|
MRI Spine Cervical, Brac Plex w/o Right
|
Professional
|
Both
|
$4,810.00
|
|
|
Service Code
|
CPT 73218 TC,RT
|
| Hospital Charge Code |
1611278
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,180.61 |
| Max. Negotiated Rate |
$4,569.50 |
| Rate for Payer: Aetna Commercial |
$4,569.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,136.60
|
| Rate for Payer: Cash Price |
$1,443.00
|
| Rate for Payer: Cash Price |
$1,443.00
|
| Rate for Payer: Cash Price |
$1,443.00
|
| Rate for Payer: Cigna Commercial |
$4,569.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,405.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,886.00
|
| Rate for Payer: Health EOS Commercial |
$4,377.10
|
| Rate for Payer: HFN Commercial |
$4,569.50
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,180.61
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,180.61
|
| Rate for Payer: Multiplan Commercial |
$3,848.00
|
| Rate for Payer: Preferred Network Access Commercial |
$4,569.50
|
| Rate for Payer: Quartz Beloit One Network |
$2,116.40
|
| Rate for Payer: Quartz Commercial |
$2,741.70
|
| Rate for Payer: The Alliance Commercial |
$2,405.00
|
| Rate for Payer: WEA Trust Commercial |
$2,645.50
|
| Rate for Payer: WPS Commercial |
$3,562.77
|
|
|
MRI Spine Cervical, Brac Plex w + w/o Lt
|
Facility
|
IP
|
$5,880.00
|
|
|
Service Code
|
CPT 73220 TC,LT
|
| Hospital Charge Code |
1611269
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$2,881.20 |
| Max. Negotiated Rate |
$5,409.60 |
| Rate for Payer: Aetna Commercial |
$5,292.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,056.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,116.40
|
| Rate for Payer: Cash Price |
$1,764.00
|
| Rate for Payer: Cigna Commercial |
$5,409.60
|
| Rate for Payer: Health EOS Commercial |
$5,233.20
|
| Rate for Payer: HFN Commercial |
$5,409.60
|
| Rate for Payer: Multiplan Commercial |
$4,704.00
|
| Rate for Payer: NAPHCARE Commercial |
$3,528.00
|
| Rate for Payer: Preferred Network Access Commercial |
$5,409.60
|
| Rate for Payer: Quartz Beloit One Network |
$2,881.20
|
| Rate for Payer: Quartz Commercial |
$3,528.00
|
| Rate for Payer: WEA Trust Commercial |
$3,234.00
|
| Rate for Payer: WPS Commercial |
$4,355.32
|
|
|
MRI Spine Cervical, Brac Plex w + w/o Lt
|
Professional
|
Both
|
$5,880.00
|
|
|
Service Code
|
CPT 73220 TC,LT
|
| Hospital Charge Code |
1611269
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,596.12 |
| Max. Negotiated Rate |
$5,586.00 |
| Rate for Payer: Aetna Commercial |
$5,586.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,056.80
|
| Rate for Payer: Cash Price |
$1,764.00
|
| Rate for Payer: Cash Price |
$1,764.00
|
| Rate for Payer: Cash Price |
$1,764.00
|
| Rate for Payer: Cigna Commercial |
$5,586.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,940.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,528.00
|
| Rate for Payer: Health EOS Commercial |
$5,350.80
|
| Rate for Payer: HFN Commercial |
$5,586.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,596.12
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,596.12
|
| Rate for Payer: Multiplan Commercial |
$4,704.00
|
| Rate for Payer: Preferred Network Access Commercial |
$5,586.00
|
| Rate for Payer: Quartz Beloit One Network |
$2,587.20
|
| Rate for Payer: Quartz Commercial |
$3,351.60
|
| Rate for Payer: The Alliance Commercial |
$2,940.00
|
| Rate for Payer: WEA Trust Commercial |
$3,234.00
|
| Rate for Payer: WPS Commercial |
$4,355.32
|
|
|
MRI Spine Cervical, Brac Plex w + w/o Lt
|
Facility
|
OP
|
$5,880.00
|
|
|
Service Code
|
CPT 73220 TC,LT
|
| Hospital Charge Code |
1611269
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$380.12 |
| Max. Negotiated Rate |
$5,409.60 |
