|
MRI Hip w/ + w/o Contrast Left
|
Facility
|
IP
|
$6,080.00
|
|
|
Service Code
|
CPT 73723
|
| Hospital Charge Code |
630981
|
| Min. Negotiated Rate |
$3,098.37 |
| Max. Negotiated Rate |
$5,817.34 |
| Rate for Payer: Aetna Commercial |
$5,690.88
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,437.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,351.30
|
| Rate for Payer: Cash Price |
$1,824.00
|
| Rate for Payer: Cigna Commercial |
$5,817.34
|
| Rate for Payer: Health EOS Commercial |
$5,627.65
|
| Rate for Payer: HFN Commercial |
$5,817.34
|
| Rate for Payer: Multiplan Commercial |
$5,058.56
|
| Rate for Payer: Preferred Network Access Commercial |
$5,817.34
|
| Rate for Payer: Quartz Beloit One Network |
$3,098.37
|
| Rate for Payer: Quartz Commercial |
$3,793.92
|
| Rate for Payer: WEA Trust Commercial |
$3,477.76
|
| Rate for Payer: WPS Commercial |
$4,683.42
|
|
|
MRI Hip w/ + w/o Contrast Left
|
Facility
|
OP
|
$6,080.00
|
|
|
Service Code
|
CPT 73723
|
| Hospital Charge Code |
630981
|
| Min. Negotiated Rate |
$367.15 |
| Max. Negotiated Rate |
$5,817.34 |
| Rate for Payer: Aetna Commercial |
$5,690.88
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,437.95
|
| Rate for Payer: Aetna Managed Medicare |
$367.15
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,110.08
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,161.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,035.14
|
| Rate for Payer: Anthem Medicare Advantage |
$367.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,351.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$367.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$367.15
|
| Rate for Payer: Cash Price |
$1,824.00
|
| Rate for Payer: Cash Price |
$1,824.00
|
| Rate for Payer: Cigna Commercial |
$5,817.34
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$367.15
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,538.56
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$367.15
|
| Rate for Payer: Health EOS Commercial |
$5,627.65
|
| Rate for Payer: HFN Commercial |
$5,817.34
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,365.80
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$367.15
|
| Rate for Payer: Independent Care Health Plan Medicare |
$367.15
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$367.15
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$367.15
|
| Rate for Payer: Multiplan Commercial |
$5,058.56
|
| Rate for Payer: NAPHCARE Commercial |
$550.73
|
| Rate for Payer: Preferred Network Access Commercial |
$5,817.34
|
| Rate for Payer: Quartz Beloit One Network |
$3,098.37
|
| Rate for Payer: Quartz Commercial |
$4,110.08
|
| Rate for Payer: Quartz Medicare Advantage |
$367.15
|
| Rate for Payer: The Alliance Commercial |
$1,468.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$367.15
|
| Rate for Payer: WEA Trust Commercial |
$3,477.76
|
| Rate for Payer: Wellcare Medicare |
$367.15
|
| Rate for Payer: WPS Commercial |
$4,683.42
|
|
|
MRI Hip w/ + w/o Contrast Left
|
Facility
|
OP
|
$6,295.00
|
|
|
Service Code
|
CPT 73723 TC,LT
|
| Hospital Charge Code |
1611137
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,833.10 |
| Max. Negotiated Rate |
$6,023.06 |
| Rate for Payer: Aetna Commercial |
$5,892.12
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,630.25
|
| Rate for Payer: Aetna Managed Medicare |
$1,833.10
|
| 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 |
$3,469.80
|
| Rate for Payer: Cash Price |
$1,888.50
|
| Rate for Payer: Cash Price |
$1,888.50
|
| Rate for Payer: Cash Price |
$1,888.50
|
| Rate for Payer: Cigna Commercial |
$6,023.06
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,663.69
|
| Rate for Payer: Health EOS Commercial |
$5,826.65
|
| Rate for Payer: HFN Commercial |
$6,023.06
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,910.10
|
| Rate for Payer: Multiplan Commercial |
$5,237.44
|
| Rate for Payer: NAPHCARE Commercial |
$3,928.08
|
| Rate for Payer: Preferred Network Access Commercial |
$6,023.06
|
| Rate for Payer: Quartz Beloit One Network |
$3,207.93
|
| Rate for Payer: Quartz Commercial |
$4,255.42
|
| Rate for Payer: Quartz Medicare Advantage |
$3,928.08
|
