|
MRI Spine Lumbar w/ + w/o Contrast
|
Professional
|
Both
|
$6,351.00
|
|
|
Service Code
|
CPT 72158 TC
|
| Hospital Charge Code |
1611293
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$838.48 |
| Max. Negotiated Rate |
$6,033.45 |
| Rate for Payer: Aetna Commercial |
$6,033.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,461.86
|
| Rate for Payer: Cash Price |
$1,905.30
|
| Rate for Payer: Cash Price |
$1,905.30
|
| Rate for Payer: Cash Price |
$1,905.30
|
| Rate for Payer: Cigna Commercial |
$6,033.45
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$3,175.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,810.60
|
| Rate for Payer: Health EOS Commercial |
$5,779.41
|
| Rate for Payer: HFN Commercial |
$6,033.45
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$838.48
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$838.48
|
| Rate for Payer: Multiplan Commercial |
$5,080.80
|
| Rate for Payer: Preferred Network Access Commercial |
$6,033.45
|
| Rate for Payer: Quartz Beloit One Network |
$2,794.44
|
| Rate for Payer: Quartz Commercial |
$3,620.07
|
| Rate for Payer: The Alliance Commercial |
$3,175.50
|
| Rate for Payer: WEA Trust Commercial |
$3,493.05
|
| Rate for Payer: WPS Commercial |
$4,704.19
|
|
|
MRI Spine Lumbar w/ + w/o Contrast
|
Facility
|
IP
|
$6,235.00
|
|
|
Service Code
|
CPT 72158
|
| Hospital Charge Code |
631277
|
| 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 Thoracic w/ Contrast
|
Facility
|
IP
|
$6,080.00
|
|
|
Service Code
|
CPT 72147
|
| Hospital Charge Code |
631289
|
| 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 Thoracic w/ Contrast
|
Professional
|
Both
|
$6,080.00
|
|
|
Service Code
|
CPT 72147
|
| Hospital Charge Code |
631289
|
| Min. Negotiated Rate |
$1,042.41 |
| 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 |
$1,042.41
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,042.41
|
| 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 Thoracic w/ Contrast
|
Facility
|
OP
|
$6,080.00
|
|
|
Service Code
|
CPT 72147
|
| Hospital Charge Code |
631289
|
| 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 Thoracic w/ Contrast
|
Facility
|
OP
|
$6,194.00
|
|
|
Service Code
|
CPT 72147 TC
|
| Hospital Charge Code |
1611319
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$380.12 |
| Max. Negotiated Rate |
$5,698.48 |
| Rate for Payer: Aetna Commercial |
$5,574.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,326.84
|
| Rate for Payer: Aetna Managed Medicare |
$380.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,496.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,871.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,726.00
|
| Rate for Payer: Anthem Medicare Advantage |
$380.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,282.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$380.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$380.12
|
| Rate for Payer: Cash Price |
$1,858.20
|
| Rate for Payer: Cash Price |
$1,858.20
|
| Rate for Payer: Cash Price |
$1,858.20
|
| Rate for Payer: Cash Price |
$1,858.20
|
| Rate for Payer: Cigna Commercial |
$5,698.48
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$380.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,466.16
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$380.12
|
| Rate for Payer: Health EOS Commercial |
$5,512.66
|
| Rate for Payer: HFN Commercial |
$5,698.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,414.05
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$380.12
|
| Rate for Payer: Independent Care Health Plan Medicare |
$380.12
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$380.12
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$380.12
|
| Rate for Payer: Multiplan Commercial |
$4,955.20
|
| Rate for Payer: NAPHCARE Commercial |
$570.18
|
| Rate for Payer: Preferred Network Access Commercial |
$5,698.48
|
| Rate for Payer: Quartz Beloit One Network |
$3,035.06
|
| Rate for Payer: Quartz Commercial |
$4,026.10
|
| Rate for Payer: Quartz Medicare Advantage |