| Rate for Payer: Aetna Commercial |
$5,292.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,056.80
|
| 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 |
$3,116.40
|
| 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 |
$1,764.00
|
| Rate for Payer: Cash Price |
$1,764.00
|
| Rate for Payer: Cash Price |
$1,764.00
|
| Rate for Payer: Cash Price |
$1,764.00
|
| Rate for Payer: Cigna Commercial |
$5,409.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$380.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,290.45
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$380.12
|
| Rate for Payer: Health EOS Commercial |
$5,233.20
|
| Rate for Payer: HFN Commercial |
$5,409.60
|
| 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 |
$4,704.00
|
| Rate for Payer: NAPHCARE Commercial |
$570.18
|
| Rate for Payer: Preferred Network Access Commercial |
$5,409.60
|
| Rate for Payer: Quartz Beloit One Network |
$2,881.20
|
| Rate for Payer: Quartz Commercial |
$3,822.00
|
| 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 |
$3,234.00
|
| Rate for Payer: Wellcare Medicare |
$380.12
|
| Rate for Payer: WPS Commercial |
$4,355.32
|
|
|
MRI Spine Cervical, Brac Plex w + w/o Rt
|
Professional
|
Both
|
$5,880.00
|
|
|
Service Code
|
CPT 72156 TC,RT
|
| Hospital Charge Code |
1611272
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,223.15 |
| Max. Negotiated Rate |
$5,586.00 |
| Rate for Payer: Aetna Commercial |
$5,586.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,056.80
|
| Rate for Payer: Cash Price |
$1,764.00
|
| Rate for Payer: Cash Price |
$1,764.00
|
| Rate for Payer: Cash Price |
$1,764.00
|
| Rate for Payer: Cigna Commercial |
$5,586.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,940.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,528.00
|
| Rate for Payer: Health EOS Commercial |
$5,350.80
|
| Rate for Payer: HFN Commercial |
$5,586.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,223.15
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,223.15
|
| Rate for Payer: Multiplan Commercial |
$4,704.00
|
| Rate for Payer: Preferred Network Access Commercial |
$5,586.00
|
| Rate for Payer: Quartz Beloit One Network |
$2,587.20
|
| Rate for Payer: Quartz Commercial |
$3,351.60
|
| Rate for Payer: The Alliance Commercial |
$2,940.00
|
| Rate for Payer: WEA Trust Commercial |
$3,234.00
|
| Rate for Payer: WPS Commercial |
$4,355.32
|
|
|
MRI Spine Cervical, Brac Plex w + w/o Rt
|
Facility
|
OP
|
$5,880.00
|
|
|
Service Code
|
CPT 72156 TC,RT
|
| Hospital Charge Code |
1611272
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$380.12 |
| Max. Negotiated Rate |
$5,409.60 |
| Rate for Payer: Aetna Commercial |
$5,292.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,056.80
|
| 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 |
$3,116.40
|
| 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 |
$1,764.00
|
| Rate for Payer: Cash Price |
$1,764.00
|
| Rate for Payer: Cash Price |
$1,764.00
|
| Rate for Payer: Cash Price |
$1,764.00
|
| Rate for Payer: Cigna Commercial |
$5,409.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$380.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,290.45
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$380.12
|
| Rate for Payer: Health EOS Commercial |
$5,233.20
|
| Rate for Payer: HFN Commercial |
$5,409.60
|
| 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 |
$4,704.00
|
| Rate for Payer: NAPHCARE Commercial |
$570.18
|
| Rate for Payer: Preferred Network Access Commercial |
$5,409.60
|
| Rate for Payer: Quartz Beloit One Network |
$2,881.20
|
| Rate for Payer: Quartz Commercial |
$3,822.00
|
| 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 |
$3,234.00
|
| Rate for Payer: Wellcare Medicare |
