|
MRI Brain, IAC w + w/o
|
Facility
|
OP
|
$6,717.00
|
|
|
Service Code
|
CPT 70553 TC
|
| Hospital Charge Code |
1610977
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$841.24 |
| 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: Aetna Managed Medicare |
$1,955.99
|
| 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 |
$3,702.41
|
| 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: Cash Price |
$2,015.10
|
| Rate for Payer: Cigna Commercial |
$6,426.83
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,909.29
|
| Rate for Payer: Health EOS Commercial |
$6,217.26
|
| Rate for Payer: HFN Commercial |
$6,426.83
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,239.26
|
| Rate for Payer: Multiplan Commercial |
$5,588.54
|
| Rate for Payer: NAPHCARE Commercial |
$4,191.41
|
| 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 |
$4,540.69
|
| Rate for Payer: Quartz Medicare Advantage |
$4,191.41
|
| Rate for Payer: The Alliance Commercial |
$841.24
|
| Rate for Payer: United Healthcare PPO |
$3,142.88
|
| Rate for Payer: WEA Trust Commercial |
$3,842.12
|
| Rate for Payer: WPS Commercial |
$1,472.16
|
|
|
MRI Brain, IAC w + w/o
|
Facility
|
IP
|
$6,385.00
|
|
|
Service Code
|
CPT 70553
|
| Hospital Charge Code |
1608822
|
| Min. Negotiated Rate |
$3,253.80 |
| 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: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,519.41
|
| Rate for Payer: Cash Price |
$1,915.50
|
| Rate for Payer: Cigna Commercial |
$6,109.17
|
| Rate for Payer: Health EOS Commercial |
$5,909.96
|
| Rate for Payer: HFN Commercial |
$6,109.17
|
| Rate for Payer: Multiplan Commercial |
$5,312.32
|
| 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 |
$3,984.24
|
| Rate for Payer: WEA Trust Commercial |
$3,652.22
|
| Rate for Payer: WPS Commercial |
$4,918.37
|
|
|
MRI Brain Unenhanced
|
Facility
|
IP
|
$5,066.00
|
|
|
Service Code
|
CPT 70551 TC
|
| Hospital Charge Code |
3072668
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$2,581.63 |
| Max. Negotiated Rate |
$4,847.15 |
| Rate for Payer: Aetna Commercial |
$4,741.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,531.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,792.38
|
| Rate for Payer: Cash Price |
$1,519.80
|
| Rate for Payer: Cigna Commercial |
$4,847.15
|
| Rate for Payer: Health EOS Commercial |
$4,689.09
|
| Rate for Payer: HFN Commercial |
$4,847.15
|
| Rate for Payer: Multiplan Commercial |
$4,214.91
|
| Rate for Payer: Preferred Network Access Commercial |
$4,847.15
|
| Rate for Payer: Quartz Beloit One Network |
$2,581.63
|
| Rate for Payer: Quartz Commercial |
$3,161.18
|
| Rate for Payer: WEA Trust Commercial |
$2,897.75
|
| Rate for Payer: WPS Commercial |
$3,902.34
|
|
|
MRI Brain Unenhanced
|
Professional
|
Both
|
$5,066.00
|
|
|
Service Code
|
CPT 70551 TC
|
| Hospital Charge Code |
3072668
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$126.67 |
| Max. Negotiated Rate |
$5,005.21 |
| Rate for Payer: Aetna Commercial |
$5,005.21
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,531.03
|
| Rate for Payer: Aetna Managed Medicare |
$126.67
|
| Rate for Payer: Anthem Medicare Advantage |
$126.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$126.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$126.67
|
| Rate for Payer: Cash Price |
$1,519.80
|
| Rate for Payer: Cash Price |
$1,519.80
|
| Rate for Payer: Cash Price |
$1,519.80
|
| Rate for Payer: Cigna Commercial |
$5,005.21
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,634.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$126.67
|
| Rate for Payer: Health EOS Commercial |
$4,794.46
|
| Rate for Payer: HFN Commercial |
$5,005.21
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$511.21
