|
MRI Pelvis w/ Contrast
|
Facility
|
IP
|
$5,965.00
|
|
|
Service Code
|
CPT 72196 TC
|
| Hospital Charge Code |
1611230
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$2,922.85 |
| 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: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,161.45
|
| Rate for Payer: Cash Price |
$1,789.50
|
| Rate for Payer: Cigna Commercial |
$5,487.80
|
| Rate for Payer: Health EOS Commercial |
$5,308.85
|
| Rate for Payer: HFN Commercial |
$5,487.80
|
| Rate for Payer: Multiplan Commercial |
$4,772.00
|
| Rate for Payer: NAPHCARE Commercial |
$3,579.00
|
| 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 |
$3,579.00
|
| Rate for Payer: WEA Trust Commercial |
$3,280.75
|
| Rate for Payer: WPS Commercial |
$4,418.28
|
|
|
MRI Pelvis w/ Contrast
|
Facility
|
OP
|
$6,080.00
|
|
|
Service Code
|
CPT 72196
|
| Hospital Charge Code |
631203
|
| 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 Pelvis w/ Contrast
|
Facility
|
IP
|
$5,965.00
|
|
|
Service Code
|
CPT 72196 TC
|
| Hospital Charge Code |
3072732
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$2,922.85 |
| 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: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,161.45
|
| Rate for Payer: Cash Price |
$1,789.50
|
| Rate for Payer: Cigna Commercial |
$5,487.80
|
| Rate for Payer: Health EOS Commercial |
$5,308.85
|
| Rate for Payer: HFN Commercial |
$5,487.80
|
| Rate for Payer: Multiplan Commercial |
$4,772.00
|
| Rate for Payer: NAPHCARE Commercial |
$3,579.00
|
| 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 |
$3,579.00
|
| Rate for Payer: WEA Trust Commercial |
$3,280.75
|
| Rate for Payer: WPS Commercial |
$4,418.28
|
|
|
MRI Pelvis w/ Contrast
|
Professional
|
Both
|
$5,965.00
|
|
|
Service Code
|
CPT 72196 TC
|
| Hospital Charge Code |
3072732
|
|
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
|
Professional
|
Both
|
$6,080.00
|
|
|
Service Code
|
CPT 72196
|
| Hospital Charge Code |
631203
|
| Min. Negotiated Rate |
$1,033.94 |
| 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 |
$1,033.94
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,033.94
|
| 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 Pelvis w/ Contrast
|
Facility
|
IP
|
$6,080.00
|
|
|
Service Code
|
CPT 72196
|
| Hospital Charge Code |
631203
|
| 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 Pelvis w/o Contrast
|
Professional
|
Both
|
$4,576.00
|
|
|
Service Code
|
CPT 72195
|
| Hospital Charge Code |
631208
|
| Min. Negotiated Rate |
$881.23 |
| Max. Negotiated Rate |
$4,347.20 |
| Rate for Payer: Aetna Commercial |
$4,347.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,935.36
|
| Rate for Payer: Cash Price |
$1,372.80
|
| Rate for Payer: Cash Price |
$1,372.80
|
| Rate for Payer: Cash Price |
$1,372.80
|
| Rate for Payer: Cigna Commercial |
$4,347.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,288.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,745.60
|
| Rate for Payer: Health EOS Commercial |
$4,164.16
|
| Rate for Payer: HFN Commercial |
$4,347.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$881.23
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$881.23
|
| Rate for Payer: Multiplan Commercial |
$3,660.80
|
| Rate for Payer: Preferred Network Access Commercial |
$4,347.20
|
| Rate for Payer: Quartz Beloit One Network |
$2,013.44
|
| Rate for Payer: Quartz Commercial |
$2,608.32
|
| Rate for Payer: The Alliance Commercial |
$2,288.00
|
| Rate for Payer: WEA Trust Commercial |
$2,516.80
|
| Rate for Payer: WPS Commercial |
$3,389.44
|
|
|
MRI Pelvis w/o Contrast
|
Facility
