|
MRI LE Non Joint w/ + w/o Contrast Left
|
Facility
|
IP
|
$6,080.00
|
|
|
Service Code
|
CPT 73720
|
| Hospital Charge Code |
631159
|
| Min. Negotiated Rate |
$2,979.20 |
| Max. Negotiated Rate |
$5,593.60 |
| Rate for Payer: Aetna Commercial |
$5,472.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,228.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,222.40
|
| Rate for Payer: Cash Price |
$1,824.00
|
| Rate for Payer: Cigna Commercial |
$5,593.60
|
| Rate for Payer: Health EOS Commercial |
$5,411.20
|
| Rate for Payer: HFN Commercial |
$5,593.60
|
| Rate for Payer: Multiplan Commercial |
$4,864.00
|
| Rate for Payer: NAPHCARE Commercial |
$3,648.00
|
| Rate for Payer: Preferred Network Access Commercial |
$5,593.60
|
| Rate for Payer: Quartz Beloit One Network |
$2,979.20
|
| Rate for Payer: Quartz Commercial |
$3,648.00
|
| Rate for Payer: WEA Trust Commercial |
$3,344.00
|
| Rate for Payer: WPS Commercial |
$4,503.46
|
|
|
MRI LE Non Joint w/ + w/o Contrast Right
|
Facility
|
IP
|
$6,080.00
|
|
|
Service Code
|
CPT 73720
|
| Hospital Charge Code |
631166
|
| Min. Negotiated Rate |
$2,979.20 |
| Max. Negotiated Rate |
$5,593.60 |
| Rate for Payer: Aetna Commercial |
$5,472.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,228.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,222.40
|
| Rate for Payer: Cash Price |
$1,824.00
|
| Rate for Payer: Cigna Commercial |
$5,593.60
|
| Rate for Payer: Health EOS Commercial |
$5,411.20
|
| Rate for Payer: HFN Commercial |
$5,593.60
|
| Rate for Payer: Multiplan Commercial |
$4,864.00
|
| Rate for Payer: NAPHCARE Commercial |
$3,648.00
|
| Rate for Payer: Preferred Network Access Commercial |
$5,593.60
|
| Rate for Payer: Quartz Beloit One Network |
$2,979.20
|
| Rate for Payer: Quartz Commercial |
$3,648.00
|
| Rate for Payer: WEA Trust Commercial |
$3,344.00
|
| Rate for Payer: WPS Commercial |
$4,503.46
|
|
|
MRI LE Non Joint w/ + w/o Contrast Right
|
Facility
|
OP
|
$6,080.00
|
|
|
Service Code
|
CPT 73720
|
| Hospital Charge Code |
631166
|
| Min. Negotiated Rate |
$380.12 |
| Max. Negotiated Rate |
$5,593.60 |
| Rate for Payer: Aetna Commercial |
$5,472.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,228.80
|
| Rate for Payer: Aetna Managed Medicare |
$380.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,952.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,040.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,918.40
|
| Rate for Payer: Anthem Medicare Advantage |
$380.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,222.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$380.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$380.12
|
| Rate for Payer: Cash Price |
$1,824.00
|
| Rate for Payer: Cash Price |
$1,824.00
|
| Rate for Payer: Cigna Commercial |
$5,593.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$380.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,402.37
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$380.12
|
| Rate for Payer: Health EOS Commercial |
$5,411.20
|
| Rate for Payer: HFN Commercial |
$5,593.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,414.05
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$380.12
|
| Rate for Payer: Independent Care Health Plan Medicare |
$380.12
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$380.12
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$380.12
|
| Rate for Payer: Multiplan Commercial |
$4,864.00
|
| Rate for Payer: NAPHCARE Commercial |
$570.18
|
| Rate for Payer: Preferred Network Access Commercial |
$5,593.60
|
| Rate for Payer: Quartz Beloit One Network |
$2,979.20
|
| Rate for Payer: Quartz Commercial |
$3,952.00
|
| Rate for Payer: Quartz Medicare Advantage |
$380.12
|
| Rate for Payer: The Alliance Commercial |
$1,520.48
|
| Rate for Payer: United Healthcare Medicare Advantage |
$380.12
|
| Rate for Payer: WEA Trust Commercial |
$3,344.00
|
| Rate for Payer: Wellcare Medicare |
$380.12
|
| Rate for Payer: WPS Commercial |
$4,503.46
|
|
|
MRI LE Non Joint w/ + w/o Contrast Right
|
Facility
|
IP
|
$6,194.00
|
|
|
Service Code
|
CPT 73720 TC,RT
|
| Hospital Charge Code |
1611211
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$3,035.06 |
| Max. Negotiated Rate |
$5,698.48 |
| Rate for Payer: Aetna Commercial |
$5,574.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,326.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,282.82
|
| Rate for Payer: Cash Price |
$1,858.20
|
| Rate for Payer: Cigna Commercial |
$5,698.48
|
| Rate for Payer: Health EOS Commercial |
$5,512.66
|
| Rate for Payer: HFN Commercial |
$5,698.48
|
