Network |
$2,201.06
|
| Rate for Payer: Quartz Commercial |
$2,851.37
|
| Rate for Payer: The Alliance Commercial |
$2,501.20
|
| Rate for Payer: WEA Trust Commercial |
$2,751.32
|
| Rate for Payer: WPS Commercial |
$3,705.14
|
|
|
MRI Brachial Plexis w/o Contrast Right
|
Facility
|
OP
|
$4,810.00
|
|
|
Service Code
|
CPT 73218 RT,TC
|
| Hospital Charge Code |
1610965
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,400.67 |
| Max. Negotiated Rate |
$4,602.21 |
| Rate for Payer: Aetna Commercial |
$4,502.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,302.06
|
| Rate for Payer: Aetna Managed Medicare |
$1,400.67
|
| 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 |
$2,651.27
|
| Rate for Payer: Cash Price |
$1,443.00
|
| Rate for Payer: Cash Price |
$1,443.00
|
| Rate for Payer: Cash Price |
$1,443.00
|
| Rate for Payer: Cigna Commercial |
$4,602.21
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,799.42
|
| Rate for Payer: Health EOS Commercial |
$4,452.14
|
| Rate for Payer: HFN Commercial |
$4,602.21
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,751.80
|
| Rate for Payer: Multiplan Commercial |
$4,001.92
|
| Rate for Payer: NAPHCARE Commercial |
$3,001.44
|
| Rate for Payer: Preferred Network Access Commercial |
$4,602.21
|
| Rate for Payer: Quartz Beloit One Network |
$2,451.18
|
| Rate for Payer: Quartz Commercial |
$3,251.56
|
| Rate for Payer: Quartz Medicare Advantage |
$3,001.44
|
| Rate for Payer: The Alliance Commercial |
$2,501.20
|
| Rate for Payer: United Healthcare PPO |
$3,142.88
|
| Rate for Payer: WEA Trust Commercial |
$2,751.32
|
| Rate for Payer: WPS Commercial |
$3,705.14
|
|
|
MRI Brachial Plexis w/o Contrast Right
|
Facility
|
IP
|
$4,810.00
|
|
|
Service Code
|
CPT 73218 RT,TC
|
| Hospital Charge Code |
1610965
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$2,451.18 |
| Max. Negotiated Rate |
$4,602.21 |
| Rate for Payer: Aetna Commercial |
$4,502.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,302.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,651.27
|
| Rate for Payer: Cash Price |
$1,443.00
|
| Rate for Payer: Cigna Commercial |
$4,602.21
|
| Rate for Payer: Health EOS Commercial |
$4,452.14
|
| Rate for Payer: HFN Commercial |
$4,602.21
|
| Rate for Payer: Multiplan Commercial |
$4,001.92
|
| Rate for Payer: Preferred Network Access Commercial |
$4,602.21
|
| Rate for Payer: Quartz Beloit One Network |
$2,451.18
|
| Rate for Payer: Quartz Commercial |
$3,001.44
|
| Rate for Payer: WEA Trust Commercial |
$2,751.32
|
| Rate for Payer: WPS Commercial |
$3,705.14
|
|
|
MRI Brachial Plexis w + w/o Contrast Lef
|
Facility
|
IP
|
$6,636.00
|
|
|
Service Code
|
CPT 73220 LT,TC
|
| Hospital Charge Code |
1610956
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$3,381.71 |
| Max. Negotiated Rate |
$6,349.32 |
| Rate for Payer: Aetna Commercial |
$6,211.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,935.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,657.76
|
| Rate for Payer: Cash Price |
$1,990.80
|
| Rate for Payer: Cigna Commercial |
$6,349.32
|
| Rate for Payer: Health EOS Commercial |
$6,142.28
|
| Rate for Payer: HFN Commercial |
$6,349.32
|
| Rate for Payer: Multiplan Commercial |
$5,521.15
|
| Rate for Payer: Preferred Network Access Commercial |
$6,349.32
|
| Rate for Payer: Quartz Beloit One Network |
$3,381.71
|
| Rate for Payer: Quartz Commercial |
$4,140.86
|
| Rate for Payer: WEA Trust Commercial |
$3,795.79
|
| Rate for Payer: WPS Commercial |
$5,111.71
|
|
|
MRI Brachial Plexis w + w/o Contrast Lef
|
Professional
|
Both
|
$6,636.00
|
|
|
Service Code
|
CPT 73220 LT,TC
|
| Hospital Charge Code |
1610956
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,659.96 |
| Max. Negotiated Rate |
$6,556.37 |
| Rate for Payer: Aetna Commercial |
$6,556.37
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,935.24
|
| Rate for Payer: Cash Price |
$1,990.80
|