|
OP
|
$5,248.00
|
|
|
Service Code
|
CPT 72195 TC
|
| Hospital Charge Code |
3072671
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$242.20 |
| Max. Negotiated Rate |
$4,828.16 |
| Rate for Payer: Aetna Commercial |
$4,723.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,513.28
|
| 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 |
$2,781.44
|
| 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 |
$1,574.40
|
| Rate for Payer: Cash Price |
$1,574.40
|
| Rate for Payer: Cash Price |
$1,574.40
|
| Rate for Payer: Cash Price |
$1,574.40
|
| Rate for Payer: Cigna Commercial |
$4,828.16
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$242.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,936.78
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$242.20
|
| Rate for Payer: Health EOS Commercial |
$4,670.72
|
| Rate for Payer: HFN Commercial |
$4,828.16
|
| 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 |
$4,198.40
|
| Rate for Payer: NAPHCARE Commercial |
$363.30
|
| Rate for Payer: Preferred Network Access Commercial |
$4,828.16
|
| Rate for Payer: Quartz Beloit One Network |
$2,571.52
|
| Rate for Payer: Quartz Commercial |
$3,411.20
|
| 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 |
$2,886.40
|
| Rate for Payer: Wellcare Medicare |
$242.20
|
| Rate for Payer: WPS Commercial |
$3,887.19
|
|
|
MRI Pelvis w/o Contrast
|
Facility
|
OP
|
$4,576.00
|
|
|
Service Code
|
CPT 72195
|
| Hospital Charge Code |
631208
|
| Min. Negotiated Rate |
$242.20 |
| Max. Negotiated Rate |
$4,209.92 |
| Rate for Payer: Aetna Commercial |
$4,118.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,935.36
|
| Rate for Payer: Aetna Managed Medicare |
$242.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,974.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,288.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,196.48
|
| Rate for Payer: Anthem Medicare Advantage |
$242.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,425.28
|
| 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 |
$1,372.80
|
| Rate for Payer: Cash Price |
$1,372.80
|
| Rate for Payer: Cigna Commercial |
$4,209.92
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$242.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,560.73
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$242.20
|
| Rate for Payer: Health EOS Commercial |
$4,072.64
|
| Rate for Payer: HFN Commercial |
$4,209.92
|
| 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 |
$3,660.80
|
| Rate for Payer: NAPHCARE Commercial |
$363.30
|
| Rate for Payer: Preferred Network Access Commercial |
$4,209.92
|
| Rate for Payer: Quartz Beloit One Network |
$2,242.24
|
| Rate for Payer: Quartz Commercial |
$2,974.40
|
| 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: WEA Trust Commercial |
$2,516.80
|
| Rate for Payer: Wellcare Medicare |
$242.20
|
| Rate for Payer: WPS Commercial |
$3,389.44
|
|
|
MRI Pelvis w/o Contrast
|
Professional
|
Both
|
$5,248.00
|
|
|
Service Code
|
CPT 72195 TC
|
| Hospital Charge Code |
3072671
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$637.73 |
| Max. Negotiated Rate |
$4,985.60 |
| Rate for Payer: Aetna Commercial |
$4,985.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,513.28
|
| Rate for Payer: Cash Price |
$1,574.40
|
| Rate for Payer: Cash Price |
$1,574.40
|
| Rate for Payer: Cash Price |
$1,574.40
|
| Rate for Payer: Cigna Commercial |
$4,985.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,624.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,148.80
|
| Rate for Payer: Health EOS Commercial |
$4,775.68
|
| Rate for Payer: HFN Commercial |