| Rate for Payer: Multiplan Commercial |
$4,955.20
|
| Rate for Payer: NAPHCARE Commercial |
$3,716.40
|
| Rate for Payer: Preferred Network Access Commercial |
$5,698.48
|
| Rate for Payer: Quartz Beloit One Network |
$3,035.06
|
| Rate for Payer: Quartz Commercial |
$3,716.40
|
| Rate for Payer: WEA Trust Commercial |
$3,406.70
|
| Rate for Payer: WPS Commercial |
$4,587.90
|
|
|
MRI LE Non Joint w/ + w/o Contrast Right
|
Professional
|
Both
|
$6,194.00
|
|
|
Service Code
|
CPT 73720 TC,RT
|
| Hospital Charge Code |
1611211
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,299.53 |
| Max. Negotiated Rate |
$5,884.30 |
| Rate for Payer: Aetna Commercial |
$5,884.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,326.84
|
| 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 |
$5,884.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$3,097.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,716.40
|
| Rate for Payer: Health EOS Commercial |
$5,636.54
|
| Rate for Payer: HFN Commercial |
$5,884.30
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,299.53
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,299.53
|
| Rate for Payer: Multiplan Commercial |
$4,955.20
|
| Rate for Payer: Preferred Network Access Commercial |
$5,884.30
|
| Rate for Payer: Quartz Beloit One Network |
$2,725.36
|
| Rate for Payer: Quartz Commercial |
$3,530.58
|
| Rate for Payer: The Alliance Commercial |
$3,097.00
|
| Rate for Payer: WEA Trust Commercial |
$3,406.70
|
| Rate for Payer: WPS Commercial |
$4,587.90
|
|
|
MRI LE Non Joint w/ + w/o Contrast Right
|
Professional
|
Both
|
$6,194.00
|
|
|
Service Code
|
CPT 73720 TC,RT
|
| Hospital Charge Code |
2980101
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,299.53 |
| Max. Negotiated Rate |
$5,884.30 |
| Rate for Payer: Aetna Commercial |
$5,884.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,326.84
|
| 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 |
$5,884.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$3,097.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,716.40
|
| Rate for Payer: Health EOS Commercial |
$5,636.54
|
| Rate for Payer: HFN Commercial |
$5,884.30
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,299.53
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,299.53
|
| Rate for Payer: Multiplan Commercial |
$4,955.20
|
| Rate for Payer: Preferred Network Access Commercial |
$5,884.30
|
| Rate for Payer: Quartz Beloit One Network |
$2,725.36
|
| Rate for Payer: Quartz Commercial |
$3,530.58
|
| Rate for Payer: The Alliance Commercial |
$3,097.00
|
| Rate for Payer: WEA Trust Commercial |
$3,406.70
|
| Rate for Payer: WPS Commercial |
$4,587.90
|
|
|
MRI LE Non Joint w/ + w/o Contrast Right
|
Facility
|
IP
|
$6,194.00
|
|
|
Service Code
|
CPT 73720 TC,RT
|
| Hospital Charge Code |
2980101
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$3,035.06 |
| Max. Negotiated Rate |
$5,698.48 |
| Rate for Payer: Aetna Commercial |
$5,574.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,326.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,282.82
|
| Rate for Payer: Cash Price |
$1,858.20
|
| Rate for Payer: Cigna Commercial |
$5,698.48
|
| Rate for Payer: Health EOS Commercial |
$5,512.66
|
| Rate for Payer: HFN Commercial |
$5,698.48
|
| Rate for Payer: Multiplan Commercial |
$4,955.20
|
| Rate for Payer: NAPHCARE Commercial |
$3,716.40
|
| Rate for Payer: Preferred Network Access Commercial |
$5,698.48
|
| Rate for Payer: Quartz Beloit One Network |
$3,035.06
|
| Rate for Payer: Quartz Commercial |
$3,716.40
|
| Rate for Payer: WEA Trust Commercial |
$3,406.70
|
| Rate for Payer: WPS Commercial |
$4,587.90
|
|
|
MRI LE Non Joint w/ + w/o Contrast Right
|
Facility
|
OP
|
$6,194.00
|
|
|
Service Code
|
CPT 73720 TC,RT
|
| Hospital Charge Code |
2980101
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$380.12 |
| Max. Negotiated Rate |
$5,698.48 |
| Rate for Payer: Aetna Commercial |
$5,574.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,326.84
|
| Rate for Payer: Aetna Managed Medicare |
$380.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,496.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,871.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,726.00
|
| Rate for Payer: Anthem Medicare Advantage |
$380.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,282.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$380.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$380.12
|
| 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 |
$5,698.48
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$380.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,466.16