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$511.21
|
| Rate for Payer: Independent Care Health Plan Medicare |
$126.67
|
| Rate for Payer: Multiplan Commercial |
$4,214.91
|
| Rate for Payer: NAPHCARE Commercial |
$190.01
|
| Rate for Payer: Preferred Network Access Commercial |
$5,005.21
|
| Rate for Payer: Quartz Beloit One Network |
$2,318.20
|
| Rate for Payer: Quartz Commercial |
$3,003.12
|
| Rate for Payer: Quartz Medicare Advantage |
$126.67
|
| Rate for Payer: The Alliance Commercial |
$481.35
|
| Rate for Payer: United Healthcare Medicare Advantage |
$126.67
|
| Rate for Payer: WEA Trust Commercial |
$2,897.75
|
| Rate for Payer: WPS Commercial |
$633.36
|
|
|
MRI Brain Unenhanced
|
Facility
|
OP
|
$5,066.00
|
|
|
Service Code
|
CPT 70551 TC
|
| Hospital Charge Code |
3072668
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$506.69 |
| Max. Negotiated Rate |
$4,847.15 |
| Rate for Payer: Aetna Commercial |
$4,741.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,531.03
|
| Rate for Payer: Aetna Managed Medicare |
$1,475.22
|
| 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 |
$2,792.38
|
| Rate for Payer: Cash Price |
$1,519.80
|
| Rate for Payer: Cash Price |
$1,519.80
|
| Rate for Payer: Cash Price |
$1,519.80
|
| Rate for Payer: Cash Price |
$1,519.80
|
| Rate for Payer: Cigna Commercial |
$4,847.15
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,948.41
|
| Rate for Payer: Health EOS Commercial |
$4,689.09
|
| Rate for Payer: HFN Commercial |
$4,847.15
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,951.48
|
| Rate for Payer: Multiplan Commercial |
$4,214.91
|
| Rate for Payer: NAPHCARE Commercial |
$3,161.18
|
| Rate for Payer: Preferred Network Access Commercial |
$4,847.15
|
| Rate for Payer: Quartz Beloit One Network |
$2,581.63
|
| Rate for Payer: Quartz Commercial |
$3,424.62
|
| Rate for Payer: Quartz Medicare Advantage |
$3,161.18
|
| Rate for Payer: The Alliance Commercial |
$506.69
|
| Rate for Payer: United Healthcare PPO |
$3,142.88
|
| Rate for Payer: WEA Trust Commercial |
$2,897.75
|
| Rate for Payer: WPS Commercial |
$886.70
|
|
|
MRI Brain w/ Contrast
|
Professional
|
Both
|
$6,080.00
|
|
|
Service Code
|
CPT 70552
|
| Hospital Charge Code |
627682
|
| Min. Negotiated Rate |
$267.72 |
| 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 |
$267.72
|
| Rate for Payer: Anthem Medicare Advantage |
$267.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$267.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$267.72
|
| 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 |
$267.72
|
| 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 |
$1,066.01
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,066.01
|
| Rate for Payer: Independent Care Health Plan Medicare |
$267.72
|
| Rate for Payer: Multiplan Commercial |
$5,058.56
|
| Rate for Payer: NAPHCARE Commercial |
$401.58
|
| 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 |
$267.72
|
| Rate for Payer: The Alliance Commercial |
$1,017.32
|
| Rate for Payer: United Healthcare Medicare Advantage |
$267.72
|
| Rate for Payer: WEA Trust Commercial |
$3,477.76
|
| Rate for Payer: WPS Commercial |
$1,338.58
|
|
|
MRI Brain w/ Contrast
|
Facility
|
IP
|
$6,194.00
|
|
|
Service Code
|
CPT 70552 TC
|
| Hospital Charge Code |
1610973
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$3,156.46 |
| Max. Negotiated Rate |
$5,926.42 |
| Rate for Payer: Aetna Commercial |
$5,797.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,539.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,414.13
|
| Rate for Payer: Cash Price |
$1,858.20
|
| Rate for Payer: Cigna Commercial |
$5,926.42
|
| Rate for Payer: Health EOS Commercial |