| Rate for Payer: The Alliance Commercial |
$3,273.40
|
| Rate for Payer: United Healthcare PPO |
$3,142.88
|
| Rate for Payer: WEA Trust Commercial |
$3,600.74
|
| Rate for Payer: WPS Commercial |
$4,849.04
|
|
|
MRI Hip w/ + w/o Contrast Left
|
Facility
|
OP
|
$5,965.00
|
|
|
Service Code
|
CPT 73723 TC,LT
|
| Hospital Charge Code |
3072727
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,737.01 |
| Max. Negotiated Rate |
$5,707.31 |
| Rate for Payer: Aetna Commercial |
$5,583.24
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,335.10
|
| Rate for Payer: Aetna Managed Medicare |
$1,737.01
|
| 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 |
$3,287.91
|
| 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 |
$5,707.31
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,471.63
|
| Rate for Payer: Health EOS Commercial |
$5,521.20
|
| Rate for Payer: HFN Commercial |
$5,707.31
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,652.70
|
| Rate for Payer: Multiplan Commercial |
$4,962.88
|
| Rate for Payer: NAPHCARE Commercial |
$3,722.16
|
| Rate for Payer: Preferred Network Access Commercial |
$5,707.31
|
| Rate for Payer: Quartz Beloit One Network |
$3,039.76
|
| Rate for Payer: Quartz Commercial |
$4,032.34
|
| Rate for Payer: Quartz Medicare Advantage |
$3,722.16
|
| Rate for Payer: The Alliance Commercial |
$3,101.80
|
| Rate for Payer: United Healthcare PPO |
$3,142.88
|
| Rate for Payer: WEA Trust Commercial |
$3,411.98
|
| Rate for Payer: WPS Commercial |
$4,594.84
|
|
|
MRI Hip w/ + w/o Contrast Left
|
Facility
|
IP
|
$6,295.00
|
|
|
Service Code
|
CPT 73723 TC,LT
|
| Hospital Charge Code |
1611137
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$3,207.93 |
| Max. Negotiated Rate |
$6,023.06 |
| Rate for Payer: Aetna Commercial |
$5,892.12
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,630.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,469.80
|
| Rate for Payer: Cash Price |
$1,888.50
|
| Rate for Payer: Cigna Commercial |
$6,023.06
|
| Rate for Payer: Health EOS Commercial |
$5,826.65
|
| Rate for Payer: HFN Commercial |
$6,023.06
|
| Rate for Payer: Multiplan Commercial |
$5,237.44
|
| Rate for Payer: Preferred Network Access Commercial |
$6,023.06
|
| Rate for Payer: Quartz Beloit One Network |
$3,207.93
|
| Rate for Payer: Quartz Commercial |
$3,928.08
|
| Rate for Payer: WEA Trust Commercial |
$3,600.74
|
| Rate for Payer: WPS Commercial |
$4,849.04
|
|
|
MRI Hip w/ + w/o Contrast Left
|
Facility
|
IP
|
$5,965.00
|
|
|
Service Code
|
CPT 73723 TC,LT
|
| Hospital Charge Code |
3072727
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$3,039.76 |
| Max. Negotiated Rate |
$5,707.31 |
| Rate for Payer: Aetna Commercial |
$5,583.24
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,335.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,287.91
|
| Rate for Payer: Cash Price |
$1,789.50
|
| Rate for Payer: Cigna Commercial |
$5,707.31
|
| Rate for Payer: Health EOS Commercial |
$5,521.20
|
| Rate for Payer: HFN Commercial |
$5,707.31
|
| Rate for Payer: Multiplan Commercial |
$4,962.88
|
| Rate for Payer: Preferred Network Access Commercial |
$5,707.31
|
| Rate for Payer: Quartz Beloit One Network |
$3,039.76
|
| Rate for Payer: Quartz Commercial |
$3,722.16
|
| Rate for Payer: WEA Trust Commercial |
$3,411.98
|
| Rate for Payer: WPS Commercial |
$4,594.84
|
|
|
MRI Hip w/ + w/o Contrast Left
|
Professional
|
Both
|
$5,965.00
|
|
|
Service Code
|
CPT 73723 TC,LT
|
| Hospital Charge Code |
3072727
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,562.68 |
| Max. Negotiated Rate |
$5,893.42 |
| Rate for Payer: Aetna Commercial |
$5,893.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,335.10
|
| 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 |
$5,893.42
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$3,101.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,722.16
|
| Rate for Payer: Health EOS Commercial |
$5,645.28
|
| Rate for Payer: HFN Commercial |
$5,893.42
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,562.68
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,562.68
|
| Rate for Payer: Multiplan Commercial |
$4,962.88
|
| Rate for Payer: Preferred Network Access Commercial |