$380.12
|
| Rate for Payer: The Alliance Commercial |
$1,520.48
|
| Rate for Payer: United Healthcare Medicare Advantage |
$380.12
|
| Rate for Payer: United Healthcare PPO |
$3,022.00
|
| Rate for Payer: WEA Trust Commercial |
$3,406.70
|
| Rate for Payer: Wellcare Medicare |
$380.12
|
| Rate for Payer: WPS Commercial |
$4,587.90
|
|
|
MRI Spine Thoracic w/ Contrast
|
Facility
|
IP
|
$6,194.00
|
|
|
Service Code
|
CPT 72147 TC
|
| Hospital Charge Code |
1611319
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$3,035.06 |
| Max. Negotiated Rate |
$5,698.48 |
| Rate for Payer: Aetna Commercial |
$5,574.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,326.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,282.82
|
| Rate for Payer: Cash Price |
$1,858.20
|
| Rate for Payer: Cigna Commercial |
$5,698.48
|
| Rate for Payer: Health EOS Commercial |
$5,512.66
|
| Rate for Payer: HFN Commercial |
$5,698.48
|
| Rate for Payer: Multiplan Commercial |
$4,955.20
|
| Rate for Payer: NAPHCARE Commercial |
$3,716.40
|
| Rate for Payer: Preferred Network Access Commercial |
$5,698.48
|
| Rate for Payer: Quartz Beloit One Network |
$3,035.06
|
| Rate for Payer: Quartz Commercial |
$3,716.40
|
| Rate for Payer: WEA Trust Commercial |
$3,406.70
|
| Rate for Payer: WPS Commercial |
$4,587.90
|
|
|
MRI Spine Thoracic w/ Contrast
|
Professional
|
Both
|
$6,194.00
|
|
|
Service Code
|
CPT 72147 TC
|
| Hospital Charge Code |
1611319
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$744.48 |
| Max. Negotiated Rate |
$5,884.30 |
| Rate for Payer: Aetna Commercial |
$5,884.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,326.84
|
| Rate for Payer: Cash Price |
$1,858.20
|
| Rate for Payer: Cash Price |
$1,858.20
|
| Rate for Payer: Cash Price |
$1,858.20
|
| Rate for Payer: Cigna Commercial |
$5,884.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$3,097.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,716.40
|
| Rate for Payer: Health EOS Commercial |
$5,636.54
|
| Rate for Payer: HFN Commercial |
$5,884.30
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$744.48
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$744.48
|
| Rate for Payer: Multiplan Commercial |
$4,955.20
|
| Rate for Payer: Preferred Network Access Commercial |
$5,884.30
|
| Rate for Payer: Quartz Beloit One Network |
$2,725.36
|
| Rate for Payer: Quartz Commercial |
$3,530.58
|
| Rate for Payer: The Alliance Commercial |
$3,097.00
|
| Rate for Payer: WEA Trust Commercial |
$3,406.70
|
| Rate for Payer: WPS Commercial |
$4,587.90
|
|
|
MRI Spine Thoracic w/o Contrast
|
Facility
|
OP
|
$4,627.00
|
|
|
Service Code
|
CPT 72146
|
| Hospital Charge Code |
631295
|
| Min. Negotiated Rate |
$242.20 |
| Max. Negotiated Rate |
$4,256.84 |
| Rate for Payer: Aetna Commercial |
$4,164.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,979.22
|
| Rate for Payer: Aetna Managed Medicare |
$242.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,007.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,313.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,220.96
|
| Rate for Payer: Anthem Medicare Advantage |
$242.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,452.31
|
| 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 |
$1,388.10
|
| Rate for Payer: Cash Price |
$1,388.10
|
| Rate for Payer: Cigna Commercial |
$4,256.84
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$242.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,589.27
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$242.20
|
| Rate for Payer: Health EOS Commercial |
$4,118.03
|
| Rate for Payer: HFN Commercial |
$4,256.84
|
| 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 |
$3,701.60
|
| Rate for Payer: NAPHCARE Commercial |
$363.30
|
| Rate for Payer: Preferred Network Access Commercial |
$4,256.84
|
| Rate for Payer: Quartz Beloit One Network |
$2,267.23
|
| Rate for Payer: Quartz Commercial |
$3,007.55
|
| 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 |
$2,544.85
|