$5,733.17
|
| Rate for Payer: HFN Commercial |
$5,926.42
|
| Rate for Payer: Multiplan Commercial |
$5,153.41
|
| Rate for Payer: Preferred Network Access Commercial |
$5,926.42
|
| Rate for Payer: Quartz Beloit One Network |
$3,156.46
|
| Rate for Payer: Quartz Commercial |
$3,865.06
|
| Rate for Payer: WEA Trust Commercial |
$3,542.97
|
| Rate for Payer: WPS Commercial |
$4,771.24
|
|
|
MRI Brain w/ Contrast
|
Facility
|
OP
|
$6,080.00
|
|
|
Service Code
|
CPT 70552
|
| Hospital Charge Code |
627682
|
| 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 Brain w/ Contrast
|
Facility
|
IP
|
$6,080.00
|
|
|
Service Code
|
CPT 70552
|
| Hospital Charge Code |
627682
|
| 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 Brain w/ Contrast
|
Facility
|
OP
|
$6,194.00
|
|
|
Service Code
|
CPT 70552 TC
|
| Hospital Charge Code |
1610973
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$742.73 |
| Max. Negotiated Rate |
$5,926.42 |
| Rate for Payer: Aetna Commercial |
$5,797.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,539.91
|
| Rate for Payer: Aetna Managed Medicare |
$1,803.69
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,635.84
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,985.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,835.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,414.13
|
| Rate for Payer: Cash Price |
$1,858.20
|
| Rate for Payer: Cash Price |
$1,858.20
|
| Rate for Payer: Cash Price |
$1,858.20
|
| Rate for Payer: Cash Price |
$1,858.20
|
| Rate for Payer: Cigna Commercial |
$5,926.42
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,604.91
|
| Rate for Payer: Health EOS Commercial |
$5,733.17
|
| Rate for Payer: HFN Commercial |
$5,926.42
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,831.32
|
| Rate for Payer: Multiplan Commercial |
$5,153.41
|
| Rate for Payer: NAPHCARE Commercial |
$3,865.06
|
| Rate for Payer: Preferred Network Access Commercial |
$5,926.42
|
| Rate for Payer: Quartz Beloit One Network |
$3,156.46
|
| Rate for Payer: Quartz Commercial |
$4,187.14
|
| Rate for Payer: Quartz Medicare Advantage |
$3,865.06
|
| Rate for Payer: The Alliance Commercial |
$742.73
|
| Rate for Payer: United Healthcare PPO |
$3,142.88
|
| Rate for Payer: WEA Trust Commercial |
$3,542.97
|
| Rate for Payer: WPS Commercial |
$1,299.77
|
|
|
MRI Brain w/ Contrast
|
Professional
|
Both
|
$6,194.00
|
|
|
Service Code
|
CPT 70552 TC
|
| Hospital Charge Code |
1610973
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$185.68 |
| Max. Negotiated Rate |
$6,119.67 |
| Rate for Payer: Aetna Commercial |
$6,119.67
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,539.91
|
| Rate for Payer: Aetna Managed Medicare |
$185.68
|
| Rate for Payer: Anthem Medicare Advantage |
$185.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$185.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$185.68
|
| Rate for Payer: Cash Price |
$1,858.20
|
| Rate for Payer: Cash Price |
$1,858.20
|
| Rate for Payer: Cash Price |
$1,858.20
|
| Rate for Payer: Cigna Commercial |
$6,119.67
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$3,220.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$185.68
|
| Rate for Payer: Health EOS Commercial |
$5,862.00
|
| Rate for Payer: HFN Commercial |
$6,119.67
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$757.33
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$757.33
|
| Rate for Payer: Independent Care Health Plan Medicare |
$185.68
|
| Rate for Payer: Multiplan Commercial |
$5,153.41
|
| Rate for Payer: NAPHCARE Commercial |
$278.52
|
| Rate for Payer: Preferred Network Access Commercial |
$6,119.67
|
| Rate for Payer: Quartz Beloit One Network |
$2,834.37
|
| Rate for Payer: Quartz Commercial |