$4,985.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$637.73
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$637.73
|
| Rate for Payer: Multiplan Commercial |
$4,198.40
|
| Rate for Payer: Preferred Network Access Commercial |
$4,985.60
|
| Rate for Payer: Quartz Beloit One Network |
$2,309.12
|
| Rate for Payer: Quartz Commercial |
$2,991.36
|
| Rate for Payer: The Alliance Commercial |
$2,624.00
|
| Rate for Payer: WEA Trust Commercial |
$2,886.40
|
| Rate for Payer: WPS Commercial |
$3,887.19
|
|
|
MRI Pelvis w/o Contrast
|
Professional
|
Both
|
$5,248.00
|
|
|
Service Code
|
CPT 72195 TC
|
| Hospital Charge Code |
1611232
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$637.73 |
| Max. Negotiated Rate |
$4,985.60 |
| Rate for Payer: Aetna Commercial |
$4,985.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,513.28
|
| Rate for Payer: Cash Price |
$1,574.40
|
| Rate for Payer: Cash Price |
$1,574.40
|
| Rate for Payer: Cash Price |
$1,574.40
|
| Rate for Payer: Cigna Commercial |
$4,985.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,624.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,148.80
|
| Rate for Payer: Health EOS Commercial |
$4,775.68
|
| Rate for Payer: HFN Commercial |
$4,985.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$637.73
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$637.73
|
| Rate for Payer: Multiplan Commercial |
$4,198.40
|
| Rate for Payer: Preferred Network Access Commercial |
$4,985.60
|
| Rate for Payer: Quartz Beloit One Network |
$2,309.12
|
| Rate for Payer: Quartz Commercial |
$2,991.36
|
| Rate for Payer: The Alliance Commercial |
$2,624.00
|
| Rate for Payer: WEA Trust Commercial |
$2,886.40
|
| Rate for Payer: WPS Commercial |
$3,887.19
|
|
|
MRI Pelvis w/o Contrast
|
Facility
|
IP
|
$5,248.00
|
|
|
Service Code
|
CPT 72195 TC
|
| Hospital Charge Code |
1611232
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$2,571.52 |
| Max. Negotiated Rate |
$4,828.16 |
| Rate for Payer: Aetna Commercial |
$4,723.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,513.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,781.44
|
| Rate for Payer: Cash Price |
$1,574.40
|
| Rate for Payer: Cigna Commercial |
$4,828.16
|
| Rate for Payer: Health EOS Commercial |
$4,670.72
|
| Rate for Payer: HFN Commercial |
$4,828.16
|
| Rate for Payer: Multiplan Commercial |
$4,198.40
|
| Rate for Payer: NAPHCARE Commercial |
$3,148.80
|
| Rate for Payer: Preferred Network Access Commercial |
$4,828.16
|
| Rate for Payer: Quartz Beloit One Network |
$2,571.52
|
| Rate for Payer: Quartz Commercial |
$3,148.80
|
| Rate for Payer: WEA Trust Commercial |
$2,886.40
|
| Rate for Payer: WPS Commercial |
$3,887.19
|
|
|
MRI Pelvis w/o Contrast
|
Facility
|
OP
|
$5,248.00
|
|
|
Service Code
|
CPT 72195 TC
|
| Hospital Charge Code |
1611232
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$242.20 |
| Max. Negotiated Rate |
$4,828.16 |
| Rate for Payer: Aetna Commercial |
$4,723.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,513.28
|
| 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 |
$2,781.44
|
| 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 |
$1,574.40
|
| Rate for Payer: Cash Price |
$1,574.40
|
| Rate for Payer: Cash Price |
$1,574.40
|
| Rate for Payer: Cash Price |
$1,574.40
|
| Rate for Payer: Cigna Commercial |
$4,828.16
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$242.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,936.78
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$242.20
|
| Rate for Payer: Health EOS Commercial |
$4,670.72
|
| Rate for Payer: HFN Commercial |
