|
MRI Head w/ w/o Contrast
|
Facility
|
IP
|
$6,607.00
|
|
|
Service Code
|
CPT 70553 TC
|
| Hospital Charge Code |
3072656
|
|
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 Head w/ w/o Contrast
|
Facility
|
OP
|
$6,607.00
|
|
|
Service Code
|
CPT 70553 TC
|
| Hospital Charge Code |
3072656
|
|
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 Head w/ w/o Contrast
|
Professional
|
Both
|
$6,607.00
|
|
|
Service Code
|
CPT 70553 TC
|
| Hospital Charge Code |
3072656
|
|
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 Hip w/ Contrast Bilateral
|
Facility
|
OP
|
$4,988.00
|
|
|
Service Code
|
CPT 73722 TC,LT
|
| Hospital Charge Code |
1611141
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,452.51 |
| Max. Negotiated Rate |
$4,772.52 |
| Rate for Payer: Aetna Commercial |
$4,668.77
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,461.27
|
| Rate for Payer: Aetna Managed Medicare |
$1,452.51
|
| 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 |
$2,749.39
|
| Rate for Payer: Cash Price |
$1,496.40
|
| Rate for Payer: Cash Price |
$1,496.40
|
| Rate for Payer: Cash Price |
$1,496.40
|
| Rate for Payer: Cigna Commercial |
$4,772.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,903.02
|
| Rate for Payer: Health EOS Commercial |
$4,616.89
|
| Rate for Payer: HFN Commercial |
$4,772.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,890.64
|
| Rate for Payer: Multiplan Commercial |
$4,150.02
|
| Rate for Payer: NAPHCARE Commercial |
$3,112.51
|
| Rate for Payer: Preferred Network Access Commercial |
$4,772.52
|
| Rate for Payer: Quartz Beloit One Network |
$2,541.88
|
| Rate for Payer: Quartz Commercial |
$3,371.89
|
| Rate for Payer: Quartz Medicare Advantage |
$3,112.51
|
| Rate for Payer: The Alliance Commercial |
$2,593.76
|
| Rate for Payer: United Healthcare PPO |
$3,142.88
|
| Rate for Payer: WEA Trust Commercial |
$2,853.14
|
| Rate for Payer: WPS Commercial |
$3,842.26
|
|
|
MRI Hip w/ Contrast Bilateral
|
Facility
|
OP
|
$10,169.00
|
|
|
Service Code
|
CPT 73722
|
| Hospital Charge Code |
630989
|
| Min. Negotiated Rate |
$824.99 |
| Max. Negotiated Rate |
$9,729.70 |
| Rate for Payer: Aetna Commercial |
$9,518.18
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,095.15
|
| Rate for Payer: Aetna Managed Medicare |
$824.99
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,874.24
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,287.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,076.36
|
| Rate for Payer: Anthem Medicare Advantage |
$824.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,605.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$824.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$824.99
|
| Rate for Payer: Cash Price |
$3,050.70
|
| Rate for Payer: Cash Price |
$3,050.70
|
| Rate for Payer: Cigna Commercial |
$9,729.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$824.99
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,918.36
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$824.99
|
| Rate for Payer: Health EOS Commercial |
$9,412.43
|
| Rate for Payer: HFN Commercial |
$9,729.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,068.96
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$824.99
|
| Rate for Payer: Independent Care Health Plan Medicare |
$824.99
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$824.99
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$824.99
|
| Rate for Payer: Multiplan Commercial |
$8,460.61
|
| Rate for Payer: NAPHCARE Commercial |
$1,237.49
|
| Rate for Payer: Preferred Network Access Commercial |
$9,729.70
|
| Rate for Payer: Quartz Beloit One Network |
$5,182.12
|
| Rate for Payer: Quartz Commercial |
$6,874.24
|
| Rate for Payer: Quartz Medicare Advantage |
$824.99
|
| Rate for Payer: The Alliance Commercial |