$3,671.80
|
| Rate for Payer: Quartz Medicare Advantage |
$185.68
|
| Rate for Payer: The Alliance Commercial |
$705.59
|
| Rate for Payer: United Healthcare Medicare Advantage |
$185.68
|
| Rate for Payer: WEA Trust Commercial |
$3,542.97
|
| Rate for Payer: WPS Commercial |
$928.41
|
|
|
MRI Brain w/o Contrast
|
Facility
|
OP
|
$4,359.00
|
|
|
Service Code
|
CPT 70551
|
| Hospital Charge Code |
627684
|
| Min. Negotiated Rate |
$251.10 |
| Max. Negotiated Rate |
$4,170.69 |
| Rate for Payer: Aetna Commercial |
$4,080.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,898.69
|
| Rate for Payer: Aetna Managed Medicare |
$251.10
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,946.68
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,266.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,176.01
|
| Rate for Payer: Anthem Medicare Advantage |
$251.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,402.68
|
| 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 |
$1,307.70
|
| Rate for Payer: Cash Price |
$1,307.70
|
| Rate for Payer: Cigna Commercial |
$4,170.69
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$251.10
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,536.94
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$251.10
|
| Rate for Payer: Health EOS Commercial |
$4,034.69
|
| Rate for Payer: HFN Commercial |
$4,170.69
|
| 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 |
$3,626.69
|
| Rate for Payer: NAPHCARE Commercial |
$376.65
|
| Rate for Payer: Preferred Network Access Commercial |
$4,170.69
|
| Rate for Payer: Quartz Beloit One Network |
$2,221.35
|
| Rate for Payer: Quartz Commercial |
$2,946.68
|
| 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 |
$2,493.35
|
| Rate for Payer: Wellcare Medicare |
$251.10
|
| Rate for Payer: WPS Commercial |
$3,357.74
|
|
|
MRI Brain w/o Contrast
|
Professional
|
Both
|
$5,066.00
|
|
|
Service Code
|
CPT 70551 TC
|
| Hospital Charge Code |
1610975
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$126.67 |
| Max. Negotiated Rate |
$5,005.21 |
| Rate for Payer: Aetna Commercial |
$5,005.21
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,531.03
|
| Rate for Payer: Aetna Managed Medicare |
$126.67
|
| Rate for Payer: Anthem Medicare Advantage |
$126.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$126.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$126.67
|
| Rate for Payer: Cash Price |
$1,519.80
|
| Rate for Payer: Cash Price |
$1,519.80
|
| Rate for Payer: Cash Price |
$1,519.80
|
| Rate for Payer: Cigna Commercial |
$5,005.21
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,634.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$126.67
|
| Rate for Payer: Health EOS Commercial |
$4,794.46
|
| Rate for Payer: HFN Commercial |
$5,005.21
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$511.21
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$511.21
|
| Rate for Payer: Independent Care Health Plan Medicare |
$126.67
|
| Rate for Payer: Multiplan Commercial |
$4,214.91
|
| Rate for Payer: NAPHCARE Commercial |
$190.01
|
| Rate for Payer: Preferred Network Access Commercial |
$5,005.21
|
| Rate for Payer: Quartz Beloit One Network |
$2,318.20
|
| Rate for Payer: Quartz Commercial |
$3,003.12
|
| Rate for Payer: Quartz Medicare Advantage |
$126.67
|
| Rate for Payer: The Alliance Commercial |
$481.35
|
| Rate for Payer: United Healthcare Medicare Advantage |
$126.67
|
| Rate for Payer: WEA Trust Commercial |
$2,897.75
|
| Rate for Payer: WPS Commercial |
$633.36
|
|
|
MRI Brain w/o Contrast
|
Professional
|
Both
|
$5,066.00
|
|
|
Service Code
|
CPT 70551 TC
|
| Hospital Charge Code |
5288677
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$126.67 |