$4,828.16
|
| 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 |
$4,198.40
|
| Rate for Payer: NAPHCARE Commercial |
$363.30
|
| Rate for Payer: Preferred Network Access Commercial |
$4,828.16
|
| Rate for Payer: Quartz Beloit One Network |
$2,571.52
|
| Rate for Payer: Quartz Commercial |
$3,411.20
|
| 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 |
$2,886.40
|
| Rate for Payer: Wellcare Medicare |
$242.20
|
| Rate for Payer: WPS Commercial |
$3,887.19
|
|
|
MRI Pelvis w/o Contrast
|
Facility
|
IP
|
$5,248.00
|
|
|
Service Code
|
CPT 72195 TC
|
| Hospital Charge Code |
3072671
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$2,571.52 |
| Max. Negotiated Rate |
$4,828.16 |
| Rate for Payer: Aetna Commercial |
$4,723.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,513.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,781.44
|
| Rate for Payer: Cash Price |
$1,574.40
|
| Rate for Payer: Cigna Commercial |
$4,828.16
|
| Rate for Payer: Health EOS Commercial |
$4,670.72
|
| Rate for Payer: HFN Commercial |
$4,828.16
|
| Rate for Payer: Multiplan Commercial |
$4,198.40
|
| Rate for Payer: NAPHCARE Commercial |
$3,148.80
|
| Rate for Payer: Preferred Network Access Commercial |
$4,828.16
|
| Rate for Payer: Quartz Beloit One Network |
$2,571.52
|
| Rate for Payer: Quartz Commercial |
$3,148.80
|
| Rate for Payer: WEA Trust Commercial |
$2,886.40
|
| Rate for Payer: WPS Commercial |
$3,887.19
|
|
|
MRI Pelvis w/o Contrast
|
Facility
|
IP
|
$4,576.00
|
|
|
Service Code
|
CPT 72195
|
| Hospital Charge Code |
631208
|
| Min. Negotiated Rate |
$2,242.24 |
| Max. Negotiated Rate |
$4,209.92 |
| Rate for Payer: Aetna Commercial |
$4,118.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,935.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,425.28
|
| Rate for Payer: Cash Price |
$1,372.80
|
| Rate for Payer: Cigna Commercial |
$4,209.92
|
| Rate for Payer: Health EOS Commercial |
$4,072.64
|
| Rate for Payer: HFN Commercial |
$4,209.92
|
| Rate for Payer: Multiplan Commercial |
$3,660.80
|
| Rate for Payer: NAPHCARE Commercial |
$2,745.60
|
| Rate for Payer: Preferred Network Access Commercial |
$4,209.92
|
| Rate for Payer: Quartz Beloit One Network |
$2,242.24
|
| Rate for Payer: Quartz Commercial |
$2,745.60
|
| Rate for Payer: WEA Trust Commercial |
$2,516.80
|
| Rate for Payer: WPS Commercial |
$3,389.44
|
|
|
MRI Pelvis w/ + w/o Contrast
|
Facility
|
OP
|
$6,946.00
|
|
|
Service Code
|
CPT 72197 TC
|
| Hospital Charge Code |
3072693
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$380.12 |
| Max. Negotiated Rate |
$6,390.32 |
| Rate for Payer: Aetna Commercial |
$6,251.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,973.56
|
| 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 |
$3,681.38
|
| 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 |
$2,083.80
|
| Rate for Payer: Cash Price |
$2,083.80
|
| Rate for Payer: Cash Price |
$2,083.80
|
| Rate for Payer: Cash Price |
$2,083.80
|
| Rate for Payer: Cigna Commercial |
$6,390.32
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$380.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,886.98
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$380.12
|
| Rate for Payer: Health EOS Commercial |
$6,181.94
|
| Rate for Payer: HFN Commercial |
$6,390.32
|
| 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 |
$5,556.80
|
| Rate for Payer: NAPHCARE Commercial |
$570.18
|
| Rate for Payer: Preferred Network Access Commercial |
$6,390.32
|
| Rate for Payer: Quartz Beloit One Network |
$3,403.54
|
| Rate for Payer: Quartz Commercial |
$4,514.90
|
| 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 |