$380.12
|
| Rate for Payer: WPS Commercial |
$4,355.32
|
|
|
MRI Spine Cervical, Brac Plex w + w/o Rt
|
Facility
|
IP
|
$5,880.00
|
|
|
Service Code
|
CPT 72156 TC,RT
|
| Hospital Charge Code |
1611272
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$2,881.20 |
| Max. Negotiated Rate |
$5,409.60 |
| Rate for Payer: Aetna Commercial |
$5,292.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,056.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,116.40
|
| Rate for Payer: Cash Price |
$1,764.00
|
| Rate for Payer: Cigna Commercial |
$5,409.60
|
| Rate for Payer: Health EOS Commercial |
$5,233.20
|
| Rate for Payer: HFN Commercial |
$5,409.60
|
| Rate for Payer: Multiplan Commercial |
$4,704.00
|
| Rate for Payer: NAPHCARE Commercial |
$3,528.00
|
| Rate for Payer: Preferred Network Access Commercial |
$5,409.60
|
| Rate for Payer: Quartz Beloit One Network |
$2,881.20
|
| Rate for Payer: Quartz Commercial |
$3,528.00
|
| Rate for Payer: WEA Trust Commercial |
$3,234.00
|
| Rate for Payer: WPS Commercial |
$4,355.32
|
|
|
MRI Spine Cervical w/ Contrast
|
Professional
|
Both
|
$5,965.00
|
|
|
Service Code
|
CPT 72142 TC
|
| Hospital Charge Code |
1611265
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$751.47 |
| 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 |
$751.47
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$751.47
|
| 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 Spine Cervical w/ Contrast
|
Facility
|
IP
|
$5,965.00
|
|
|
Service Code
|
CPT 72142 TC
|
| Hospital Charge Code |
1611265
|
|
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 Spine Cervical w/ Contrast
|
Professional
|
Both
|
$6,080.00
|
|
|
Service Code
|
CPT 72142
|
| Hospital Charge Code |
629596
|
| Min. Negotiated Rate |
$1,049.40 |
| 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 |
$1,049.40
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,049.40
|
| 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 Spine Cervical w/ Contrast
|
Facility
|
OP
|
$5,965.00
|
|
|
Service Code
|
CPT 72142 TC
|
| Hospital Charge Code |
1611265
|
|
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 Spine Cervical w/ Contrast
|
Facility
|
IP
|
$6,080.00
|
|
|
Service Code
|
CPT 72142
|
| Hospital Charge Code |
629596
|
| 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 Spine Cervical w/ Contrast
|
Facility
|
OP
|
$6,080.00
|
|
|
Service Code
|
CPT 72142
|
| Hospital Charge Code |
629596
|
| 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 Spine Cervical w/o Contrast
|
Facility
|
IP
|
$5,058.00
|
|
|
Service Code
|
CPT 72141 TC
|
| Hospital Charge Code |
1611267
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$2,478.42 |
| Max. Negotiated Rate |
$4,653.36 |
| Rate for Payer: Aetna Commercial |
$4,552.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,349.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,680.74
|
| Rate for Payer: Cash Price |
$1,517.40
|
| Rate for Payer: Cigna Commercial |
$4,653.36
|
| Rate for Payer: Health EOS Commercial |
$4,501.62
|
| Rate for Payer: HFN Commercial |
$4,653.36
|
| Rate for Payer: Multiplan Commercial |
$4,046.40
|
| Rate for Payer: NAPHCARE Commercial |
$3,034.80
|
| Rate for Payer: Preferred Network Access Commercial |
$4,653.36
|
| Rate for Payer: Quartz Beloit One Network |
$2,478.42
|
| Rate for Payer: Quartz Commercial |
$3,034.80
|
| Rate for Payer: WEA Trust Commercial |
$2,781.90
|
| Rate for Payer: WPS Commercial |
$3,746.46
|
|
|
MRI Spine Cervical w/o Contrast
|
Facility
|
OP
|
$5,058.00
|
|
|
Service Code
|
CPT 72141 TC
|
| Hospital Charge Code |
3072640
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$242.20 |
| Max. Negotiated Rate |
$4,653.36 |
| Rate for Payer: Aetna Commercial |