$3,299.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$824.99
|
| Rate for Payer: WEA Trust Commercial |
$5,816.67
|
| Rate for Payer: Wellcare Medicare |
$824.99
|
| Rate for Payer: WPS Commercial |
$7,833.18
|
|
|
MRI Hip w/ Contrast Bilateral
|
Facility
|
IP
|
$4,988.00
|
|
|
Service Code
|
CPT 73722 TC,LT
|
| Hospital Charge Code |
1611141
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$2,541.88 |
| Max. Negotiated Rate |
$4,772.52 |
| Rate for Payer: Aetna Commercial |
$4,668.77
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,461.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,749.39
|
| Rate for Payer: Cash Price |
$1,496.40
|
| Rate for Payer: Cigna Commercial |
$4,772.52
|
| Rate for Payer: Health EOS Commercial |
$4,616.89
|
| Rate for Payer: HFN Commercial |
$4,772.52
|
| Rate for Payer: Multiplan Commercial |
$4,150.02
|
| Rate for Payer: Preferred Network Access Commercial |
$4,772.52
|
| Rate for Payer: Quartz Beloit One Network |
$2,541.88
|
| Rate for Payer: Quartz Commercial |
$3,112.51
|
| Rate for Payer: WEA Trust Commercial |
$2,853.14
|
| Rate for Payer: WPS Commercial |
$3,842.26
|
|
|
MRI Hip w/ Contrast Bilateral
|
Facility
|
IP
|
$10,169.00
|
|
|
Service Code
|
CPT 73722
|
| Hospital Charge Code |
630989
|
| Min. Negotiated Rate |
$5,182.12 |
| Max. Negotiated Rate |
$9,729.70 |
| Rate for Payer: Aetna Commercial |
$9,518.18
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,095.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,605.15
|
| Rate for Payer: Cash Price |
$3,050.70
|
| Rate for Payer: Cigna Commercial |
$9,729.70
|
| Rate for Payer: Health EOS Commercial |
$9,412.43
|
| Rate for Payer: HFN Commercial |
$9,729.70
|
| Rate for Payer: Multiplan Commercial |
$8,460.61
|
| Rate for Payer: Preferred Network Access Commercial |
$9,729.70
|
| Rate for Payer: Quartz Beloit One Network |
$5,182.12
|
| Rate for Payer: Quartz Commercial |
$6,345.46
|
| Rate for Payer: WEA Trust Commercial |
$5,816.67
|
| Rate for Payer: WPS Commercial |
$7,833.18
|
|
|
MRI Hip w/ Contrast Bilateral
|
Professional
|
Both
|
$10,169.00
|
|
|
Service Code
|
CPT 73722
|
| Hospital Charge Code |
630989
|
| Min. Negotiated Rate |
$313.63 |
| Max. Negotiated Rate |
$10,046.97 |
| Rate for Payer: Aetna Commercial |
$10,046.97
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,095.15
|
| Rate for Payer: Aetna Managed Medicare |
$313.63
|
| Rate for Payer: Anthem Medicare Advantage |
$313.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$313.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$313.63
|
| Rate for Payer: Cash Price |
$3,050.70
|
| Rate for Payer: Cash Price |
$3,050.70
|
| Rate for Payer: Cash Price |
$3,050.70
|
| Rate for Payer: Cigna Commercial |
$10,046.97
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$5,287.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$313.63
|
| Rate for Payer: Health EOS Commercial |
$9,623.94
|
| Rate for Payer: HFN Commercial |
$10,046.97
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,271.19
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,271.19
|
| Rate for Payer: Independent Care Health Plan Medicare |
$313.63
|
| Rate for Payer: Multiplan Commercial |
$8,460.61
|
| Rate for Payer: NAPHCARE Commercial |
$470.45
|
| Rate for Payer: Preferred Network Access Commercial |
$10,046.97
|
| Rate for Payer: Quartz Beloit One Network |
$4,653.33
|
| Rate for Payer: Quartz Commercial |
$6,028.18
|
| Rate for Payer: Quartz Medicare Advantage |
$313.63
|
| Rate for Payer: The Alliance Commercial |
$1,191.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$313.63
|
| Rate for Payer: WEA Trust Commercial |
$5,816.67
|
| Rate for Payer: WPS Commercial |
$1,568.16
|
|
|
MRI Hip w/ Contrast Bilateral
|
Professional
|
Both
|
$4,988.00
|
|
|
Service Code