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$380.12
|
| Rate for Payer: Health EOS Commercial |
$5,512.66
|
| Rate for Payer: HFN Commercial |
$5,698.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,414.05
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$380.12
|
| Rate for Payer: Independent Care Health Plan Medicare |
$380.12
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$380.12
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$380.12
|
| Rate for Payer: Multiplan Commercial |
$4,955.20
|
| Rate for Payer: NAPHCARE Commercial |
$570.18
|
| Rate for Payer: Preferred Network Access Commercial |
$5,698.48
|
| Rate for Payer: Quartz Beloit One Network |
$3,035.06
|
| Rate for Payer: Quartz Commercial |
$4,026.10
|
| Rate for Payer: Quartz Medicare Advantage |
$380.12
|
| Rate for Payer: The Alliance Commercial |
$1,520.48
|
| Rate for Payer: United Healthcare Medicare Advantage |
$380.12
|
| Rate for Payer: United Healthcare PPO |
$3,022.00
|
| Rate for Payer: WEA Trust Commercial |
$3,406.70
|
| Rate for Payer: Wellcare Medicare |
$380.12
|
| Rate for Payer: WPS Commercial |
$4,587.90
|
|
|
MRI LE Non Joint w/ + w/o Contrast Right
|
Facility
|
OP
|
$6,194.00
|
|
|
Service Code
|
CPT 73720 TC,RT
|
| Hospital Charge Code |
1611211
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$380.12 |
| Max. Negotiated Rate |
$5,698.48 |
| Rate for Payer: Aetna Commercial |
$5,574.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,326.84
|
| Rate for Payer: Aetna Managed Medicare |
$380.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,496.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,871.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,726.00
|
| Rate for Payer: Anthem Medicare Advantage |
$380.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,282.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$380.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$380.12
|
| 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 |
$5,698.48
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$380.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,466.16
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$380.12
|
| Rate for Payer: Health EOS Commercial |
$5,512.66
|
| Rate for Payer: HFN Commercial |
$5,698.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,414.05
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$380.12
|
| Rate for Payer: Independent Care Health Plan Medicare |
$380.12
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$380.12
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$380.12
|
| Rate for Payer: Multiplan Commercial |
$4,955.20
|
| Rate for Payer: NAPHCARE Commercial |
$570.18
|
| Rate for Payer: Preferred Network Access Commercial |
$5,698.48
|
| Rate for Payer: Quartz Beloit One Network |
$3,035.06
|
| Rate for Payer: Quartz Commercial |
$4,026.10
|
| Rate for Payer: Quartz Medicare Advantage |
$380.12
|
| Rate for Payer: The Alliance Commercial |
$1,520.48
|
| Rate for Payer: United Healthcare Medicare Advantage |
$380.12
|
| Rate for Payer: United Healthcare PPO |
$3,022.00
|
| Rate for Payer: WEA Trust Commercial |
$3,406.70
|
| Rate for Payer: Wellcare Medicare |
$380.12
|
| Rate for Payer: WPS Commercial |
$4,587.90
|
|
|
MRI LE Non Joint w/ + w/o Contrast Right
|
Professional
|
Both
|
$6,080.00
|
|
|
Service Code
|
CPT 73720
|
| Hospital Charge Code |
631166
|
| Min. Negotiated Rate |
$1,299.53 |
| Max. Negotiated Rate |
$5,776.00 |
| Rate for Payer: Aetna Commercial |
$5,776.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,228.80
|
| 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 |
$5,776.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$3,040.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,648.00
|
| Rate for Payer: Health EOS Commercial |
$5,532.80
|
| Rate for Payer: HFN Commercial |
$5,776.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,299.53
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,299.53
|
| Rate for Payer: Multiplan Commercial |
$4,864.00
|
| Rate for Payer: Preferred Network Access Commercial |
$5,776.00
|
| Rate for Payer: Quartz Beloit One Network |
$2,675.20
|
| Rate for Payer: Quartz Commercial |
$3,465.60
|
| Rate for Payer: The Alliance Commercial |
$3,040.00
|
| Rate for Payer: WEA Trust Commercial |
$3,344.00
|
| Rate for Payer: WPS Commercial |
$4,503.46
|
|
|
MRI Lumbar Combined
|
Professional
|
Both
|
$6,351.00
|
|
|
Service Code
|
CPT 72158 TC
|
| Hospital Charge Code |
3072657
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$838.48 |
| Max. Negotiated Rate |