$4,552.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,349.88
|
| 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 |
$2,680.74
|
| 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 |
$1,517.40
|
| Rate for Payer: Cash Price |
$1,517.40
|
| Rate for Payer: Cash Price |
$1,517.40
|
| Rate for Payer: Cash Price |
$1,517.40
|
| Rate for Payer: Cigna Commercial |
$4,653.36
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$242.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,830.46
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$242.20
|
| Rate for Payer: Health EOS Commercial |
$4,501.62
|
| Rate for Payer: HFN Commercial |
$4,653.36
|
| 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 |
$4,046.40
|
| Rate for Payer: NAPHCARE Commercial |
$363.30
|
| Rate for Payer: Preferred Network Access Commercial |
$4,653.36
|
| Rate for Payer: Quartz Beloit One Network |
$2,478.42
|
| Rate for Payer: Quartz Commercial |
$3,287.70
|
| 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 |
$2,781.90
|
| Rate for Payer: Wellcare Medicare |
$242.20
|
| Rate for Payer: WPS Commercial |
$3,746.46
|
|
|
MRI Spine Cervical w/o Contrast
|
Professional
|
Both
|
$5,058.00
|
|
|
Service Code
|
CPT 72141 TC
|
| Hospital Charge Code |
3072640
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$474.93 |
| Max. Negotiated Rate |
$4,805.10 |
| Rate for Payer: Aetna Commercial |
$4,805.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,349.88
|
| Rate for Payer: Cash Price |
$1,517.40
|
| Rate for Payer: Cash Price |
$1,517.40
|
| Rate for Payer: Cash Price |
$1,517.40
|
| Rate for Payer: Cigna Commercial |
$4,805.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,529.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,034.80
|
| Rate for Payer: Health EOS Commercial |
$4,602.78
|
| Rate for Payer: HFN Commercial |
$4,805.10
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$474.93
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$474.93
|
| Rate for Payer: Multiplan Commercial |
$4,046.40
|
| Rate for Payer: Preferred Network Access Commercial |
$4,805.10
|
| Rate for Payer: Quartz Beloit One Network |
$2,225.52
|
| Rate for Payer: Quartz Commercial |
$2,883.06
|
| Rate for Payer: The Alliance Commercial |
$2,529.00
|
| Rate for Payer: WEA Trust Commercial |
$2,781.90
|
| Rate for Payer: WPS Commercial |
$3,746.46
|
|
|
MRI Spine Cervical w/o Contrast
|
Facility
|
IP
|
$5,058.00
|
|
|
Service Code
|
CPT 72141 TC
|
| Hospital Charge Code |
3072640
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$2,478.42 |
| Max. Negotiated Rate |
$4,653.36 |
| Rate for Payer: Aetna Commercial |
$4,552.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,349.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,680.74
|
| Rate for Payer: Cash Price |
$1,517.40
|
| Rate for Payer: Cigna Commercial |
$4,653.36
|
| Rate for Payer: Health EOS Commercial |
$4,501.62
|
| Rate for Payer: HFN Commercial |
$4,653.36
|
| Rate for Payer: Multiplan Commercial |
$4,046.40
|
| Rate for Payer: NAPHCARE Commercial |
$3,034.80
|
| Rate for Payer: Preferred Network Access Commercial |
$4,653.36
|
| Rate for Payer: Quartz Beloit One Network |
$2,478.42
|
| Rate for Payer: Quartz Commercial |
$3,034.80
|
| Rate for Payer: WEA Trust Commercial |
$2,781.90
|
| Rate for Payer: WPS Commercial |
$3,746.46
|
|
|
MRI Spine Cervical w/o Contrast
|
Facility
|
IP
|
$4,633.00
|
|
|
Service Code
|
CPT 72141
|
| Hospital Charge Code |
629598
|
| Min. Negotiated Rate |
$2,270.17 |
| Max. Negotiated Rate |
$4,262.36 |
| Rate for Payer: Aetna Commercial |
$4,169.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,984.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,455.49
|
| Rate for Payer: Cash Price |