| Max. Negotiated Rate |
$5,005.21 |
| Rate for Payer: Aetna Commercial |
$5,005.21
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,531.03
|
| Rate for Payer: Aetna Managed Medicare |
$126.67
|
| Rate for Payer: Anthem Medicare Advantage |
$126.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$126.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$126.67
|
| Rate for Payer: Cash Price |
$1,519.80
|
| Rate for Payer: Cash Price |
$1,519.80
|
| Rate for Payer: Cash Price |
$1,519.80
|
| Rate for Payer: Cigna Commercial |
$5,005.21
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,634.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$126.67
|
| Rate for Payer: Health EOS Commercial |
$4,794.46
|
| Rate for Payer: HFN Commercial |
$5,005.21
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$511.21
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$511.21
|
| Rate for Payer: Independent Care Health Plan Medicare |
$126.67
|
| Rate for Payer: Multiplan Commercial |
$4,214.91
|
| Rate for Payer: NAPHCARE Commercial |
$190.01
|
| Rate for Payer: Preferred Network Access Commercial |
$5,005.21
|
| Rate for Payer: Quartz Beloit One Network |
$2,318.20
|
| Rate for Payer: Quartz Commercial |
$3,003.12
|
| Rate for Payer: Quartz Medicare Advantage |
$126.67
|
| Rate for Payer: The Alliance Commercial |
$481.35
|
| Rate for Payer: United Healthcare Medicare Advantage |
$126.67
|
| Rate for Payer: WEA Trust Commercial |
$2,897.75
|
| Rate for Payer: WPS Commercial |
$633.36
|
|
|
MRI Brain w/o Contrast
|
Facility
|
IP
|
$5,066.00
|
|
|
Service Code
|
CPT 70551 TC
|
| Hospital Charge Code |
1610975
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$2,581.63 |
| Max. Negotiated Rate |
$4,847.15 |
| Rate for Payer: Aetna Commercial |
$4,741.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,531.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,792.38
|
| Rate for Payer: Cash Price |
$1,519.80
|
| Rate for Payer: Cigna Commercial |
$4,847.15
|
| Rate for Payer: Health EOS Commercial |
$4,689.09
|
| Rate for Payer: HFN Commercial |
$4,847.15
|
| Rate for Payer: Multiplan Commercial |
$4,214.91
|
| Rate for Payer: Preferred Network Access Commercial |
$4,847.15
|
| Rate for Payer: Quartz Beloit One Network |
$2,581.63
|
| Rate for Payer: Quartz Commercial |
$3,161.18
|
| Rate for Payer: WEA Trust Commercial |
$2,897.75
|
| Rate for Payer: WPS Commercial |
$3,902.34
|
|
|
MRI Brain w/o Contrast
|
Facility
|
OP
|
$5,066.00
|
|
|
Service Code
|
CPT 70551 TC
|
| Hospital Charge Code |
1610975
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$506.69 |
| Max. Negotiated Rate |
$4,847.15 |
| Rate for Payer: Aetna Commercial |
$4,741.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,531.03
|
| Rate for Payer: Aetna Managed Medicare |
$1,475.22
|
| 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 |
$2,792.38
|
| Rate for Payer: Cash Price |
$1,519.80
|
| Rate for Payer: Cash Price |
$1,519.80
|
| Rate for Payer: Cash Price |
$1,519.80
|
| Rate for Payer: Cash Price |
$1,519.80
|
| Rate for Payer: Cigna Commercial |
$4,847.15
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,948.41
|
| Rate for Payer: Health EOS Commercial |
$4,689.09
|
| Rate for Payer: HFN Commercial |
$4,847.15
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,951.48
|
| Rate for Payer: Multiplan Commercial |
$4,214.91
|
| Rate for Payer: NAPHCARE Commercial |
$3,161.18
|
| Rate for Payer: Preferred Network Access Commercial |
$4,847.15
|
| Rate for Payer: Quartz Beloit One Network |
$2,581.63
|
| Rate for Payer: Quartz Commercial |
$3,424.62
|
| Rate for Payer: Quartz Medicare Advantage |
$3,161.18
|
| Rate for Payer: The Alliance Commercial |
$506.69
|