| Rate for Payer: Cash Price |
$1,990.80
|
| Rate for Payer: Cash Price |
$1,990.80
|
| Rate for Payer: Cigna Commercial |
$6,556.37
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$3,450.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,140.86
|
| Rate for Payer: Health EOS Commercial |
$6,280.31
|
| Rate for Payer: HFN Commercial |
$6,556.37
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,659.96
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,659.96
|
| Rate for Payer: Multiplan Commercial |
$5,521.15
|
| Rate for Payer: Preferred Network Access Commercial |
$6,556.37
|
| Rate for Payer: Quartz Beloit One Network |
$3,036.63
|
| Rate for Payer: Quartz Commercial |
$3,933.82
|
| Rate for Payer: The Alliance Commercial |
$3,450.72
|
| Rate for Payer: WEA Trust Commercial |
$3,795.79
|
| Rate for Payer: WPS Commercial |
$5,111.71
|
|
|
MRI Brachial Plexis w + w/o Contrast Lef
|
Facility
|
OP
|
$6,636.00
|
|
|
Service Code
|
CPT 73220 LT,TC
|
| Hospital Charge Code |
1610956
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,932.40 |
| Max. Negotiated Rate |
$6,349.32 |
| Rate for Payer: Aetna Commercial |
$6,211.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,935.24
|
| Rate for Payer: Aetna Managed Medicare |
$1,932.40
|
| 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 |
$3,657.76
|
| Rate for Payer: Cash Price |
$1,990.80
|
| Rate for Payer: Cash Price |
$1,990.80
|
| Rate for Payer: Cash Price |
$1,990.80
|
| Rate for Payer: Cigna Commercial |
$6,349.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,862.15
|
| Rate for Payer: Health EOS Commercial |
$6,142.28
|
| Rate for Payer: HFN Commercial |
$6,349.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,176.08
|
| Rate for Payer: Multiplan Commercial |
$5,521.15
|
| Rate for Payer: NAPHCARE Commercial |
$4,140.86
|
| Rate for Payer: Preferred Network Access Commercial |
$6,349.32
|
| Rate for Payer: Quartz Beloit One Network |
$3,381.71
|
| Rate for Payer: Quartz Commercial |
$4,485.94
|
| Rate for Payer: Quartz Medicare Advantage |
$4,140.86
|
| Rate for Payer: The Alliance Commercial |
$3,450.72
|
| Rate for Payer: United Healthcare PPO |
$3,142.88
|
| Rate for Payer: WEA Trust Commercial |
$3,795.79
|
| Rate for Payer: WPS Commercial |
$5,111.71
|
|
|
MRI Brachial Plexis w + w/o Contrast Rig
|
Facility
|
IP
|
$6,636.00
|
|
|
Service Code
|
CPT 73220 RT,TC
|
| Hospital Charge Code |
1610959
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$3,381.71 |
| Max. Negotiated Rate |
$6,349.32 |
| Rate for Payer: Aetna Commercial |
$6,211.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,935.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,657.76
|
| Rate for Payer: Cash Price |
$1,990.80
|
| Rate for Payer: Cigna Commercial |
$6,349.32
|
| Rate for Payer: Health EOS Commercial |
$6,142.28
|
| Rate for Payer: HFN Commercial |
$6,349.32
|
| Rate for Payer: Multiplan Commercial |
$5,521.15
|
| Rate for Payer: Preferred Network Access Commercial |
$6,349.32
|
| Rate for Payer: Quartz Beloit One Network |
$3,381.71
|
| Rate for Payer: Quartz Commercial |
$4,140.86
|
| Rate for Payer: WEA Trust Commercial |
$3,795.79
|
| Rate for Payer: WPS Commercial |
$5,111.71
|
|
|
MRI Brachial Plexis w + w/o Contrast Rig
|
Professional
|
Both
|
$6,636.00
|
|
|
Service Code
|
CPT 73220 RT,TC
|
| Hospital Charge Code |
1610959
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,659.96 |
| Max. Negotiated Rate |
$6,556.37 |
| Rate for Payer: Aetna Commercial |
$6,556.37
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,935.24
|
| Rate for Payer: Cash Price |
$1,990.80
|
| Rate for Payer: Cash Price |
$1,990.80
|
| Rate for Payer: Cash Price |
$1,990.80
|
| Rate for Payer: Cigna Commercial |
$6,556.37
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$3,450.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,140.86
|
| Rate for Payer: Health EOS Commercial |