$5,893.42
|
| Rate for Payer: Quartz Beloit One Network |
$2,729.58
|
| Rate for Payer: Quartz Commercial |
$3,536.05
|
| Rate for Payer: The Alliance Commercial |
$3,101.80
|
| Rate for Payer: WEA Trust Commercial |
$3,411.98
|
| Rate for Payer: WPS Commercial |
$4,594.84
|
|
|
MRI Hip w/ + w/o Contrast Right
|
Professional
|
Both
|
$6,295.00
|
|
|
Service Code
|
CPT 73723 TC,RT
|
| Hospital Charge Code |
1611139
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,562.68 |
| Max. Negotiated Rate |
$6,219.46 |
| Rate for Payer: Aetna Commercial |
$6,219.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,630.25
|
| Rate for Payer: Cash Price |
$1,888.50
|
| Rate for Payer: Cash Price |
$1,888.50
|
| Rate for Payer: Cash Price |
$1,888.50
|
| Rate for Payer: Cigna Commercial |
$6,219.46
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$3,273.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,928.08
|
| Rate for Payer: Health EOS Commercial |
$5,957.59
|
| Rate for Payer: HFN Commercial |
$6,219.46
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,562.68
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,562.68
|
| Rate for Payer: Multiplan Commercial |
$5,237.44
|
| Rate for Payer: Preferred Network Access Commercial |
$6,219.46
|
| Rate for Payer: Quartz Beloit One Network |
$2,880.59
|
| Rate for Payer: Quartz Commercial |
$3,731.68
|
| Rate for Payer: The Alliance Commercial |
$3,273.40
|
| Rate for Payer: WEA Trust Commercial |
$3,600.74
|
| Rate for Payer: WPS Commercial |
$4,849.04
|
|
|
MRI Hip w/ + w/o Contrast Right
|
Facility
|
IP
|
$5,965.00
|
|
|
Service Code
|
CPT 73723 TC,RT
|
| Hospital Charge Code |
3072752
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$3,039.76 |
| Max. Negotiated Rate |
$5,707.31 |
| Rate for Payer: Aetna Commercial |
$5,583.24
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,335.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,287.91
|
| Rate for Payer: Cash Price |
$1,789.50
|
| Rate for Payer: Cigna Commercial |
$5,707.31
|
| Rate for Payer: Health EOS Commercial |
$5,521.20
|
| Rate for Payer: HFN Commercial |
$5,707.31
|
| Rate for Payer: Multiplan Commercial |
$4,962.88
|
| Rate for Payer: Preferred Network Access Commercial |
$5,707.31
|
| Rate for Payer: Quartz Beloit One Network |
$3,039.76
|
| Rate for Payer: Quartz Commercial |
$3,722.16
|
| Rate for Payer: WEA Trust Commercial |
$3,411.98
|
| Rate for Payer: WPS Commercial |
$4,594.84
|
|
|
MRI Hip w/ + w/o Contrast Right
|
Professional
|
Both
|
$5,965.00
|
|
|
Service Code
|
CPT 73723 TC,RT
|
| Hospital Charge Code |
3072752
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,562.68 |
| Max. Negotiated Rate |
$5,893.42 |
| Rate for Payer: Aetna Commercial |
$5,893.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,335.10
|
| 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 |
$5,893.42
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$3,101.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,722.16
|
| Rate for Payer: Health EOS Commercial |
$5,645.28
|
| Rate for Payer: HFN Commercial |
$5,893.42
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,562.68
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,562.68
|
| Rate for Payer: Multiplan Commercial |
$4,962.88
|
| Rate for Payer: Preferred Network Access Commercial |
$5,893.42
|
| Rate for Payer: Quartz Beloit One Network |
$2,729.58
|
| Rate for Payer: Quartz Commercial |
$3,536.05
|
| Rate for Payer: The Alliance Commercial |
$3,101.80
|
| Rate for Payer: WEA Trust Commercial |
$3,411.98
|
| Rate for Payer: WPS Commercial |
$4,594.84
|
|
|
MRI Hip w/ + w/o Contrast Right
|
Facility
|
IP
|
$6,080.00
|
|
|
Service Code
|
CPT 73723
|
| Hospital Charge Code |
630985
|
| Min. Negotiated Rate |
$3,098.37 |
| Max. Negotiated Rate |
$5,817.34 |
| Rate for Payer: Aetna Commercial |
$5,690.88
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,437.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,351.30
|
| Rate for Payer: Cash Price |
$1,824.00
|
| Rate for Payer: Cigna Commercial |
$5,817.34
|
| Rate for Payer: Health EOS Commercial |
$5,627.65
|
| Rate for Payer: HFN Commercial |
$5,817.34
|
| Rate for Payer: Multiplan Commercial |