$3,820.30
|
| Rate for Payer: Wellcare Medicare |
$380.12
|
| Rate for Payer: WPS Commercial |
$5,144.90
|
|
|
MRI Pelvis w/ + w/o Contrast
|
Facility
|
IP
|
$6,946.00
|
|
|
Service Code
|
CPT 72197 TC
|
| Hospital Charge Code |
1611228
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$3,403.54 |
| Max. Negotiated Rate |
$6,390.32 |
| Rate for Payer: Aetna Commercial |
$6,251.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,973.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,681.38
|
| Rate for Payer: Cash Price |
$2,083.80
|
| Rate for Payer: Cigna Commercial |
$6,390.32
|
| Rate for Payer: Health EOS Commercial |
$6,181.94
|
| Rate for Payer: HFN Commercial |
$6,390.32
|
| Rate for Payer: Multiplan Commercial |
$5,556.80
|
| Rate for Payer: NAPHCARE Commercial |
$4,167.60
|
| Rate for Payer: Preferred Network Access Commercial |
$6,390.32
|
| Rate for Payer: Quartz Beloit One Network |
$3,403.54
|
| Rate for Payer: Quartz Commercial |
$4,167.60
|
| Rate for Payer: WEA Trust Commercial |
$3,820.30
|
| Rate for Payer: WPS Commercial |
$5,144.90
|
|
|
MRI Pelvis w/ + w/o Contrast
|
Professional
|
Both
|
$6,946.00
|
|
|
Service Code
|
CPT 72197 TC
|
| Hospital Charge Code |
1611228
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$933.61 |
| Max. Negotiated Rate |
$6,598.70 |
| Rate for Payer: Aetna Commercial |
$6,598.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,973.56
|
| Rate for Payer: Cash Price |
$2,083.80
|
| Rate for Payer: Cash Price |
$2,083.80
|
| Rate for Payer: Cash Price |
$2,083.80
|
| Rate for Payer: Cigna Commercial |
$6,598.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$3,473.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,167.60
|
| Rate for Payer: Health EOS Commercial |
$6,320.86
|
| Rate for Payer: HFN Commercial |
$6,598.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$933.61
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$933.61
|
| Rate for Payer: Multiplan Commercial |
$5,556.80
|
| Rate for Payer: Preferred Network Access Commercial |
$6,598.70
|
| Rate for Payer: Quartz Beloit One Network |
$3,056.24
|
| Rate for Payer: Quartz Commercial |
$3,959.22
|
| Rate for Payer: The Alliance Commercial |
$3,473.00
|
| Rate for Payer: WEA Trust Commercial |
$3,820.30
|
| Rate for Payer: WPS Commercial |
$5,144.90
|
|
|
MRI Pelvis w/ + w/o Contrast
|
Facility
|
IP
|
$6,092.00
|
|
|
Service Code
|
CPT 72197
|
| Hospital Charge Code |
631199
|
| Min. Negotiated Rate |
$2,985.08 |
| Max. Negotiated Rate |
$5,604.64 |
| Rate for Payer: Aetna Commercial |
$5,482.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,239.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,228.76
|
| Rate for Payer: Cash Price |
$1,827.60
|
| Rate for Payer: Cigna Commercial |
$5,604.64
|
| Rate for Payer: Health EOS Commercial |
$5,421.88
|
| Rate for Payer: HFN Commercial |
$5,604.64
|
| Rate for Payer: Multiplan Commercial |
$4,873.60
|
| Rate for Payer: NAPHCARE Commercial |
$3,655.20
|
| Rate for Payer: Preferred Network Access Commercial |
$5,604.64
|
| Rate for Payer: Quartz Beloit One Network |
$2,985.08
|
| Rate for Payer: Quartz Commercial |
$3,655.20
|
| Rate for Payer: WEA Trust Commercial |
$3,350.60
|
| Rate for Payer: WPS Commercial |
$4,512.34
|
|
|
MRI Pelvis w/ + w/o Contrast
|
Facility
|
OP
|
$6,092.00
|
|
|
Service Code
|
CPT 72197
|
| Hospital Charge Code |
631199
|
| Min. Negotiated Rate |
$380.12 |
| Max. Negotiated Rate |
$5,604.64 |
| Rate for Payer: Aetna Commercial |
$5,482.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,239.12
|
| Rate for Payer: Aetna Managed Medicare |