|
CPT 73722 TC,LT
|
| Hospital Charge Code |
1611141
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,271.19 |
| Max. Negotiated Rate |
$4,928.14 |
| Rate for Payer: Aetna Commercial |
$4,928.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,461.27
|
| Rate for Payer: Cash Price |
$1,496.40
|
| Rate for Payer: Cash Price |
$1,496.40
|
| Rate for Payer: Cash Price |
$1,496.40
|
| Rate for Payer: Cigna Commercial |
$4,928.14
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,593.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,112.51
|
| Rate for Payer: Health EOS Commercial |
$4,720.64
|
| Rate for Payer: HFN Commercial |
$4,928.14
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,271.19
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,271.19
|
| Rate for Payer: Multiplan Commercial |
$4,150.02
|
| Rate for Payer: Preferred Network Access Commercial |
$4,928.14
|
| Rate for Payer: Quartz Beloit One Network |
$2,282.51
|
| Rate for Payer: Quartz Commercial |
$2,956.89
|
| Rate for Payer: The Alliance Commercial |
$2,593.76
|
| Rate for Payer: WEA Trust Commercial |
$2,853.14
|
| Rate for Payer: WPS Commercial |
$3,842.26
|
|
|
MRI Hip w/ Contrast Left
|
Facility
|
IP
|
$5,085.00
|
|
|
Service Code
|
CPT 73722
|
| Hospital Charge Code |
630994
|
| Min. Negotiated Rate |
$2,591.32 |
| Max. Negotiated Rate |
$4,865.33 |
| Rate for Payer: Aetna Commercial |
$4,759.56
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,548.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,802.85
|
| Rate for Payer: Cash Price |
$1,525.50
|
| Rate for Payer: Cigna Commercial |
$4,865.33
|
| Rate for Payer: Health EOS Commercial |
$4,706.68
|
| Rate for Payer: HFN Commercial |
$4,865.33
|
| Rate for Payer: Multiplan Commercial |
$4,230.72
|
| Rate for Payer: Preferred Network Access Commercial |
$4,865.33
|
| Rate for Payer: Quartz Beloit One Network |
$2,591.32
|
| Rate for Payer: Quartz Commercial |
$3,173.04
|
| Rate for Payer: WEA Trust Commercial |
$2,908.62
|
| Rate for Payer: WPS Commercial |
$3,916.98
|
|
|
MRI Hip w/ Contrast Left
|
Facility
|
OP
|
$5,180.00
|
|
|
Service Code
|
CPT 73722 TC,LT
|
| Hospital Charge Code |
1611143
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,508.42 |
| Max. Negotiated Rate |
$4,956.22 |
| Rate for Payer: Aetna Commercial |
$4,848.48
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,632.99
|
| Rate for Payer: Aetna Managed Medicare |
$1,508.42
|
| 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 |
$2,855.22
|
| Rate for Payer: Cash Price |
$1,554.00
|
| Rate for Payer: Cash Price |
$1,554.00
|
| Rate for Payer: Cash Price |
$1,554.00
|
| Rate for Payer: Cigna Commercial |
$4,956.22
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,014.76
|
| Rate for Payer: Health EOS Commercial |
$4,794.61
|
| Rate for Payer: HFN Commercial |
$4,956.22
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,040.40
|
| Rate for Payer: Multiplan Commercial |
$4,309.76
|
| Rate for Payer: NAPHCARE Commercial |
$3,232.32
|
| Rate for Payer: Preferred Network Access Commercial |
$4,956.22
|
| Rate for Payer: Quartz Beloit One Network |
$2,639.73
|
| Rate for Payer: Quartz Commercial |
$3,501.68
|
| Rate for Payer: Quartz Medicare Advantage |
$3,232.32
|
| Rate for Payer: The Alliance Commercial |
$2,693.60
|
| Rate for Payer: United Healthcare PPO |
$3,142.88
|
| Rate for Payer: WEA Trust Commercial |
$2,962.96
|
| Rate for Payer: WPS Commercial |
$3,990.15
|
|
|
MRI Hip w/ Contrast Left
|
Facility
|
IP
|
$5,180.00
|
|
|
Service Code
|
CPT 73722 TC,LT
|
| Hospital Charge Code |
1611143
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$2,639.73 |
| Max. Negotiated Rate |
$4,956.22 |
| Rate for Payer: Aetna Commercial |
$4,848.48
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,632.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,855.22