$5,058.56
|
| Rate for Payer: Preferred Network Access Commercial |
$5,817.34
|
| Rate for Payer: Quartz Beloit One Network |
$3,098.37
|
| Rate for Payer: Quartz Commercial |
$3,793.92
|
| Rate for Payer: WEA Trust Commercial |
$3,477.76
|
| Rate for Payer: WPS Commercial |
$4,683.42
|
|
|
MRI Hip w/ + w/o Contrast Right
|
Professional
|
Both
|
$6,080.00
|
|
|
Service Code
|
CPT 73723
|
| Hospital Charge Code |
630985
|
| Min. Negotiated Rate |
$379.71 |
| Max. Negotiated Rate |
$6,007.04 |
| Rate for Payer: Aetna Commercial |
$6,007.04
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,437.95
|
| Rate for Payer: Aetna Managed Medicare |
$379.71
|
| Rate for Payer: Anthem Medicare Advantage |
$379.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$379.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$379.71
|
| Rate for Payer: Cash Price |
$1,824.00
|
| Rate for Payer: Cash Price |
$1,824.00
|
| Rate for Payer: Cash Price |
$1,824.00
|
| Rate for Payer: Cigna Commercial |
$6,007.04
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$3,161.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$379.71
|
| Rate for Payer: Health EOS Commercial |
$5,754.11
|
| Rate for Payer: HFN Commercial |
$6,007.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,562.68
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,562.68
|
| Rate for Payer: Independent Care Health Plan Medicare |
$379.71
|
| Rate for Payer: Multiplan Commercial |
$5,058.56
|
| Rate for Payer: NAPHCARE Commercial |
$569.57
|
| Rate for Payer: Preferred Network Access Commercial |
$6,007.04
|
| Rate for Payer: Quartz Beloit One Network |
$2,782.21
|
| Rate for Payer: Quartz Commercial |
$3,604.22
|
| Rate for Payer: Quartz Medicare Advantage |
$379.71
|
| Rate for Payer: The Alliance Commercial |
$1,442.91
|
| Rate for Payer: United Healthcare Medicare Advantage |
$379.71
|
| Rate for Payer: WEA Trust Commercial |
$3,477.76
|
| Rate for Payer: WPS Commercial |
$1,898.57
|
|
|
MRI Hip w/ + w/o Contrast Right
|
Facility
|
OP
|
$5,965.00
|
|
|
Service Code
|
CPT 73723 TC,RT
|
| Hospital Charge Code |
3072752
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,737.01 |
| Max. Negotiated Rate |
$5,707.31 |
| Rate for Payer: Aetna Commercial |
$5,583.24
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,335.10
|
| Rate for Payer: Aetna Managed Medicare |
$1,737.01
|
| 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 |
$3,287.91
|
| 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 |
$5,707.31
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,471.63
|
| Rate for Payer: Health EOS Commercial |
$5,521.20
|
| Rate for Payer: HFN Commercial |
$5,707.31
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,652.70
|
| Rate for Payer: Multiplan Commercial |
$4,962.88
|
| Rate for Payer: NAPHCARE Commercial |
$3,722.16
|
| Rate for Payer: Preferred Network Access Commercial |
$5,707.31
|
| Rate for Payer: Quartz Beloit One Network |
$3,039.76
|
| Rate for Payer: Quartz Commercial |
$4,032.34
|
| Rate for Payer: Quartz Medicare Advantage |
$3,722.16
|
| Rate for Payer: The Alliance Commercial |
$3,101.80
|
| Rate for Payer: United Healthcare PPO |
$3,142.88
|
| Rate for Payer: WEA Trust Commercial |
$3,411.98
|
| Rate for Payer: WPS Commercial |
$4,594.84
|
|
|
MRI Hip w/ + w/o Contrast Right
|
Facility
|
IP
|
$6,295.00
|
|
|
Service Code
|
CPT 73723 TC,RT
|
| Hospital Charge Code |
1611139
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$3,207.93 |
| Max. Negotiated Rate |
$6,023.06 |
| Rate for Payer: Aetna Commercial |
$5,892.12
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,630.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,469.80
|
| Rate for Payer: Cash Price |
$1,888.50
|
| Rate for Payer: Cigna Commercial |
$6,023.06
|
| Rate for Payer: Health EOS Commercial |
$5,826.65
|
| Rate for Payer: HFN Commercial |
$6,023.06
|
| Rate for Payer: Multiplan Commercial |
$5,237.44
|
| Rate for Payer: Preferred Network Access Commercial |
$6,023.06
|
| Rate for Payer: Quartz Beloit One Network |
$3,207.93
|
| Rate for Payer: Quartz Commercial |
$3,928.08
|
| Rate for Payer: WEA Trust Commercial |
$3,600.74
|
| Rate for Payer: WPS Commercial |