$1,389.90
|
| Rate for Payer: Cigna Commercial |
$4,262.36
|
| Rate for Payer: Health EOS Commercial |
$4,123.37
|
| Rate for Payer: HFN Commercial |
$4,262.36
|
| Rate for Payer: Multiplan Commercial |
$3,706.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,779.80
|
| Rate for Payer: Preferred Network Access Commercial |
$4,262.36
|
| Rate for Payer: Quartz Beloit One Network |
$2,270.17
|
| Rate for Payer: Quartz Commercial |
$2,779.80
|
| Rate for Payer: WEA Trust Commercial |
$2,548.15
|
| Rate for Payer: WPS Commercial |
$3,431.66
|
|
|
MRI Spine Cervical w/o Contrast
|
Facility
|
OP
|
$4,633.00
|
|
|
Service Code
|
CPT 72141
|
| Hospital Charge Code |
629598
|
| Min. Negotiated Rate |
$242.20 |
| Max. Negotiated Rate |
$4,262.36 |
| Rate for Payer: Aetna Commercial |
$4,169.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,984.38
|
| Rate for Payer: Aetna Managed Medicare |
$242.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,011.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,316.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,223.84
|
| Rate for Payer: Anthem Medicare Advantage |
$242.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,455.49
|
| 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 |
$1,389.90
|
| Rate for Payer: Cash Price |
$1,389.90
|
| Rate for Payer: Cigna Commercial |
$4,262.36
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$242.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,592.63
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$242.20
|
| Rate for Payer: Health EOS Commercial |
$4,123.37
|
| Rate for Payer: HFN Commercial |
$4,262.36
|
| 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 |
$3,706.40
|
| Rate for Payer: NAPHCARE Commercial |
$363.30
|
| Rate for Payer: Preferred Network Access Commercial |
$4,262.36
|
| Rate for Payer: Quartz Beloit One Network |
$2,270.17
|
| Rate for Payer: Quartz Commercial |
$3,011.45
|
| 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 |
$2,548.15
|
| Rate for Payer: Wellcare Medicare |
$242.20
|
| Rate for Payer: WPS Commercial |
$3,431.66
|
|
|
MRI Spine Cervical w/o Contrast
|
Professional
|
Both
|
$4,633.00
|
|
|
Service Code
|
CPT 72141
|
| Hospital Charge Code |
629598
|
| Min. Negotiated Rate |
$722.06 |
| Max. Negotiated Rate |
$4,401.35 |
| Rate for Payer: Aetna Commercial |
$4,401.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,984.38
|
| Rate for Payer: Cash Price |
$1,389.90
|
| Rate for Payer: Cash Price |
$1,389.90
|
| Rate for Payer: Cash Price |
$1,389.90
|
| Rate for Payer: Cigna Commercial |
$4,401.35
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,316.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,779.80
|
| Rate for Payer: Health EOS Commercial |
$4,216.03
|
| Rate for Payer: HFN Commercial |
$4,401.35
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$722.06
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$722.06
|
| Rate for Payer: Multiplan Commercial |
$3,706.40
|
| Rate for Payer: Preferred Network Access Commercial |
$4,401.35
|
| Rate for Payer: Quartz Beloit One Network |
$2,038.52
|
| Rate for Payer: Quartz Commercial |
$2,640.81
|
| Rate for Payer: The Alliance Commercial |
$2,316.50
|
| Rate for Payer: WEA Trust Commercial |
$2,548.15
|
| Rate for Payer: WPS Commercial |
$3,431.66
|
|
|
MRI Spine Cervical w/o Contrast
|
Professional
|
Both
|
$5,058.00
|
|
|
Service Code
|
CPT 72141 TC
|
| Hospital Charge Code |
1611267
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$474.93 |
| Max. Negotiated Rate |
$4,805.10 |
| Rate for Payer: Aetna Commercial |
$4,805.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,349.88
|
| Rate for Payer: Cash Price |
$1,517.40
|
| Rate for Payer: Cash Price |
$1,517.40