|
| Rate for Payer: Cash Price |
$1,554.00
|
| Rate for Payer: Cigna Commercial |
$4,956.22
|
| Rate for Payer: Health EOS Commercial |
$4,794.61
|
| Rate for Payer: HFN Commercial |
$4,956.22
|
| Rate for Payer: Multiplan Commercial |
$4,309.76
|
| Rate for Payer: Preferred Network Access Commercial |
$4,956.22
|
| Rate for Payer: Quartz Beloit One Network |
$2,639.73
|
| Rate for Payer: Quartz Commercial |
$3,232.32
|
| Rate for Payer: WEA Trust Commercial |
$2,962.96
|
| Rate for Payer: WPS Commercial |
$3,990.15
|
|
|
MRI Hip w/ Contrast Left
|
Professional
|
Both
|
$5,085.00
|
|
|
Service Code
|
CPT 73722
|
| Hospital Charge Code |
630994
|
| Min. Negotiated Rate |
$313.63 |
| Max. Negotiated Rate |
$5,023.98 |
| Rate for Payer: Aetna Commercial |
$5,023.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,548.02
|
| Rate for Payer: Aetna Managed Medicare |
$313.63
|
| Rate for Payer: Anthem Medicare Advantage |
$313.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$313.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$313.63
|
| Rate for Payer: Cash Price |
$1,525.50
|
| Rate for Payer: Cash Price |
$1,525.50
|
| Rate for Payer: Cash Price |
$1,525.50
|
| Rate for Payer: Cigna Commercial |
$5,023.98
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,644.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$313.63
|
| Rate for Payer: Health EOS Commercial |
$4,812.44
|
| Rate for Payer: HFN Commercial |
$5,023.98
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,271.19
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,271.19
|
| Rate for Payer: Independent Care Health Plan Medicare |
$313.63
|
| Rate for Payer: Multiplan Commercial |
$4,230.72
|
| Rate for Payer: NAPHCARE Commercial |
$470.45
|
| Rate for Payer: Preferred Network Access Commercial |
$5,023.98
|
| Rate for Payer: Quartz Beloit One Network |
$2,326.90
|
| Rate for Payer: Quartz Commercial |
$3,014.39
|
| Rate for Payer: Quartz Medicare Advantage |
$313.63
|
| Rate for Payer: The Alliance Commercial |
$1,191.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$313.63
|
| Rate for Payer: WEA Trust Commercial |
$2,908.62
|
| Rate for Payer: WPS Commercial |
$1,568.16
|
|
|
MRI Hip w/ Contrast Left
|
Facility
|
OP
|
$5,085.00
|
|
|
Service Code
|
CPT 73722
|
| Hospital Charge Code |
630994
|
| Min. Negotiated Rate |
$824.99 |
| Max. Negotiated Rate |
$4,865.33 |
| Rate for Payer: Aetna Commercial |
$4,759.56
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,548.02
|
| Rate for Payer: Aetna Managed Medicare |
$824.99
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,437.46
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,644.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,538.43
|
| Rate for Payer: Anthem Medicare Advantage |
$824.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,802.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$824.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$824.99
|
| Rate for Payer: Cash Price |
$1,525.50
|
| Rate for Payer: Cash Price |
$1,525.50
|
| Rate for Payer: Cigna Commercial |
$4,865.33
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$824.99
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,959.47
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$824.99
|
| Rate for Payer: Health EOS Commercial |
$4,706.68
|
| Rate for Payer: HFN Commercial |
$4,865.33
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,068.96
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$824.99
|
| Rate for Payer: Independent Care Health Plan Medicare |
$824.99
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$824.99
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$824.99
|
| Rate for Payer: Multiplan Commercial |
$4,230.72
|
| Rate for Payer: NAPHCARE Commercial |