$4,849.04
|
|
|
MRI Hip w/ + w/o Contrast Right
|
Facility
|
OP
|
$6,295.00
|
|
|
Service Code
|
CPT 73723 TC,RT
|
| Hospital Charge Code |
1611139
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,833.10 |
| Max. Negotiated Rate |
$6,023.06 |
| Rate for Payer: Aetna Commercial |
$5,892.12
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,630.25
|
| Rate for Payer: Aetna Managed Medicare |
$1,833.10
|
| 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 |
$3,469.80
|
| Rate for Payer: Cash Price |
$1,888.50
|
| Rate for Payer: Cash Price |
$1,888.50
|
| Rate for Payer: Cash Price |
$1,888.50
|
| Rate for Payer: Cigna Commercial |
$6,023.06
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,663.69
|
| Rate for Payer: Health EOS Commercial |
$5,826.65
|
| Rate for Payer: HFN Commercial |
$6,023.06
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,910.10
|
| Rate for Payer: Multiplan Commercial |
$5,237.44
|
| Rate for Payer: NAPHCARE Commercial |
$3,928.08
|
| Rate for Payer: Preferred Network Access Commercial |
$6,023.06
|
| Rate for Payer: Quartz Beloit One Network |
$3,207.93
|
| Rate for Payer: Quartz Commercial |
$4,255.42
|
| Rate for Payer: Quartz Medicare Advantage |
$3,928.08
|
| Rate for Payer: The Alliance Commercial |
$3,273.40
|
| Rate for Payer: United Healthcare PPO |
$3,142.88
|
| Rate for Payer: WEA Trust Commercial |
$3,600.74
|
| Rate for Payer: WPS Commercial |
$4,849.04
|
|
|
MRI Hip w/ + w/o Contrast Right
|
Facility
|
OP
|
$6,080.00
|
|
|
Service Code
|
CPT 73723
|
| Hospital Charge Code |
630985
|
| Min. Negotiated Rate |
$367.15 |
| Max. Negotiated Rate |
$5,817.34 |
| Rate for Payer: Aetna Commercial |
$5,690.88
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,437.95
|
| Rate for Payer: Aetna Managed Medicare |
$367.15
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,110.08
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,161.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,035.14
|
| Rate for Payer: Anthem Medicare Advantage |
$367.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,351.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$367.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$367.15
|
| Rate for Payer: Cash Price |
$1,824.00
|
| Rate for Payer: Cash Price |
$1,824.00
|
| Rate for Payer: Cigna Commercial |
$5,817.34
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$367.15
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,538.56
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$367.15
|
| Rate for Payer: Health EOS Commercial |
$5,627.65
|
| Rate for Payer: HFN Commercial |
$5,817.34
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,365.80
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$367.15
|
| Rate for Payer: Independent Care Health Plan Medicare |
$367.15
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$367.15
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$367.15
|
| Rate for Payer: Multiplan Commercial |
$5,058.56
|
| Rate for Payer: NAPHCARE Commercial |
$550.73
|
| Rate for Payer: Preferred Network Access Commercial |
$5,817.34
|
| Rate for Payer: Quartz Beloit One Network |
$3,098.37
|
| Rate for Payer: Quartz Commercial |
$4,110.08
|
| Rate for Payer: Quartz Medicare Advantage |
$367.15
|
| Rate for Payer: The Alliance Commercial |
$1,468.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$367.15
|
| Rate for Payer: WEA Trust Commercial |
$3,477.76
|
| Rate for Payer: Wellcare Medicare |
$367.15
|
| Rate for Payer: WPS Commercial |
$4,683.42
|
|
|
MRI Humerus w/ Contrast Bilateral
|
Facility
|
IP
|
$5,063.00
|
|
|
Service Code
|
CPT 73219 TC,LT
|
| Hospital Charge Code |
1611159
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$2,580.10 |
| Max. Negotiated Rate |
$4,844.28 |
| Rate for Payer: Aetna Commercial |
$4,738.97
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,528.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,790.73
|
| Rate for Payer: Cash Price |
$1,518.90
|
| Rate for Payer: Cigna Commercial |
$4,844.28
|
| Rate for Payer: Health EOS Commercial |
$4,686.31
|
| Rate for Payer: HFN Commercial |
$4,844.28
|
| Rate for Payer: Multiplan Commercial |
$4,212.42
|