|
| Rate for Payer: Cash Price |
$1,517.40
|
| Rate for Payer: Cigna Commercial |
$4,805.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,529.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,034.80
|
| Rate for Payer: Health EOS Commercial |
$4,602.78
|
| Rate for Payer: HFN Commercial |
$4,805.10
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$474.93
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$474.93
|
| Rate for Payer: Multiplan Commercial |
$4,046.40
|
| Rate for Payer: Preferred Network Access Commercial |
$4,805.10
|
| Rate for Payer: Quartz Beloit One Network |
$2,225.52
|
| Rate for Payer: Quartz Commercial |
$2,883.06
|
| Rate for Payer: The Alliance Commercial |
$2,529.00
|
| Rate for Payer: WEA Trust Commercial |
$2,781.90
|
| Rate for Payer: WPS Commercial |
$3,746.46
|
|
|
MRI Spine Cervical w/o Contrast
|
Facility
|
OP
|
$5,058.00
|
|
|
Service Code
|
CPT 72141 TC
|
| Hospital Charge Code |
1611267
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$242.20 |
| Max. Negotiated Rate |
$4,653.36 |
| Rate for Payer: Aetna Commercial |
$4,552.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,349.88
|
| 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 |
$2,680.74
|
| 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 |
$1,517.40
|
| Rate for Payer: Cash Price |
$1,517.40
|
| Rate for Payer: Cash Price |
$1,517.40
|
| Rate for Payer: Cash Price |
$1,517.40
|
| Rate for Payer: Cigna Commercial |
$4,653.36
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$242.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,830.46
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$242.20
|
| Rate for Payer: Health EOS Commercial |
$4,501.62
|
| Rate for Payer: HFN Commercial |
$4,653.36
|
| 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 |
$4,046.40
|
| Rate for Payer: NAPHCARE Commercial |
$363.30
|
| Rate for Payer: Preferred Network Access Commercial |
$4,653.36
|
| Rate for Payer: Quartz Beloit One Network |
$2,478.42
|
| Rate for Payer: Quartz Commercial |
$3,287.70
|
| 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 |
$2,781.90
|
| Rate for Payer: Wellcare Medicare |
$242.20
|
| Rate for Payer: WPS Commercial |
$3,746.46
|
|
|
MRI Spine Cervical w/ + w/o Contrast
|
Facility
|
IP
|
$6,235.00
|
|
|
Service Code
|
CPT 72156
|
| Hospital Charge Code |
629594
|
| Min. Negotiated Rate |
$3,055.15 |
| Max. Negotiated Rate |
$5,736.20 |
| Rate for Payer: Aetna Commercial |
$5,611.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,362.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,304.55
|
| Rate for Payer: Cash Price |
$1,870.50
|
| Rate for Payer: Cigna Commercial |
$5,736.20
|
| Rate for Payer: Health EOS Commercial |
$5,549.15
|
| Rate for Payer: HFN Commercial |
$5,736.20
|
| Rate for Payer: Multiplan Commercial |
$4,988.00
|
| Rate for Payer: NAPHCARE Commercial |
$3,741.00
|
| Rate for Payer: Preferred Network Access Commercial |
$5,736.20
|
| Rate for Payer: Quartz Beloit One Network |
$3,055.15
|
| Rate for Payer: Quartz Commercial |
$3,741.00
|
| Rate for Payer: WEA Trust Commercial |
$3,429.25
|
| Rate for Payer: WPS Commercial |
$4,618.26
|
|
|
MRI Spine Cervical w/ + w/o Contrast
|
Facility
|
OP
|
$6,351.00
|
|
|
Service Code
|
CPT 72156 TC
|
| Hospital Charge Code |
1611263
|
|
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 Spine Cervical w/ + w/o Contrast
|
Professional
|
Both
|
$6,351.00
|
|
|
Service Code
|
CPT 72156 TC
|
| Hospital Charge Code |
1611263
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$840.78 |
| 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 |
$840.78
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$840.78
|
| 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
|
|