$1,237.49
|
| Rate for Payer: Preferred Network Access Commercial |
$4,865.33
|
| Rate for Payer: Quartz Beloit One Network |
$2,591.32
|
| Rate for Payer: Quartz Commercial |
$3,437.46
|
| Rate for Payer: Quartz Medicare Advantage |
$824.99
|
| Rate for Payer: The Alliance Commercial |
$3,299.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$824.99
|
| Rate for Payer: WEA Trust Commercial |
$2,908.62
|
| Rate for Payer: Wellcare Medicare |
$824.99
|
| Rate for Payer: WPS Commercial |
$3,916.98
|
|
|
MRI Hip w/ Contrast Left
|
Professional
|
Both
|
$5,180.00
|
|
|
Service Code
|
CPT 73722 TC,LT
|
| Hospital Charge Code |
1611143
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,271.19 |
| Max. Negotiated Rate |
$5,117.84 |
| Rate for Payer: Aetna Commercial |
$5,117.84
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,632.99
|
| Rate for Payer: Cash Price |
$1,554.00
|
| Rate for Payer: Cash Price |
$1,554.00
|
| Rate for Payer: Cash Price |
$1,554.00
|
| Rate for Payer: Cigna Commercial |
$5,117.84
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,693.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,232.32
|
| Rate for Payer: Health EOS Commercial |
$4,902.35
|
| Rate for Payer: HFN Commercial |
$5,117.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,271.19
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,271.19
|
| Rate for Payer: Multiplan Commercial |
$4,309.76
|
| Rate for Payer: Preferred Network Access Commercial |
$5,117.84
|
| Rate for Payer: Quartz Beloit One Network |
$2,370.37
|
| Rate for Payer: Quartz Commercial |
$3,070.70
|
| Rate for Payer: The Alliance Commercial |
$2,693.60
|
| Rate for Payer: WEA Trust Commercial |
$2,962.96
|
| Rate for Payer: WPS Commercial |
$3,990.15
|
|
|
MRI Hip w/ Contrast Right
|
Facility
|
OP
|
$5,085.00
|
|
|
Service Code
|
CPT 73722
|
| Hospital Charge Code |
630999
|
| Min. Negotiated Rate |
$824.99 |
| Max. Negotiated Rate |
$4,865.33 |
| Rate for Payer: Aetna Commercial |
$4,759.56
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,548.02
|
| Rate for Payer: Aetna Managed Medicare |
$824.99
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,437.46
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,644.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,538.43
|
| Rate for Payer: Anthem Medicare Advantage |
$824.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,802.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$824.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$824.99
|
| Rate for Payer: Cash Price |
$1,525.50
|
| Rate for Payer: Cash Price |
$1,525.50
|
| Rate for Payer: Cigna Commercial |
$4,865.33
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$824.99
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,959.47
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$824.99
|
| Rate for Payer: Health EOS Commercial |
$4,706.68
|
| Rate for Payer: HFN Commercial |
$4,865.33
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,068.96
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$824.99
|
| Rate for Payer: Independent Care Health Plan Medicare |
$824.99
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$824.99
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$824.99
|
| Rate for Payer: Multiplan Commercial |
$4,230.72
|
| Rate for Payer: NAPHCARE Commercial |
$1,237.49
|
| Rate for Payer: Preferred Network Access Commercial |
$4,865.33
|
| Rate for Payer: Quartz Beloit One Network |
$2,591.32
|
| Rate for Payer: Quartz Commercial |
$3,437.46
|
| Rate for Payer: Quartz Medicare Advantage |
$824.99
|
| Rate for Payer: The Alliance Commercial |
$3,299.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$824.99
|
| Rate for Payer: WEA Trust Commercial |
$2,908.62
|
| Rate for Payer: Wellcare Medicare |
$824.99
|