| Rate for Payer: Preferred Network Access Commercial |
$4,844.28
|
| Rate for Payer: Quartz Beloit One Network |
$2,580.10
|
| Rate for Payer: Quartz Commercial |
$3,159.31
|
| Rate for Payer: WEA Trust Commercial |
$2,896.04
|
| Rate for Payer: WPS Commercial |
$3,900.03
|
|
|
MRI Humerus w/ Contrast Bilateral
|
Facility
|
OP
|
$5,063.00
|
|
|
Service Code
|
CPT 73219 TC,LT
|
| Hospital Charge Code |
1611159
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,474.35 |
| Max. Negotiated Rate |
$4,844.28 |
| Rate for Payer: Aetna Commercial |
$4,738.97
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,528.35
|
| Rate for Payer: Aetna Managed Medicare |
$1,474.35
|
| 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 |
$2,790.73
|
| Rate for Payer: Cash Price |
$1,518.90
|
| Rate for Payer: Cash Price |
$1,518.90
|
| Rate for Payer: Cash Price |
$1,518.90
|
| Rate for Payer: Cigna Commercial |
$4,844.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,946.67
|
| Rate for Payer: Health EOS Commercial |
$4,686.31
|
| Rate for Payer: HFN Commercial |
$4,844.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,949.14
|
| Rate for Payer: Multiplan Commercial |
$4,212.42
|
| Rate for Payer: NAPHCARE Commercial |
$3,159.31
|
| Rate for Payer: Preferred Network Access Commercial |
$4,844.28
|
| Rate for Payer: Quartz Beloit One Network |
$2,580.10
|
| Rate for Payer: Quartz Commercial |
$3,422.59
|
| Rate for Payer: Quartz Medicare Advantage |
$3,159.31
|
| Rate for Payer: The Alliance Commercial |
$2,632.76
|
| Rate for Payer: United Healthcare PPO |
$3,142.88
|
| Rate for Payer: WEA Trust Commercial |
$2,896.04
|
| Rate for Payer: WPS Commercial |
$3,900.03
|
|
|
MRI Humerus w/ Contrast Bilateral
|
Professional
|
Both
|
$5,063.00
|
|
|
Service Code
|
CPT 73219 TC,LT
|
| Hospital Charge Code |
1611159
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,339.95 |
| Max. Negotiated Rate |
$5,002.24 |
| Rate for Payer: Aetna Commercial |
$5,002.24
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,528.35
|
| Rate for Payer: Cash Price |
$1,518.90
|
| Rate for Payer: Cash Price |
$1,518.90
|
| Rate for Payer: Cash Price |
$1,518.90
|
| Rate for Payer: Cigna Commercial |
$5,002.24
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,632.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,159.31
|
| Rate for Payer: Health EOS Commercial |
$4,791.62
|
| Rate for Payer: HFN Commercial |
$5,002.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,339.95
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,339.95
|
| Rate for Payer: Multiplan Commercial |
$4,212.42
|
| Rate for Payer: Preferred Network Access Commercial |
$5,002.24
|
| Rate for Payer: Quartz Beloit One Network |
$2,316.83
|
| Rate for Payer: Quartz Commercial |
$3,001.35
|
| Rate for Payer: The Alliance Commercial |
$2,632.76
|
| Rate for Payer: WEA Trust Commercial |
$2,896.04
|
| Rate for Payer: WPS Commercial |
$3,900.03
|
|
|
MRI Humerus w/ Contrast Bilateral
|
Facility
|
OP
|
$10,322.00
|
|
|
Service Code
|
CPT 73219
|
| Hospital Charge Code |
631031
|
| Min. Negotiated Rate |
$367.15 |
| Max. Negotiated Rate |
$9,876.09 |
| Rate for Payer: Aetna Commercial |
$9,661.39
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,232.00
|
| Rate for Payer: Aetna Managed Medicare |
$367.15
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,977.67
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,367.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,152.74
|
| Rate for Payer: Anthem Medicare Advantage |
$367.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,689.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$367.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$367.15
|
| Rate for Payer: Cash Price |
$3,096.60
|
| Rate for Payer: Cash Price |
$3,096.60
|
| Rate for Payer: Cigna Commercial |
$9,876.09
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$367.15
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,007.40
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$367.15
|
| Rate for Payer: Health EOS Commercial |
$9,554.04
|
| Rate for Payer: HFN Commercial |
$9,876.09
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,365.80
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$367.15