| Rate for Payer: United Healthcare PPO |
$3,142.88
|
| Rate for Payer: WEA Trust Commercial |
$2,897.75
|
| Rate for Payer: WPS Commercial |
$886.70
|
|
|
MRI Brain w/o Contrast
|
Professional
|
Both
|
$4,359.00
|
|
|
Service Code
|
CPT 70551
|
| Hospital Charge Code |
627684
|
| Min. Negotiated Rate |
$194.52 |
| Max. Negotiated Rate |
$4,306.69 |
| Rate for Payer: Aetna Commercial |
$4,306.69
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,898.69
|
| Rate for Payer: Aetna Managed Medicare |
$194.52
|
| Rate for Payer: Anthem Medicare Advantage |
$194.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$194.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$194.52
|
| Rate for Payer: Cash Price |
$1,307.70
|
| Rate for Payer: Cash Price |
$1,307.70
|
| Rate for Payer: Cash Price |
$1,307.70
|
| Rate for Payer: Cigna Commercial |
$4,306.69
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,266.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$194.52
|
| Rate for Payer: Health EOS Commercial |
$4,125.36
|
| Rate for Payer: HFN Commercial |
$4,306.69
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$767.02
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$767.02
|
| Rate for Payer: Independent Care Health Plan Medicare |
$194.52
|
| Rate for Payer: Multiplan Commercial |
$3,626.69
|
| Rate for Payer: NAPHCARE Commercial |
$291.78
|
| Rate for Payer: Preferred Network Access Commercial |
$4,306.69
|
| Rate for Payer: Quartz Beloit One Network |
$1,994.68
|
| Rate for Payer: Quartz Commercial |
$2,584.02
|
| Rate for Payer: Quartz Medicare Advantage |
$194.52
|
| Rate for Payer: The Alliance Commercial |
$739.18
|
| Rate for Payer: United Healthcare Medicare Advantage |
$194.52
|
| Rate for Payer: WEA Trust Commercial |
$2,493.35
|
| Rate for Payer: WPS Commercial |
$972.61
|
|
|
MRI Brain w/o Contrast
|
Facility
|
IP
|
$4,359.00
|
|
|
Service Code
|
CPT 70551
|
| Hospital Charge Code |
627684
|
| Min. Negotiated Rate |
$2,221.35 |
| Max. Negotiated Rate |
$4,170.69 |
| Rate for Payer: Aetna Commercial |
$4,080.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,898.69
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,402.68
|
| Rate for Payer: Cash Price |
$1,307.70
|
| Rate for Payer: Cigna Commercial |
$4,170.69
|
| Rate for Payer: Health EOS Commercial |
$4,034.69
|
| Rate for Payer: HFN Commercial |
$4,170.69
|
| Rate for Payer: Multiplan Commercial |
$3,626.69
|
| Rate for Payer: Preferred Network Access Commercial |
$4,170.69
|
| Rate for Payer: Quartz Beloit One Network |
$2,221.35
|
| Rate for Payer: Quartz Commercial |
$2,720.02
|
| Rate for Payer: WEA Trust Commercial |
$2,493.35
|
| Rate for Payer: WPS Commercial |
$3,357.74
|
|
|
MRI Brain w/o Contrast
|
Facility
|
IP
|
$5,066.00
|
|
|
Service Code
|
CPT 70551 TC
|
| Hospital Charge Code |
5288677
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$2,581.63 |
| Max. Negotiated Rate |
$4,847.15 |
| Rate for Payer: Aetna Commercial |
$4,741.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,531.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,792.38
|
| Rate for Payer: Cash Price |
$1,519.80
|
| Rate for Payer: Cigna Commercial |
$4,847.15
|
| Rate for Payer: Health EOS Commercial |
$4,689.09
|
| Rate for Payer: HFN Commercial |
$4,847.15
|
| Rate for Payer: Multiplan Commercial |
$4,214.91
|
| Rate for Payer: Preferred Network Access Commercial |
$4,847.15
|
| Rate for Payer: Quartz Beloit One Network |
$2,581.63
|
| Rate for Payer: Quartz Commercial |
$3,161.18
|
| Rate for Payer: WEA Trust Commercial |
$2,897.75
|
| Rate for Payer: WPS Commercial |
$3,902.34
|
|
|
MRI Brain w/o Contrast
|
Facility
|
OP
|
$5,066.00
|
|
|
Service Code
|
CPT 70551 TC
|
| Hospital Charge Code |
5288677