| Rate for Payer: WPS Commercial |
$3,916.98
|
|
|
MRI Hip w/ Contrast Right
|
Professional
|
Both
|
$5,085.00
|
|
|
Service Code
|
CPT 73722
|
| Hospital Charge Code |
630999
|
| Min. Negotiated Rate |
$313.63 |
| Max. Negotiated Rate |
$5,023.98 |
| Rate for Payer: Aetna Commercial |
$5,023.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,548.02
|
| Rate for Payer: Aetna Managed Medicare |
$313.63
|
| Rate for Payer: Anthem Medicare Advantage |
$313.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$313.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$313.63
|
| Rate for Payer: Cash Price |
$1,525.50
|
| Rate for Payer: Cash Price |
$1,525.50
|
| Rate for Payer: Cash Price |
$1,525.50
|
| Rate for Payer: Cigna Commercial |
$5,023.98
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,644.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$313.63
|
| Rate for Payer: Health EOS Commercial |
$4,812.44
|
| Rate for Payer: HFN Commercial |
$5,023.98
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,271.19
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,271.19
|
| Rate for Payer: Independent Care Health Plan Medicare |
$313.63
|
| Rate for Payer: Multiplan Commercial |
$4,230.72
|
| Rate for Payer: NAPHCARE Commercial |
$470.45
|
| Rate for Payer: Preferred Network Access Commercial |
$5,023.98
|
| Rate for Payer: Quartz Beloit One Network |
$2,326.90
|
| Rate for Payer: Quartz Commercial |
$3,014.39
|
| Rate for Payer: Quartz Medicare Advantage |
$313.63
|
| Rate for Payer: The Alliance Commercial |
$1,191.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$313.63
|
| Rate for Payer: WEA Trust Commercial |
$2,908.62
|
| Rate for Payer: WPS Commercial |
$1,568.16
|
|
|
MRI Hip w/ Contrast Right
|
Facility
|
IP
|
$4,988.00
|
|
|
Service Code
|
CPT 73722 TC,RT
|
| Hospital Charge Code |
2980108
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$2,541.88 |
| Max. Negotiated Rate |
$4,772.52 |
| Rate for Payer: Aetna Commercial |
$4,668.77
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,461.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,749.39
|
| Rate for Payer: Cash Price |
$1,496.40
|
| Rate for Payer: Cigna Commercial |
$4,772.52
|
| Rate for Payer: Health EOS Commercial |
$4,616.89
|
| Rate for Payer: HFN Commercial |
$4,772.52
|
| Rate for Payer: Multiplan Commercial |
$4,150.02
|
| Rate for Payer: Preferred Network Access Commercial |
$4,772.52
|
| Rate for Payer: Quartz Beloit One Network |
$2,541.88
|
| Rate for Payer: Quartz Commercial |
$3,112.51
|
| Rate for Payer: WEA Trust Commercial |
$2,853.14
|
| Rate for Payer: WPS Commercial |
$3,842.26
|
|
|
MRI Hip w/ Contrast Right
|
Facility
|
OP
|
$4,988.00
|
|
|
Service Code
|
CPT 73722 TC,RT
|
| Hospital Charge Code |
2980108
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,452.51 |
| Max. Negotiated Rate |
$4,772.52 |
| Rate for Payer: Aetna Commercial |
$4,668.77
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,461.27
|
| Rate for Payer: Aetna Managed Medicare |
$1,452.51
|
| 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 |
$2,749.39
|
| Rate for Payer: Cash Price |
$1,496.40
|
| Rate for Payer: Cash Price |
$1,496.40
|
| Rate for Payer: Cash Price |
$1,496.40
|
| Rate for Payer: Cigna Commercial |
$4,772.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,903.02
|
| Rate for Payer: Health EOS Commercial |
$4,616.89
|
| Rate for Payer: HFN Commercial |
$4,772.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,890.64
|
| Rate for Payer: Multiplan Commercial |
$4,150.02
|
| Rate for Payer: NAPHCARE Commercial |
$3,112.51
|
| Rate for Payer: Preferred Network Access Commercial |
$4,772.52
|
| Rate for Payer: Quartz Beloit One Network |
$2,541.88
|
| Rate for Payer: Quartz Commercial |
$3,371.89
|
| Rate for Payer: Quartz Medicare Advantage |