$6,033.45 |
| Rate for Payer: Aetna Commercial |
$6,033.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,461.86
|
| Rate for Payer: Cash Price |
$1,905.30
|
| Rate for Payer: Cash Price |
$1,905.30
|
| Rate for Payer: Cash Price |
$1,905.30
|
| Rate for Payer: Cigna Commercial |
$6,033.45
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$3,175.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,810.60
|
| Rate for Payer: Health EOS Commercial |
$5,779.41
|
| Rate for Payer: HFN Commercial |
$6,033.45
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$838.48
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$838.48
|
| Rate for Payer: Multiplan Commercial |
$5,080.80
|
| Rate for Payer: Preferred Network Access Commercial |
$6,033.45
|
| Rate for Payer: Quartz Beloit One Network |
$2,794.44
|
| Rate for Payer: Quartz Commercial |
$3,620.07
|
| Rate for Payer: The Alliance Commercial |
$3,175.50
|
| Rate for Payer: WEA Trust Commercial |
$3,493.05
|
| Rate for Payer: WPS Commercial |
$4,704.19
|
|
|
MRI Lumbar Combined
|
Facility
|
IP
|
$6,351.00
|
|
|
Service Code
|
CPT 72158 TC
|
| Hospital Charge Code |
3072657
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$3,111.99 |
| Max. Negotiated Rate |
$5,842.92 |
| Rate for Payer: Aetna Commercial |
$5,715.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,461.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,366.03
|
| Rate for Payer: Cash Price |
$1,905.30
|
| Rate for Payer: Cigna Commercial |
$5,842.92
|
| Rate for Payer: Health EOS Commercial |
$5,652.39
|
| Rate for Payer: HFN Commercial |
$5,842.92
|
| Rate for Payer: Multiplan Commercial |
$5,080.80
|
| Rate for Payer: NAPHCARE Commercial |
$3,810.60
|
| Rate for Payer: Preferred Network Access Commercial |
$5,842.92
|
| Rate for Payer: Quartz Beloit One Network |
$3,111.99
|
| Rate for Payer: Quartz Commercial |
$3,810.60
|
| Rate for Payer: WEA Trust Commercial |
$3,493.05
|
| Rate for Payer: WPS Commercial |
$4,704.19
|
|
|
MRI Lumbar Combined
|
Facility
|
OP
|
$6,351.00
|
|
|
Service Code
|
CPT 72158 TC
|
| Hospital Charge Code |
3072657
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$380.12 |
| Max. Negotiated Rate |
$5,842.92 |
| Rate for Payer: Aetna Commercial |
$5,715.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,461.86
|
| Rate for Payer: Aetna Managed Medicare |
$380.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,496.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,871.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,726.00
|
| Rate for Payer: Anthem Medicare Advantage |
$380.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,366.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$380.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$380.12
|
| Rate for Payer: Cash Price |
$1,905.30
|
| Rate for Payer: Cash Price |
$1,905.30
|
| Rate for Payer: Cash Price |
$1,905.30
|
| Rate for Payer: Cash Price |
$1,905.30
|
| Rate for Payer: Cigna Commercial |
$5,842.92
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$380.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,554.02
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$380.12
|
| Rate for Payer: Health EOS Commercial |
$5,652.39
|
| Rate for Payer: HFN Commercial |
$5,842.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,414.05
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$380.12
|
| Rate for Payer: Independent Care Health Plan Medicare |
$380.12
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$380.12
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$380.12
|
| Rate for Payer: Multiplan Commercial |
$5,080.80
|
| Rate for Payer: NAPHCARE Commercial |
$570.18
|
| Rate for Payer: Preferred Network Access Commercial |
$5,842.92
|
| Rate for Payer: Quartz Beloit One Network |
$3,111.99
|
| Rate for Payer: Quartz Commercial |
$4,128.15
|
| Rate for Payer: Quartz Medicare Advantage |
$380.12
|
| Rate for Payer: The Alliance Commercial |
$1,520.48
|
| Rate for Payer: United Healthcare Medicare Advantage |
$380.12
|
| Rate for Payer: United Healthcare PPO |
$3,022.00
|
| Rate for Payer: WEA Trust Commercial |
$3,493.05
|
| Rate for Payer: Wellcare Medicare |
$380.12
|
| Rate for Payer: WPS Commercial |
$4,704.19
|
|
|
MRI Lumbar w/o Contrast
|
Facility
|
OP
|
$4,820.00
|
|
|
Service Code
|
CPT 72148 TC
|
| Hospital Charge Code |
3072639
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$242.20 |
| Max. Negotiated Rate |
$4,434.40 |
| Rate for Payer: Aetna Commercial |
$4,338.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,145.20
|
| Rate for Payer: Aetna Managed Medicare |