$6,280.31
|
| Rate for Payer: HFN Commercial |
$6,556.37
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,659.96
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,659.96
|
| Rate for Payer: Multiplan Commercial |
$5,521.15
|
| Rate for Payer: Preferred Network Access Commercial |
$6,556.37
|
| Rate for Payer: Quartz Beloit One Network |
$3,036.63
|
| Rate for Payer: Quartz Commercial |
$3,933.82
|
| Rate for Payer: The Alliance Commercial |
$3,450.72
|
| Rate for Payer: WEA Trust Commercial |
$3,795.79
|
| Rate for Payer: WPS Commercial |
$5,111.71
|
|
|
MRI Brachial Plexis w + w/o Contrast Rig
|
Facility
|
OP
|
$6,636.00
|
|
|
Service Code
|
CPT 73220 RT,TC
|
| Hospital Charge Code |
1610959
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,932.40 |
| Max. Negotiated Rate |
$6,349.32 |
| Rate for Payer: Aetna Commercial |
$6,211.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,935.24
|
| Rate for Payer: Aetna Managed Medicare |
$1,932.40
|
| 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 |
$3,657.76
|
| Rate for Payer: Cash Price |
$1,990.80
|
| Rate for Payer: Cash Price |
$1,990.80
|
| Rate for Payer: Cash Price |
$1,990.80
|
| Rate for Payer: Cigna Commercial |
$6,349.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,862.15
|
| Rate for Payer: Health EOS Commercial |
$6,142.28
|
| Rate for Payer: HFN Commercial |
$6,349.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,176.08
|
| Rate for Payer: Multiplan Commercial |
$5,521.15
|
| Rate for Payer: NAPHCARE Commercial |
$4,140.86
|
| Rate for Payer: Preferred Network Access Commercial |
$6,349.32
|
| Rate for Payer: Quartz Beloit One Network |
$3,381.71
|
| Rate for Payer: Quartz Commercial |
$4,485.94
|
| Rate for Payer: Quartz Medicare Advantage |
$4,140.86
|
| Rate for Payer: The Alliance Commercial |
$3,450.72
|
| Rate for Payer: United Healthcare PPO |
$3,142.88
|
| Rate for Payer: WEA Trust Commercial |
$3,795.79
|
| Rate for Payer: WPS Commercial |
$5,111.71
|
|
|
MRI Brain, IAC w + w/o
|
Facility
|
IP
|
$6,717.00
|
|
|
Service Code
|
CPT 70553 TC
|
| Hospital Charge Code |
1610977
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$3,422.98 |
| Max. Negotiated Rate |
$6,426.83 |
| Rate for Payer: Aetna Commercial |
$6,287.11
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,007.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,702.41
|
| Rate for Payer: Cash Price |
$2,015.10
|
| Rate for Payer: Cigna Commercial |
$6,426.83
|
| Rate for Payer: Health EOS Commercial |
$6,217.26
|
| Rate for Payer: HFN Commercial |
$6,426.83
|
| Rate for Payer: Multiplan Commercial |
$5,588.54
|
| Rate for Payer: Preferred Network Access Commercial |
$6,426.83
|
| Rate for Payer: Quartz Beloit One Network |
$3,422.98
|
| Rate for Payer: Quartz Commercial |
$4,191.41
|
| Rate for Payer: WEA Trust Commercial |
$3,842.12
|
| Rate for Payer: WPS Commercial |
$5,174.11
|
|
|
MRI Brain, IAC w + w/o
|
Professional
|
Both
|
$6,717.00
|
|
|
Service Code
|
CPT 70553 TC
|
| Hospital Charge Code |
1610977
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$210.31 |
| Max. Negotiated Rate |
$6,636.40 |
| Rate for Payer: Aetna Commercial |
$6,636.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,007.68
|
| Rate for Payer: Aetna Managed Medicare |
$210.31
|
| Rate for Payer: Anthem Medicare Advantage |
$210.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$210.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$210.31
|
| Rate for Payer: Cash Price |
$2,015.10
|
| Rate for Payer: Cash Price |
$2,015.10
|
| Rate for Payer: Cash Price |
$2,015.10
|
| Rate for Payer: Cigna Commercial |
$6,636.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$3,492.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$210.31
|
| Rate for Payer: Health EOS Commercial |
$6,356.97
|
| Rate for Payer: HFN Commercial |
$6,636.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$862.37