$3,112.51
|
| Rate for Payer: The Alliance Commercial |
$2,593.76
|
| Rate for Payer: United Healthcare PPO |
$3,142.88
|
| Rate for Payer: WEA Trust Commercial |
$2,853.14
|
| Rate for Payer: WPS Commercial |
$3,842.26
|
|
|
MRI Hip w/ Contrast Right
|
Facility
|
IP
|
$5,085.00
|
|
|
Service Code
|
CPT 73722
|
| Hospital Charge Code |
630999
|
| Min. Negotiated Rate |
$2,591.32 |
| Max. Negotiated Rate |
$4,865.33 |
| Rate for Payer: Aetna Commercial |
$4,759.56
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,548.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,802.85
|
| Rate for Payer: Cash Price |
$1,525.50
|
| Rate for Payer: Cigna Commercial |
$4,865.33
|
| Rate for Payer: Health EOS Commercial |
$4,706.68
|
| Rate for Payer: HFN Commercial |
$4,865.33
|
| Rate for Payer: Multiplan Commercial |
$4,230.72
|
| Rate for Payer: Preferred Network Access Commercial |
$4,865.33
|
| Rate for Payer: Quartz Beloit One Network |
$2,591.32
|
| Rate for Payer: Quartz Commercial |
$3,173.04
|
| Rate for Payer: WEA Trust Commercial |
$2,908.62
|
| Rate for Payer: WPS Commercial |
$3,916.98
|
|
|
MRI Hip w/ Contrast Right
|
Facility
|
IP
|
$5,180.00
|
|
|
Service Code
|
CPT 73722 TC,RT
|
| Hospital Charge Code |
1611145
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$2,639.73 |
| Max. Negotiated Rate |
$4,956.22 |
| Rate for Payer: Aetna Commercial |
$4,848.48
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,632.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,855.22
|
| Rate for Payer: Cash Price |
$1,554.00
|
| Rate for Payer: Cigna Commercial |
$4,956.22
|
| Rate for Payer: Health EOS Commercial |
$4,794.61
|
| Rate for Payer: HFN Commercial |
$4,956.22
|
| Rate for Payer: Multiplan Commercial |
$4,309.76
|
| Rate for Payer: Preferred Network Access Commercial |
$4,956.22
|
| Rate for Payer: Quartz Beloit One Network |
$2,639.73
|
| Rate for Payer: Quartz Commercial |
$3,232.32
|
| Rate for Payer: WEA Trust Commercial |
$2,962.96
|
| Rate for Payer: WPS Commercial |
$3,990.15
|
|
|
MRI Hip w/ Contrast Right
|
Facility
|
OP
|
$5,180.00
|
|
|
Service Code
|
CPT 73722 TC,RT
|
| Hospital Charge Code |
1611145
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,508.42 |
| Max. Negotiated Rate |
$4,956.22 |
| Rate for Payer: Aetna Commercial |
$4,848.48
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,632.99
|
| Rate for Payer: Aetna Managed Medicare |
$1,508.42
|
| 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 |
$2,855.22
|
| Rate for Payer: Cash Price |
$1,554.00
|
| Rate for Payer: Cash Price |
$1,554.00
|
| Rate for Payer: Cash Price |
$1,554.00
|
| Rate for Payer: Cigna Commercial |
$4,956.22
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,014.76
|
| Rate for Payer: Health EOS Commercial |
$4,794.61
|
| Rate for Payer: HFN Commercial |
$4,956.22
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,040.40
|
| Rate for Payer: Multiplan Commercial |
$4,309.76
|
| Rate for Payer: NAPHCARE Commercial |
$3,232.32
|
| Rate for Payer: Preferred Network Access Commercial |
$4,956.22
|
| Rate for Payer: Quartz Beloit One Network |
$2,639.73
|
| Rate for Payer: Quartz Commercial |
$3,501.68
|
| Rate for Payer: Quartz Medicare Advantage |
$3,232.32
|
| Rate for Payer: The Alliance Commercial |
$2,693.60
|
| Rate for Payer: United Healthcare PPO |
$3,142.88
|
| Rate for Payer: WEA Trust Commercial |
$2,962.96
|
| Rate for Payer: WPS Commercial |
$3,990.15
|
|
|
MRI Hip w/ Contrast Right
|
Professional
|
Both
|
$5,180.00
|
|
|
Service Code
|
CPT 73722 TC,RT
|
| Hospital Charge Code |
1611145
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,271.19 |
| Max. Negotiated Rate |
$5,117.84 |
| Rate for Payer: Aetna Commercial |
$5,117.84
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,632.99
|
| Rate for Payer: Cash Price |