|
| Rate for Payer: Independent Care Health Plan Medicare |
$367.15
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$367.15
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$367.15
|
| Rate for Payer: Multiplan Commercial |
$8,587.90
|
| Rate for Payer: NAPHCARE Commercial |
$550.73
|
| Rate for Payer: Preferred Network Access Commercial |
$9,876.09
|
| Rate for Payer: Quartz Beloit One Network |
$5,260.09
|
| Rate for Payer: Quartz Commercial |
$6,977.67
|
| Rate for Payer: Quartz Medicare Advantage |
$367.15
|
| Rate for Payer: The Alliance Commercial |
$1,468.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$367.15
|
| Rate for Payer: WEA Trust Commercial |
$5,904.18
|
| Rate for Payer: Wellcare Medicare |
$367.15
|
| Rate for Payer: WPS Commercial |
$7,951.04
|
|
|
MRI Humerus w/ Contrast Bilateral
|
Facility
|
IP
|
$10,322.00
|
|
|
Service Code
|
CPT 73219
|
| Hospital Charge Code |
631031
|
| Min. Negotiated Rate |
$5,260.09 |
| Max. Negotiated Rate |
$9,876.09 |
| Rate for Payer: Aetna Commercial |
$9,661.39
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,232.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,689.49
|
| Rate for Payer: Cash Price |
$3,096.60
|
| Rate for Payer: Cigna Commercial |
$9,876.09
|
| Rate for Payer: Health EOS Commercial |
$9,554.04
|
| Rate for Payer: HFN Commercial |
$9,876.09
|
| Rate for Payer: Multiplan Commercial |
$8,587.90
|
| Rate for Payer: Preferred Network Access Commercial |
$9,876.09
|
| Rate for Payer: Quartz Beloit One Network |
$5,260.09
|
| Rate for Payer: Quartz Commercial |
$6,440.93
|
| Rate for Payer: WEA Trust Commercial |
$5,904.18
|
| Rate for Payer: WPS Commercial |
$7,951.04
|
|
|
MRI Humerus w/ Contrast Bilateral
|
Professional
|
Both
|
$10,322.00
|
|
|
Service Code
|
CPT 73219
|
| Hospital Charge Code |
631031
|
| Min. Negotiated Rate |
$328.28 |
| Max. Negotiated Rate |
$10,198.14 |
| Rate for Payer: Aetna Commercial |
$10,198.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,232.00
|
| Rate for Payer: Aetna Managed Medicare |
$328.28
|
| Rate for Payer: Anthem Medicare Advantage |
$328.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$328.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$328.28
|
| Rate for Payer: Cash Price |
$3,096.60
|
| Rate for Payer: Cash Price |
$3,096.60
|
| Rate for Payer: Cash Price |
$3,096.60
|
| Rate for Payer: Cigna Commercial |
$10,198.14
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$5,367.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$328.28
|
| Rate for Payer: Health EOS Commercial |
$9,768.74
|
| Rate for Payer: HFN Commercial |
$10,198.14
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,339.95
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,339.95
|
| Rate for Payer: Independent Care Health Plan Medicare |
$328.28
|
| Rate for Payer: Multiplan Commercial |
$8,587.90
|
| Rate for Payer: NAPHCARE Commercial |
$492.41
|
| Rate for Payer: Preferred Network Access Commercial |
$10,198.14
|
| Rate for Payer: Quartz Beloit One Network |
$4,723.35
|
| Rate for Payer: Quartz Commercial |
$6,118.88
|
| Rate for Payer: Quartz Medicare Advantage |
$328.28
|
| Rate for Payer: The Alliance Commercial |
$1,247.45
|
| Rate for Payer: United Healthcare Medicare Advantage |
$328.28
|
| Rate for Payer: WEA Trust Commercial |
$5,904.18
|
| Rate for Payer: WPS Commercial |
$1,641.38
|
|
|
MRI Humerus w/ Contrast Left
|
Professional
|
Both
|
$5,162.00
|
|
|
Service Code
|
CPT 73219
|
| Hospital Charge Code |
631033
|
| Min. Negotiated Rate |
$328.28 |
| Max. Negotiated Rate |
$5,100.06 |
| Rate for Payer: Aetna Commercial |
$5,100.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,616.89
|
| Rate for Payer: Aetna Managed Medicare |
$328.28
|
| Rate for Payer: Anthem Medicare Advantage |
$328.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$328.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$328.28
|
| Rate for Payer: Cash Price |
$1,548.60
|
| Rate for Payer: Cash Price |
$1,548.60
|
| Rate for Payer: Cash Price |
$1,548.60
|
| Rate for Payer: Cigna Commercial |
$5,100.06
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,684.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$328.28