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$506.69 |
| Max. Negotiated Rate |
$4,847.15 |
| Rate for Payer: Aetna Commercial |
$4,741.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,531.03
|
| Rate for Payer: Aetna Managed Medicare |
$1,475.22
|
| 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 |
$2,792.38
|
| Rate for Payer: Cash Price |
$1,519.80
|
| Rate for Payer: Cash Price |
$1,519.80
|
| Rate for Payer: Cash Price |
$1,519.80
|
| Rate for Payer: Cash Price |
$1,519.80
|
| Rate for Payer: Cigna Commercial |
$4,847.15
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,948.41
|
| Rate for Payer: Health EOS Commercial |
$4,689.09
|
| Rate for Payer: HFN Commercial |
$4,847.15
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,951.48
|
| Rate for Payer: Multiplan Commercial |
$4,214.91
|
| Rate for Payer: NAPHCARE Commercial |
$3,161.18
|
| Rate for Payer: Preferred Network Access Commercial |
$4,847.15
|
| Rate for Payer: Quartz Beloit One Network |
$2,581.63
|
| Rate for Payer: Quartz Commercial |
$3,424.62
|
| Rate for Payer: Quartz Medicare Advantage |
$3,161.18
|
| Rate for Payer: The Alliance Commercial |
$506.69
|
| Rate for Payer: United Healthcare PPO |
$3,142.88
|
| Rate for Payer: WEA Trust Commercial |
$2,897.75
|
| Rate for Payer: WPS Commercial |
$886.70
|
|
|
MRI Brain w + w/o Contrast
|
Professional
|
Both
|
$6,607.00
|
|
|
Service Code
|
CPT 70553 TC
|
| Hospital Charge Code |
5288675
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$210.31 |
| Max. Negotiated Rate |
$6,527.72 |
| Rate for Payer: Aetna Commercial |
$6,527.72
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,909.30
|
| 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 |
$1,982.10
|
| Rate for Payer: Cash Price |
$1,982.10
|
| Rate for Payer: Cash Price |
$1,982.10
|
| Rate for Payer: Cigna Commercial |
$6,527.72
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$3,435.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$210.31
|
| Rate for Payer: Health EOS Commercial |
$6,252.86
|
| Rate for Payer: HFN Commercial |
$6,527.72
|
| 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 |
$5,497.02
|
| Rate for Payer: NAPHCARE Commercial |
$315.46
|
| Rate for Payer: Preferred Network Access Commercial |
$6,527.72
|
| Rate for Payer: Quartz Beloit One Network |
$3,023.36
|
| Rate for Payer: Quartz Commercial |
$3,916.63
|
| 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 |
$3,779.20
|
| Rate for Payer: WPS Commercial |
$1,051.54
|
|
|
MRI Brain w + w/o Contrast
|
Facility
|
IP
|
$6,607.00
|
|
|
Service Code
|
CPT 70553 TC
|
| Hospital Charge Code |
5288675
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$3,366.93 |
| Max. Negotiated Rate |
$6,321.58 |
| Rate for Payer: Aetna Commercial |
$6,184.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,909.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,641.78
|
| Rate for Payer: Cash Price |
$1,982.10
|
| Rate for Payer: Cigna Commercial |
$6,321.58
|
| Rate for Payer: Health EOS Commercial |
$6,115.44
|
| Rate for Payer: HFN Commercial |
$6,321.58
|
| Rate for Payer: Multiplan Commercial |
$5,497.02
|
| Rate for Payer: Preferred Network Access Commercial |
$6,321.58
|
| Rate for Payer: Quartz Beloit One Network |
$3,366.93
|
| Rate for Payer: Quartz Commercial |
$4,122.77
|
| Rate for Payer: WEA Trust Commercial |
$3,779.20
|
| Rate for Payer: WPS Commercial |
$5,089.37
|
|
|
MRI Brain w + w/o Contrast
|
Facility
|
OP
|
$6,607.00
|
|
|
Service Code
|
CPT 70553 TC
|
| Hospital Charge Code |
5288675
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$841.24 |
| Max. Negotiated Rate |
$6,321.58 |
| Rate for Payer: Aetna Commercial |
$6,184.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,909.30