$242.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,496.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,871.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,726.00
|
| Rate for Payer: Anthem Medicare Advantage |
$242.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,554.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$242.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$242.20
|
| Rate for Payer: Cash Price |
$1,446.00
|
| Rate for Payer: Cash Price |
$1,446.00
|
| Rate for Payer: Cash Price |
$1,446.00
|
| Rate for Payer: Cash Price |
$1,446.00
|
| Rate for Payer: Cigna Commercial |
$4,434.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$242.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,697.27
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$242.20
|
| Rate for Payer: Health EOS Commercial |
$4,289.80
|
| Rate for Payer: HFN Commercial |
$4,434.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$900.98
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$242.20
|
| Rate for Payer: Independent Care Health Plan Medicare |
$242.20
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$242.20
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$242.20
|
| Rate for Payer: Multiplan Commercial |
$3,856.00
|
| Rate for Payer: NAPHCARE Commercial |
$363.30
|
| Rate for Payer: Preferred Network Access Commercial |
$4,434.40
|
| Rate for Payer: Quartz Beloit One Network |
$2,361.80
|
| Rate for Payer: Quartz Commercial |
$3,133.00
|
| Rate for Payer: Quartz Medicare Advantage |
$242.20
|
| Rate for Payer: The Alliance Commercial |
$968.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$242.20
|
| Rate for Payer: United Healthcare PPO |
$3,022.00
|
| Rate for Payer: WEA Trust Commercial |
$2,651.00
|
| Rate for Payer: Wellcare Medicare |
$242.20
|
| Rate for Payer: WPS Commercial |
$3,570.17
|
|
|
MRI Lumbar w/o Contrast
|
Professional
|
Both
|
$4,820.00
|
|
|
Service Code
|
CPT 72148 TC
|
| Hospital Charge Code |
3072639
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$476.09 |
| Max. Negotiated Rate |
$4,579.00 |
| Rate for Payer: Aetna Commercial |
$4,579.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,145.20
|
| Rate for Payer: Cash Price |
$1,446.00
|
| Rate for Payer: Cash Price |
$1,446.00
|
| Rate for Payer: Cash Price |
$1,446.00
|
| Rate for Payer: Cigna Commercial |
$4,579.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,410.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,892.00
|
| Rate for Payer: Health EOS Commercial |
$4,386.20
|
| Rate for Payer: HFN Commercial |
$4,579.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$476.09
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$476.09
|
| Rate for Payer: Multiplan Commercial |
$3,856.00
|
| Rate for Payer: Preferred Network Access Commercial |
$4,579.00
|
| Rate for Payer: Quartz Beloit One Network |
$2,120.80
|
| Rate for Payer: Quartz Commercial |
$2,747.40
|
| Rate for Payer: The Alliance Commercial |
$2,410.00
|
| Rate for Payer: WEA Trust Commercial |
$2,651.00
|
| Rate for Payer: WPS Commercial |
$3,570.17
|
|
|
MRI Lumbar w/o Contrast
|
Facility
|
IP
|
$4,820.00
|
|
|
Service Code
|
CPT 72148 TC
|
| Hospital Charge Code |
3072639
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$2,361.80 |
| Max. Negotiated Rate |
$4,434.40 |
| Rate for Payer: Aetna Commercial |
$4,338.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,145.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,554.60
|
| Rate for Payer: Cash Price |
$1,446.00
|
| Rate for Payer: Cigna Commercial |
$4,434.40
|
| Rate for Payer: Health EOS Commercial |
$4,289.80
|
| Rate for Payer: HFN Commercial |
$4,434.40
|
| Rate for Payer: Multiplan Commercial |
$3,856.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,892.00
|
| Rate for Payer: Preferred Network Access Commercial |
$4,434.40
|
| Rate for Payer: Quartz Beloit One Network |
$2,361.80
|
| Rate for Payer: Quartz Commercial |
$2,892.00
|
| Rate for Payer: WEA Trust Commercial |
$2,651.00
|
| Rate for Payer: WPS Commercial |
$3,570.17
|
|
|
MRI Orbit Face Neck w/wo Con
|
Facility
|
IP
|
$7,100.00
|
|
|
Service Code
|
CPT 70543 TC
|
| Hospital Charge Code |
3072669
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$3,479.00 |
| Max. Negotiated Rate |
$6,532.00 |
| Rate for Payer: Aetna Commercial |
$6,390.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,106.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,763.00
|
| Rate for Payer: Cash Price |
$2,130.00
|
| Rate for Payer: Cigna Commercial |
$6,532.00
|
| Rate for Payer: Health EOS Commercial |
$6,319.00
|