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$862.37
|
| Rate for Payer: Independent Care Health Plan Medicare |
$210.31
|
| Rate for Payer: Multiplan Commercial |
$5,588.54
|
| Rate for Payer: NAPHCARE Commercial |
$315.46
|
| Rate for Payer: Preferred Network Access Commercial |
$6,636.40
|
| Rate for Payer: Quartz Beloit One Network |
$3,073.70
|
| Rate for Payer: Quartz Commercial |
$3,981.84
|
| Rate for Payer: Quartz Medicare Advantage |
$210.31
|
| Rate for Payer: The Alliance Commercial |
$799.17
|
| Rate for Payer: United Healthcare Medicare Advantage |
$210.31
|
| Rate for Payer: WEA Trust Commercial |
$3,842.12
|
| Rate for Payer: WPS Commercial |
$1,051.54
|
|
|
MRI Brain, IAC w + w/o
|
Professional
|
Both
|
$6,385.00
|
|
|
Service Code
|
CPT 70553
|
| Hospital Charge Code |
1608822
|
| Min. Negotiated Rate |
$315.45 |
| Max. Negotiated Rate |
$6,308.38 |
| Rate for Payer: Aetna Commercial |
$6,308.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,710.74
|
| Rate for Payer: Aetna Managed Medicare |
$315.45
|
| Rate for Payer: Anthem Medicare Advantage |
$315.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$315.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$315.45
|
| Rate for Payer: Cash Price |
$1,915.50
|
| Rate for Payer: Cash Price |
$1,915.50
|
| Rate for Payer: Cash Price |
$1,915.50
|
| Rate for Payer: Cigna Commercial |
$6,308.38
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$3,320.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$315.45
|
| Rate for Payer: Health EOS Commercial |
$6,042.76
|
| Rate for Payer: HFN Commercial |
$6,308.38
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,260.03
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,260.03
|
| Rate for Payer: Independent Care Health Plan Medicare |
$315.45
|
| Rate for Payer: Multiplan Commercial |
$5,312.32
|
| Rate for Payer: NAPHCARE Commercial |
$473.18
|
| Rate for Payer: Preferred Network Access Commercial |
$6,308.38
|
| Rate for Payer: Quartz Beloit One Network |
$2,921.78
|
| Rate for Payer: Quartz Commercial |
$3,785.03
|
| Rate for Payer: Quartz Medicare Advantage |
$315.45
|
| Rate for Payer: The Alliance Commercial |
$1,198.72
|
| Rate for Payer: United Healthcare Medicare Advantage |
$315.45
|
| Rate for Payer: WEA Trust Commercial |
$3,652.22
|
| Rate for Payer: WPS Commercial |
$1,577.26
|
|
|
MRI Brain, IAC w + w/o
|
Facility
|
OP
|
$6,385.00
|
|
|
Service Code
|
CPT 70553
|
| Hospital Charge Code |
1608822
|
| Min. Negotiated Rate |
$367.15 |
| Max. Negotiated Rate |
$6,109.17 |
| Rate for Payer: Aetna Commercial |
$5,976.36
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,710.74
|
| Rate for Payer: Aetna Managed Medicare |
$367.15
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,316.26
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,320.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,187.39
|
| Rate for Payer: Anthem Medicare Advantage |
$367.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,519.41
|
| 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 |
$1,915.50
|
| Rate for Payer: Cash Price |
$1,915.50
|
| Rate for Payer: Cigna Commercial |
$6,109.17
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$367.15
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,716.07
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$367.15
|
| Rate for Payer: Health EOS Commercial |
$5,909.96
|
| Rate for Payer: HFN Commercial |
$6,109.17
|
| 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 |
$5,312.32
|
| Rate for Payer: NAPHCARE Commercial |
$550.73
|
| Rate for Payer: Preferred Network Access Commercial |
$6,109.17
|
| Rate for Payer: Quartz Beloit One Network |
$3,253.80
|
| Rate for Payer: Quartz Commercial |
$4,316.26
|
| 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 |
$3,652.22
|
| Rate for Payer: Wellcare Medicare |
$367.15
|
| Rate for Payer: WPS Commercial |
$4,918.37
|
|