|
| Rate for Payer: Aetna Managed Medicare |
$1,923.96
|
| 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 |
$3,641.78
|
| Rate for Payer: Cash Price |
$1,982.10
|
| Rate for Payer: Cash Price |
$1,982.10
|
| Rate for Payer: Cash Price |
$1,982.10
|
| Rate for Payer: Cash Price |
$1,982.10
|
| Rate for Payer: Cigna Commercial |
$6,321.58
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,845.27
|
| Rate for Payer: Health EOS Commercial |
$6,115.44
|
| Rate for Payer: HFN Commercial |
$6,321.58
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,153.46
|
| Rate for Payer: Multiplan Commercial |
$5,497.02
|
| Rate for Payer: NAPHCARE Commercial |
$4,122.77
|
| Rate for Payer: Preferred Network Access Commercial |
$6,321.58
|
| Rate for Payer: Quartz Beloit One Network |
$3,366.93
|
| Rate for Payer: Quartz Commercial |
$4,466.33
|
| Rate for Payer: Quartz Medicare Advantage |
$4,122.77
|
| Rate for Payer: The Alliance Commercial |
$841.24
|
| Rate for Payer: United Healthcare PPO |
$3,142.88
|
| Rate for Payer: WEA Trust Commercial |
$3,779.20
|
| Rate for Payer: WPS Commercial |
$1,472.16
|
|
|
MRI Brain w/ + w/o Contrast
|
Facility
|
OP
|
$6,607.00
|
|
|
Service Code
|
CPT 70553 TC
|
| Hospital Charge Code |
1610971
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$841.24 |
| Max. Negotiated Rate |
$6,321.58 |
| Rate for Payer: Aetna Commercial |
$6,184.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,909.30
|
| Rate for Payer: Aetna Managed Medicare |
$1,923.96
|
| 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 |
$3,641.78
|
| Rate for Payer: Cash Price |
$1,982.10
|
| Rate for Payer: Cash Price |
$1,982.10
|
| Rate for Payer: Cash Price |
$1,982.10
|
| Rate for Payer: Cash Price |
$1,982.10
|
| Rate for Payer: Cigna Commercial |
$6,321.58
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,845.27
|
| Rate for Payer: Health EOS Commercial |
$6,115.44
|
| Rate for Payer: HFN Commercial |
$6,321.58
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,153.46
|
| Rate for Payer: Multiplan Commercial |
$5,497.02
|
| Rate for Payer: NAPHCARE Commercial |
$4,122.77
|
| Rate for Payer: Preferred Network Access Commercial |
$6,321.58
|
| Rate for Payer: Quartz Beloit One Network |
$3,366.93
|
| Rate for Payer: Quartz Commercial |
$4,466.33
|
| Rate for Payer: Quartz Medicare Advantage |
$4,122.77
|
| Rate for Payer: The Alliance Commercial |
$841.24
|
| Rate for Payer: United Healthcare PPO |
$3,142.88
|
| Rate for Payer: WEA Trust Commercial |
$3,779.20
|
| Rate for Payer: WPS Commercial |
$1,472.16
|
|
|
MRI Brain w/ + w/o Contrast
|
Professional
|
Both
|
$6,280.00
|
|
|
Service Code
|
CPT 70553
|
| Hospital Charge Code |
627680
|
| Min. Negotiated Rate |
$315.45 |
| Max. Negotiated Rate |
$6,204.64 |
| Rate for Payer: Aetna Commercial |
$6,204.64
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,616.83
|
| 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 |
$1,884.00
|
| Rate for Payer: Cash Price |
$1,884.00
|
| Rate for Payer: Cash Price |
$1,884.00
|
| Rate for Payer: Cigna Commercial |
$6,204.64
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$3,265.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$315.45
|
| Rate for Payer: Health EOS Commercial |
$5,943.39
|
| Rate for Payer: HFN Commercial |
$6,204.64
|
| 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 |
$5,224.96
|
| Rate for Payer: NAPHCARE Commercial |
$473.18
|
| Rate for Payer: Preferred Network Access Commercial |
$6,204.64
|
| Rate for Payer: Quartz Beloit One Network |
$2,873.73
|
| Rate for Payer: Quartz Commercial |
$3,722.78
|
| 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 |
$3,592.16
|
| Rate for Payer: WPS Commercial |
$1,577.26
|
|