$1,554.00
|
| Rate for Payer: Cash Price |
$1,554.00
|
| Rate for Payer: Cash Price |
$1,554.00
|
| Rate for Payer: Cigna Commercial |
$5,117.84
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,693.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,232.32
|
| Rate for Payer: Health EOS Commercial |
$4,902.35
|
| Rate for Payer: HFN Commercial |
$5,117.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,271.19
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,271.19
|
| Rate for Payer: Multiplan Commercial |
$4,309.76
|
| Rate for Payer: Preferred Network Access Commercial |
$5,117.84
|
| Rate for Payer: Quartz Beloit One Network |
$2,370.37
|
| Rate for Payer: Quartz Commercial |
$3,070.70
|
| Rate for Payer: The Alliance Commercial |
$2,693.60
|
| Rate for Payer: WEA Trust Commercial |
$2,962.96
|
| Rate for Payer: WPS Commercial |
$3,990.15
|
|
|
MRI Hip w/ Contrast Right
|
Professional
|
Both
|
$4,988.00
|
|
|
Service Code
|
CPT 73722 TC,RT
|
| Hospital Charge Code |
2980108
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,271.19 |
| Max. Negotiated Rate |
$4,928.14 |
| Rate for Payer: Aetna Commercial |
$4,928.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,461.27
|
| Rate for Payer: Cash Price |
$1,496.40
|
| Rate for Payer: Cash Price |
$1,496.40
|
| Rate for Payer: Cash Price |
$1,496.40
|
| Rate for Payer: Cigna Commercial |
$4,928.14
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,593.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,112.51
|
| Rate for Payer: Health EOS Commercial |
$4,720.64
|
| Rate for Payer: HFN Commercial |
$4,928.14
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,271.19
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,271.19
|
| Rate for Payer: Multiplan Commercial |
$4,150.02
|
| Rate for Payer: Preferred Network Access Commercial |
$4,928.14
|
| Rate for Payer: Quartz Beloit One Network |
$2,282.51
|
| Rate for Payer: Quartz Commercial |
$2,956.89
|
| Rate for Payer: The Alliance Commercial |
$2,593.76
|
| Rate for Payer: WEA Trust Commercial |
$2,853.14
|
| Rate for Payer: WPS Commercial |
$3,842.26
|
|
|
MRI Hip w/o Contrast Bilateral
|
Professional
|
Both
|
$9,048.00
|
|
|
Service Code
|
CPT 73721
|
| Hospital Charge Code |
631002
|
| Min. Negotiated Rate |
$203.56 |
| Max. Negotiated Rate |
$8,939.42 |
| Rate for Payer: Aetna Commercial |
$8,939.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,092.53
|
| Rate for Payer: Aetna Managed Medicare |
$203.56
|
| Rate for Payer: Anthem Medicare Advantage |
$203.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$203.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$203.56
|
| Rate for Payer: Cash Price |
$2,714.40
|
| Rate for Payer: Cash Price |
$2,714.40
|
| Rate for Payer: Cash Price |
$2,714.40
|
| Rate for Payer: Cigna Commercial |
$8,939.42
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$4,704.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$203.56
|
| Rate for Payer: Health EOS Commercial |
$8,563.03
|
| Rate for Payer: HFN Commercial |
$8,939.42
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$792.57
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$792.57
|
| Rate for Payer: Independent Care Health Plan Medicare |
$203.56
|
| Rate for Payer: Multiplan Commercial |
$7,527.94
|
| Rate for Payer: NAPHCARE Commercial |
$305.34
|
| Rate for Payer: Preferred Network Access Commercial |
$8,939.42
|
| Rate for Payer: Quartz Beloit One Network |
$4,140.36
|
| Rate for Payer: Quartz Commercial |
$5,363.65
|
| Rate for Payer: Quartz Medicare Advantage |
$203.56
|
| Rate for Payer: The Alliance Commercial |
$773.52
|
| Rate for Payer: United Healthcare Medicare Advantage |
$203.56
|
| Rate for Payer: WEA Trust Commercial |
$5,175.46
|
| Rate for Payer: WPS Commercial |
$1,017.80
|
|