$380.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,959.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,046.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,924.16
|
| Rate for Payer: Anthem Medicare Advantage |
$380.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,228.76
|
| 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 |
$1,827.60
|
| Rate for Payer: Cash Price |
$1,827.60
|
| Rate for Payer: Cigna Commercial |
$5,604.64
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$380.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,409.08
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$380.12
|
| Rate for Payer: Health EOS Commercial |
$5,421.88
|
| Rate for Payer: HFN Commercial |
$5,604.64
|
| 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 |
$4,873.60
|
| Rate for Payer: NAPHCARE Commercial |
$570.18
|
| Rate for Payer: Preferred Network Access Commercial |
$5,604.64
|
| Rate for Payer: Quartz Beloit One Network |
$2,985.08
|
| Rate for Payer: Quartz Commercial |
$3,959.80
|
| 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 |
$3,350.60
|
| Rate for Payer: Wellcare Medicare |
$380.12
|
| Rate for Payer: WPS Commercial |
$4,512.34
|
|
|
MRI Pelvis w/ + w/o Contrast
|
Facility
|
IP
|
$6,946.00
|
|
|
Service Code
|
CPT 72197 TC
|
| Hospital Charge Code |
3072693
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$3,403.54 |
| Max. Negotiated Rate |
$6,390.32 |
| Rate for Payer: Aetna Commercial |
$6,251.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,973.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,681.38
|
| Rate for Payer: Cash Price |
$2,083.80
|
| Rate for Payer: Cigna Commercial |
$6,390.32
|
| Rate for Payer: Health EOS Commercial |
$6,181.94
|
| Rate for Payer: HFN Commercial |
$6,390.32
|
| Rate for Payer: Multiplan Commercial |
$5,556.80
|
| Rate for Payer: NAPHCARE Commercial |
$4,167.60
|
| Rate for Payer: Preferred Network Access Commercial |
$6,390.32
|
| Rate for Payer: Quartz Beloit One Network |
$3,403.54
|
| Rate for Payer: Quartz Commercial |
$4,167.60
|
| Rate for Payer: WEA Trust Commercial |
$3,820.30
|
| Rate for Payer: WPS Commercial |
$5,144.90
|
|
|
MRI Pelvis w/ + w/o Contrast
|
Facility
|
OP
|
$6,946.00
|
|
|
Service Code
|
CPT 72197 TC
|
| Hospital Charge Code |
1611228
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$380.12 |
| Max. Negotiated Rate |
$6,390.32 |
| Rate for Payer: Aetna Commercial |
$6,251.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,973.56
|
| 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 |
$3,681.38
|
| 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 |
$2,083.80
|
| Rate for Payer: Cash Price |
$2,083.80
|
| Rate for Payer: Cash Price |
$2,083.80
|
| Rate for Payer: Cash Price |
$2,083.80
|
| Rate for Payer: Cigna Commercial |
$6,390.32
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$380.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,886.98
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$380.12
|
| Rate for Payer: Health EOS Commercial |
$6,181.94
|
| Rate for Payer: HFN Commercial |
$6,390.32
|
| 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 |
$5,556.80
|
| Rate for Payer: NAPHCARE Commercial |
$570.18
|
| Rate for Payer: Preferred Network Access Commercial |
$6,390.32
|
| Rate for Payer: Quartz Beloit One Network |
$3,403.54
|
| Rate for Payer: Quartz Commercial |
$4,514.90
|
| 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 |
$3,820.30
|
| Rate for Payer: Wellcare Medicare |
$380.12
|
| Rate for Payer: WPS Commercial |
$5,144.90
|
|
|
MRI Pelvis w/ + w/o Contrast
|
Professional
|
Both
|
$6,946.00