| Rate for Payer: HFN Commercial |
$6,532.00
|
| Rate for Payer: Multiplan Commercial |
$5,680.00
|
| Rate for Payer: NAPHCARE Commercial |
$4,260.00
|
| Rate for Payer: Preferred Network Access Commercial |
$6,532.00
|
| Rate for Payer: Quartz Beloit One Network |
$3,479.00
|
| Rate for Payer: Quartz Commercial |
$4,260.00
|
| Rate for Payer: WEA Trust Commercial |
$3,905.00
|
| Rate for Payer: WPS Commercial |
$5,258.97
|
|
|
MRI Orbit Face Neck w/wo Con
|
Professional
|
Both
|
$7,100.00
|
|
|
Service Code
|
CPT 70543 TC
|
| Hospital Charge Code |
3072669
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$941.73 |
| Max. Negotiated Rate |
$6,745.00 |
| Rate for Payer: Aetna Commercial |
$6,745.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,106.00
|
| Rate for Payer: Cash Price |
$2,130.00
|
| Rate for Payer: Cash Price |
$2,130.00
|
| Rate for Payer: Cash Price |
$2,130.00
|
| Rate for Payer: Cigna Commercial |
$6,745.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$3,550.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,260.00
|
| Rate for Payer: Health EOS Commercial |
$6,461.00
|
| Rate for Payer: HFN Commercial |
$6,745.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$941.73
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$941.73
|
| Rate for Payer: Multiplan Commercial |
$5,680.00
|
| Rate for Payer: Preferred Network Access Commercial |
$6,745.00
|
| Rate for Payer: Quartz Beloit One Network |
$3,124.00
|
| Rate for Payer: Quartz Commercial |
$4,047.00
|
| Rate for Payer: The Alliance Commercial |
$3,550.00
|
| Rate for Payer: WEA Trust Commercial |
$3,905.00
|
| Rate for Payer: WPS Commercial |
$5,258.97
|
|
|
MRI Orbit Face Neck w/wo Con
|
Facility
|
OP
|
$7,100.00
|
|
|
Service Code
|
CPT 70543 TC
|
| Hospital Charge Code |
3072669
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$380.12 |
| Max. Negotiated Rate |
$6,532.00 |
| Rate for Payer: Aetna Commercial |
$6,390.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,106.00
|
| Rate for Payer: Aetna Managed Medicare |
$380.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,496.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,871.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,726.00
|
| Rate for Payer: Anthem Medicare Advantage |
$380.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,763.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$380.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$380.12
|
| Rate for Payer: Cash Price |
$2,130.00
|
| Rate for Payer: Cash Price |
$2,130.00
|
| Rate for Payer: Cash Price |
$2,130.00
|
| Rate for Payer: Cash Price |
$2,130.00
|
| Rate for Payer: Cigna Commercial |
$6,532.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$380.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,973.16
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$380.12
|
| Rate for Payer: Health EOS Commercial |
$6,319.00
|
| Rate for Payer: HFN Commercial |
$6,532.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,414.05
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$380.12
|
| Rate for Payer: Independent Care Health Plan Medicare |
$380.12
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$380.12
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$380.12
|
| Rate for Payer: Multiplan Commercial |
$5,680.00
|
| Rate for Payer: NAPHCARE Commercial |
$570.18
|
| Rate for Payer: Preferred Network Access Commercial |
$6,532.00
|
| Rate for Payer: Quartz Beloit One Network |
$3,479.00
|
| Rate for Payer: Quartz Commercial |
$4,615.00
|
| Rate for Payer: Quartz Medicare Advantage |
$380.12
|
| Rate for Payer: The Alliance Commercial |
$1,520.48
|
| Rate for Payer: United Healthcare Medicare Advantage |
$380.12
|
| Rate for Payer: United Healthcare PPO |
$3,022.00
|
| Rate for Payer: WEA Trust Commercial |
$3,905.00
|
| Rate for Payer: Wellcare Medicare |
$380.12
|
| Rate for Payer: WPS Commercial |
$5,258.97
|
|
|
MRI Pelvis Hydrogel w/o Contrast
|
Professional
|
Both
|
$5,056.00
|
|
|
Service Code
|
CPT 76498 TC
|
| Hospital Charge Code |
5577503
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$2,224.64 |
| Max. Negotiated Rate |
$4,803.20 |
| Rate for Payer: Aetna Commercial |
$4,803.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,348.16
|
| Rate for Payer: Cash Price |
$1,516.80
|
| Rate for Payer: Cash Price |
$1,516.80
|
| Rate for Payer: Cigna Commercial |
$4,803.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,528.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,033.60
|
| Rate for Payer: Health EOS Commercial |
$4,600.96
|
| Rate for Payer: HFN Commercial |
$4,803.20
|