|
| Rate for Payer: Health EOS Commercial |
$4,885.32
|
| Rate for Payer: HFN Commercial |
$5,100.06
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,339.95
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,339.95
|
| Rate for Payer: Independent Care Health Plan Medicare |
$328.28
|
| Rate for Payer: Multiplan Commercial |
$4,294.78
|
| Rate for Payer: NAPHCARE Commercial |
$492.41
|
| Rate for Payer: Preferred Network Access Commercial |
$5,100.06
|
| Rate for Payer: Quartz Beloit One Network |
$2,362.13
|
| Rate for Payer: Quartz Commercial |
$3,060.03
|
| Rate for Payer: Quartz Medicare Advantage |
$328.28
|
| Rate for Payer: The Alliance Commercial |
$1,247.45
|
| Rate for Payer: United Healthcare Medicare Advantage |
$328.28
|
| Rate for Payer: WEA Trust Commercial |
$2,952.66
|
| Rate for Payer: WPS Commercial |
$1,641.38
|
|
|
MRI Humerus w/ Contrast Left
|
Facility
|
OP
|
$5,162.00
|
|
|
Service Code
|
CPT 73219
|
| Hospital Charge Code |
631033
|
| Min. Negotiated Rate |
$367.15 |
| Max. Negotiated Rate |
$4,939.00 |
| Rate for Payer: Aetna Commercial |
$4,831.63
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,616.89
|
| Rate for Payer: Aetna Managed Medicare |
$367.15
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,489.51
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,684.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,576.87
|
| Rate for Payer: Anthem Medicare Advantage |
$367.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,845.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$367.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$367.15
|
| Rate for Payer: Cash Price |
$1,548.60
|
| Rate for Payer: Cash Price |
$1,548.60
|
| Rate for Payer: Cigna Commercial |
$4,939.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$367.15
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,004.28
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$367.15
|
| Rate for Payer: Health EOS Commercial |
$4,777.95
|
| Rate for Payer: HFN Commercial |
$4,939.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,365.80
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$367.15
|
| Rate for Payer: Independent Care Health Plan Medicare |
$367.15
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$367.15
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$367.15
|
| Rate for Payer: Multiplan Commercial |
$4,294.78
|
| Rate for Payer: NAPHCARE Commercial |
$550.73
|
| Rate for Payer: Preferred Network Access Commercial |
$4,939.00
|
| Rate for Payer: Quartz Beloit One Network |
$2,630.56
|
| Rate for Payer: Quartz Commercial |
$3,489.51
|
| Rate for Payer: Quartz Medicare Advantage |
$367.15
|
| Rate for Payer: The Alliance Commercial |
$1,468.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$367.15
|
| Rate for Payer: WEA Trust Commercial |
$2,952.66
|
| Rate for Payer: Wellcare Medicare |
$367.15
|
| Rate for Payer: WPS Commercial |
$3,976.29
|
|
|
MRI Humerus w/ Contrast Left
|
Professional
|
Both
|
$5,063.00
|
|
|
Service Code
|
CPT 73219 TC,LT
|
| Hospital Charge Code |
1611161
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,339.95 |
| Max. Negotiated Rate |
$5,002.24 |
| Rate for Payer: Aetna Commercial |
$5,002.24
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,528.35
|
| Rate for Payer: Cash Price |
$1,518.90
|
| Rate for Payer: Cash Price |
$1,518.90
|
| Rate for Payer: Cash Price |
$1,518.90
|
| Rate for Payer: Cigna Commercial |
$5,002.24
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,632.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,159.31
|
| Rate for Payer: Health EOS Commercial |
$4,791.62
|
| Rate for Payer: HFN Commercial |
$5,002.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,339.95
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,339.95
|
| Rate for Payer: Multiplan Commercial |
$4,212.42
|
| Rate for Payer: Preferred Network Access Commercial |
$5,002.24
|
| Rate for Payer: Quartz Beloit One Network |
$2,316.83
|
| Rate for Payer: Quartz Commercial |
$3,001.35
|
| Rate for Payer: The Alliance Commercial |
$2,632.76
|
| Rate for Payer: WEA Trust Commercial |
$2,896.04
|
| Rate for Payer: WPS Commercial |
$3,900.03
|
|