|
|
|
Service Code
|
CPT 72197 TC
|
| Hospital Charge Code |
3072693
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$933.61 |
| Max. Negotiated Rate |
$6,598.70 |
| Rate for Payer: Aetna Commercial |
$6,598.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,973.56
|
| Rate for Payer: Cash Price |
$2,083.80
|
| Rate for Payer: Cash Price |
$2,083.80
|
| Rate for Payer: Cash Price |
$2,083.80
|
| Rate for Payer: Cigna Commercial |
$6,598.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$3,473.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,167.60
|
| Rate for Payer: Health EOS Commercial |
$6,320.86
|
| Rate for Payer: HFN Commercial |
$6,598.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$933.61
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$933.61
|
| Rate for Payer: Multiplan Commercial |
$5,556.80
|
| Rate for Payer: Preferred Network Access Commercial |
$6,598.70
|
| Rate for Payer: Quartz Beloit One Network |
$3,056.24
|
| Rate for Payer: Quartz Commercial |
$3,959.22
|
| Rate for Payer: The Alliance Commercial |
$3,473.00
|
| Rate for Payer: WEA Trust Commercial |
$3,820.30
|
| Rate for Payer: WPS Commercial |
$5,144.90
|
|
|
MRI Pelvis w/ + w/o Contrast
|
Professional
|
Both
|
$6,092.00
|
|
|
Service Code
|
CPT 72197
|
| Hospital Charge Code |
631199
|
| Min. Negotiated Rate |
$1,299.89 |
| Max. Negotiated Rate |
$5,787.40 |
| Rate for Payer: Aetna Commercial |
$5,787.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,239.12
|
| Rate for Payer: Cash Price |
$1,827.60
|
| Rate for Payer: Cash Price |
$1,827.60
|
| Rate for Payer: Cash Price |
$1,827.60
|
| Rate for Payer: Cigna Commercial |
$5,787.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$3,046.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,655.20
|
| Rate for Payer: Health EOS Commercial |
$5,543.72
|
| Rate for Payer: HFN Commercial |
$5,787.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,299.89
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,299.89
|
| Rate for Payer: Multiplan Commercial |
$4,873.60
|
| Rate for Payer: Preferred Network Access Commercial |
$5,787.40
|
| Rate for Payer: Quartz Beloit One Network |
$2,680.48
|
| Rate for Payer: Quartz Commercial |
$3,472.44
|
| Rate for Payer: The Alliance Commercial |
$3,046.00
|
| Rate for Payer: WEA Trust Commercial |
$3,350.60
|
| Rate for Payer: WPS Commercial |
$4,512.34
|
|
|
MRI Penile/Scrotum w/o Contrast
|
Professional
|
Both
|
$5,248.00
|
|
|
Service Code
|
CPT 72195 TC
|
| Hospital Charge Code |
6230680
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$637.73 |
| Max. Negotiated Rate |
$4,985.60 |
| Rate for Payer: Aetna Commercial |
$4,985.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,513.28
|
| Rate for Payer: Cash Price |
$1,574.40
|
| Rate for Payer: Cash Price |
$1,574.40
|
| Rate for Payer: Cash Price |
$1,574.40
|
| Rate for Payer: Cigna Commercial |
$4,985.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,624.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,148.80
|
| Rate for Payer: Health EOS Commercial |
$4,775.68
|
| Rate for Payer: HFN Commercial |
$4,985.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$637.73
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$637.73
|
| Rate for Payer: Multiplan Commercial |
$4,198.40
|
| Rate for Payer: Preferred Network Access Commercial |
$4,985.60
|
| Rate for Payer: Quartz Beloit One Network |
$2,309.12
|
| Rate for Payer: Quartz Commercial |
$2,991.36
|
| Rate for Payer: The Alliance Commercial |
$2,624.00
|
| Rate for Payer: WEA Trust Commercial |
$2,886.40
|
| Rate for Payer: WPS Commercial |
$3,887.19
|
|