| Rate for Payer: Multiplan Commercial |
$4,044.80
|
| Rate for Payer: Preferred Network Access Commercial |
$4,803.20
|
| Rate for Payer: Quartz Beloit One Network |
$2,224.64
|
| Rate for Payer: Quartz Commercial |
$2,881.92
|
| Rate for Payer: The Alliance Commercial |
$2,528.00
|
| Rate for Payer: WEA Trust Commercial |
$2,780.80
|
| Rate for Payer: WPS Commercial |
$3,744.98
|
|
|
MRI Pelvis Hydrogel w/o Contrast
|
Facility
|
OP
|
$5,056.00
|
|
|
Service Code
|
CPT 76498 TC
|
| Hospital Charge Code |
5577503
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$89.82 |
| Max. Negotiated Rate |
$4,651.52 |
| Rate for Payer: Aetna Commercial |
$4,550.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,348.16
|
| Rate for Payer: Aetna Managed Medicare |
$89.82
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,496.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,871.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,726.00
|
| Rate for Payer: Anthem Medicare Advantage |
$89.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,679.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$89.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$89.82
|
| Rate for Payer: Cash Price |
$1,516.80
|
| Rate for Payer: Cash Price |
$1,516.80
|
| Rate for Payer: Cash Price |
$1,516.80
|
| Rate for Payer: Cash Price |
$1,516.80
|
| Rate for Payer: Cigna Commercial |
$4,651.52
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$89.82
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,829.34
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$89.82
|
| Rate for Payer: Health EOS Commercial |
$4,499.84
|
| Rate for Payer: HFN Commercial |
$4,651.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$334.13
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$89.82
|
| Rate for Payer: Independent Care Health Plan Medicare |
$89.82
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$89.82
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$89.82
|
| Rate for Payer: Multiplan Commercial |
$4,044.80
|
| Rate for Payer: NAPHCARE Commercial |
$134.73
|
| Rate for Payer: Preferred Network Access Commercial |
$4,651.52
|
| Rate for Payer: Quartz Beloit One Network |
$2,477.44
|
| Rate for Payer: Quartz Commercial |
$3,286.40
|
| Rate for Payer: Quartz Medicare Advantage |
$89.82
|
| Rate for Payer: The Alliance Commercial |
$359.28
|
| Rate for Payer: United Healthcare Medicare Advantage |
$89.82
|
| Rate for Payer: United Healthcare PPO |
$3,022.00
|
| Rate for Payer: WEA Trust Commercial |
$2,780.80
|
| Rate for Payer: Wellcare Medicare |
$89.82
|
| Rate for Payer: WPS Commercial |
$3,744.98
|
|
|
MRI Pelvis Hydrogel w/o Contrast
|
Facility
|
IP
|
$5,056.00
|
|
|
Service Code
|
CPT 76498 TC
|
| Hospital Charge Code |
5577503
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$2,477.44 |
| Max. Negotiated Rate |
$4,651.52 |
| Rate for Payer: Aetna Commercial |
$4,550.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,348.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,679.68
|
| Rate for Payer: Cash Price |
$1,516.80
|
| Rate for Payer: Cigna Commercial |
$4,651.52
|
| Rate for Payer: Health EOS Commercial |
$4,499.84
|
| Rate for Payer: HFN Commercial |
$4,651.52
|
| Rate for Payer: Multiplan Commercial |
$4,044.80
|
| Rate for Payer: NAPHCARE Commercial |
$3,033.60
|
| Rate for Payer: Preferred Network Access Commercial |
$4,651.52
|
| Rate for Payer: Quartz Beloit One Network |
$2,477.44
|
| Rate for Payer: Quartz Commercial |
$3,033.60
|
| Rate for Payer: WEA Trust Commercial |
$2,780.80
|
| Rate for Payer: WPS Commercial |
$3,744.98
|
|
|
MRI Pelvis w/ Contrast
|
Professional
|
Both
|
$5,965.00
|
|
|
Service Code
|
CPT 72196 TC
|
| Hospital Charge Code |
1611230
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$744.48 |
| Max. Negotiated Rate |
$5,666.75 |
| Rate for Payer: Aetna Commercial |
$5,666.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,129.90
|
| 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 |
$5,666.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,982.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,579.00
|
| Rate for Payer: Health EOS Commercial |
$5,428.15
|
| Rate for Payer: HFN Commercial |
$5,666.75
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$744.48
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$744.48
|
| Rate for Payer: Multiplan Commercial |
$4,772.00
|
| Rate for Payer: Preferred Network Access Commercial |
$5,666.75
|
| Rate for Payer: Quartz Beloit One Network |
$2,624.60
|
| Rate for Payer: Quartz Commercial |
$3,400.05
|
| Rate for Payer: The Alliance Commercial |
$2,982.50
|
| Rate for Payer: WEA Trust Commercial |
$3,280.75
|
| Rate for Payer: WPS Commercial |
$4,418.28
|
|
|
MRI Pelvis w/ Contrast
|
Facility
|
OP
|
$5,965.00
|
|
|
Service Code
|
CPT 72196 TC
|
| Hospital Charge Code |
3072732
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$380.12 |
| Max. Negotiated Rate |
$5,487.80 |
| Rate for Payer: Aetna Commercial |
$5,368.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,129.90
|
| Rate for Payer: Aetna Managed Medicare |
$380.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,496.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,871.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,726.00
|
| Rate for Payer: Anthem Medicare Advantage |
$380.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,161.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$380.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$380.12
|
| Rate for Payer: Cash Price |
$1,789.50
|
| Rate for Payer: Cash Price |
$1,789.50
|
| Rate for Payer: Cash Price |
$1,789.50
|
| Rate for Payer: Cash Price |
$1,789.50
|
| Rate for Payer: Cigna Commercial |
$5,487.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$380.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,338.01
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$380.12
|
| Rate for Payer: Health EOS Commercial |
$5,308.85
|
| Rate for Payer: HFN Commercial |
$5,487.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,414.05
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$380.12
|
| Rate for Payer: Independent Care Health Plan Medicare |
$380.12
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$380.12
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$380.12
|
| Rate for Payer: Multiplan Commercial |
$4,772.00
|
| Rate for Payer: NAPHCARE Commercial |
$570.18
|
| Rate for Payer: Preferred Network Access Commercial |
$5,487.80
|
| Rate for Payer: Quartz Beloit One Network |
$2,922.85
|
| Rate for Payer: Quartz Commercial |
$3,877.25
|
| Rate for Payer: Quartz Medicare Advantage |
$380.12
|
| Rate for Payer: The Alliance Commercial |
$1,520.48
|
| Rate for Payer: United Healthcare Medicare Advantage |
$380.12
|
| Rate for Payer: United Healthcare PPO |
$3,022.00
|
| Rate for Payer: WEA Trust Commercial |
$3,280.75
|
| Rate for Payer: Wellcare Medicare |
$380.12
|
| Rate for Payer: WPS Commercial |
$4,418.28
|
|
|
MRI Pelvis w/ Contrast
|
Facility
|
OP
|
$5,965.00
|
|
|
Service Code
|
CPT 72196 TC
|
| Hospital Charge Code |
1611230
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$380.12 |
| Max. Negotiated Rate |
$5,487.80 |
| Rate for Payer: Aetna Commercial |
$5,368.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,129.90
|
| Rate for Payer: Aetna Managed Medicare |
$380.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,496.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,871.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,726.00
|
| Rate for Payer: Anthem Medicare Advantage |
$380.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,161.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$380.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$380.12
|
| Rate for Payer: Cash Price |
$1,789.50
|
| Rate for Payer: Cash Price |
$1,789.50
|
| Rate for Payer: Cash Price |
$1,789.50
|
| Rate for Payer: Cash Price |
$1,789.50
|
| Rate for Payer: Cigna Commercial |
$5,487.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$380.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,338.01
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$380.12
|
| Rate for Payer: Health EOS Commercial |
$5,308.85
|
| Rate for Payer: HFN Commercial |
$5,487.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,414.05
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$380.12
|
| Rate for Payer: Independent Care Health Plan Medicare |
$380.12
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$380.12
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$380.12
|
| Rate for Payer: Multiplan Commercial |
$4,772.00
|
| Rate for Payer: NAPHCARE Commercial |
$570.18
|
| Rate for Payer: Preferred Network Access Commercial |
$5,487.80
|
| Rate for Payer: Quartz Beloit One Network |
$2,922.85
|
| Rate for Payer: Quartz Commercial |
$3,877.25
|
| Rate for Payer: Quartz Medicare Advantage |
$380.12
|
| Rate for Payer: The Alliance Commercial |
$1,520.48
|
| Rate for Payer: United Healthcare Medicare Advantage |
$380.12
|
| Rate for Payer: United Healthcare PPO |
$3,022.00
|
| Rate for Payer: WEA Trust Commercial |
$3,280.75
|
| Rate for Payer: Wellcare Medicare |
$380.12
|
| Rate for Payer: WPS Commercial |
$4,418.28
|
|