| Rate for Payer: Wellcare Medicare |
$242.20
|
| Rate for Payer: WPS Commercial |
$3,427.22
|
|
|
MRI Spine Thoracic w/o Contrast
|
Facility
|
IP
|
$4,627.00
|
|
|
Service Code
|
CPT 72146
|
| Hospital Charge Code |
631295
|
| Min. Negotiated Rate |
$2,267.23 |
| Max. Negotiated Rate |
$4,256.84 |
| Rate for Payer: Aetna Commercial |
$4,164.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,979.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,452.31
|
| Rate for Payer: Cash Price |
$1,388.10
|
| Rate for Payer: Cigna Commercial |
$4,256.84
|
| Rate for Payer: Health EOS Commercial |
$4,118.03
|
| Rate for Payer: HFN Commercial |
$4,256.84
|
| Rate for Payer: Multiplan Commercial |
$3,701.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,776.20
|
| Rate for Payer: Preferred Network Access Commercial |
$4,256.84
|
| Rate for Payer: Quartz Beloit One Network |
$2,267.23
|
| Rate for Payer: Quartz Commercial |
$2,776.20
|
| Rate for Payer: WEA Trust Commercial |
$2,544.85
|
| Rate for Payer: WPS Commercial |
$3,427.22
|
|
|
MRI Spine Thoracic w/o Contrast
|
Professional
|
Both
|
$4,627.00
|
|
|
Service Code
|
CPT 72146
|
| Hospital Charge Code |
631295
|
| Min. Negotiated Rate |
$722.06 |
| Max. Negotiated Rate |
$4,395.65 |
| Rate for Payer: Aetna Commercial |
$4,395.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,979.22
|
| Rate for Payer: Cash Price |
$1,388.10
|
| Rate for Payer: Cash Price |
$1,388.10
|
| Rate for Payer: Cash Price |
$1,388.10
|
| Rate for Payer: Cigna Commercial |
$4,395.65
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,313.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,776.20
|
| Rate for Payer: Health EOS Commercial |
$4,210.57
|
| Rate for Payer: HFN Commercial |
$4,395.65
|
| 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 |
$3,701.60
|
| Rate for Payer: Preferred Network Access Commercial |
$4,395.65
|
| Rate for Payer: Quartz Beloit One Network |
$2,035.88
|
| Rate for Payer: Quartz Commercial |
$2,637.39
|
| Rate for Payer: The Alliance Commercial |
$2,313.50
|
| Rate for Payer: WEA Trust Commercial |
$2,544.85
|
| Rate for Payer: WPS Commercial |
$3,427.22
|
|
|
MRI Spine Thoracic w/o Contrast
|
Facility
|
OP
|
$5,410.00
|
|
|
Service Code
|
CPT 72146 TC
|
| Hospital Charge Code |
3072643
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$242.20 |
| Max. Negotiated Rate |
$4,977.20 |
| Rate for Payer: Aetna Commercial |
$4,869.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,652.60
|
| 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 |
$2,867.30
|
| 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 |
$1,623.00
|
| Rate for Payer: Cash Price |
$1,623.00
|
| Rate for Payer: Cash Price |
$1,623.00
|
| Rate for Payer: Cash Price |
$1,623.00
|
| Rate for Payer: Cigna Commercial |
$4,977.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$242.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,027.44
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$242.20
|
| Rate for Payer: Health EOS Commercial |
$4,814.90
|
| Rate for Payer: HFN Commercial |
$4,977.20
|
| 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 |
$4,328.00
|
| Rate for Payer: NAPHCARE Commercial |
$363.30
|
| Rate for Payer: Preferred Network Access Commercial |
$4,977.20
|
| Rate for Payer: Quartz Beloit One Network |
$2,650.90
|
| Rate for Payer: Quartz Commercial |
$3,516.50
|
| 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 |
$2,975.50
|
| Rate for Payer: Wellcare Medicare |
$242.20
|
| Rate for Payer: WPS Commercial |
$4,007.19
|
|
|
MRI Spine Thoracic w/o Contrast
|
Professional
|
Both
|
$5,410.00
|
|
|
Service Code
|
CPT 72146 TC
|
| Hospital Charge Code |
1611321
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$474.93 |
| Max. Negotiated Rate |
$5,139.50 |
| Rate for Payer: Aetna Commercial |
$5,139.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,652.60
|
| Rate for Payer: Cash Price |
$1,623.00
|
| Rate for Payer: Cash Price |
$1,623.00
|
| Rate for Payer: Cash Price |
$1,623.00
|
| Rate for Payer: Cigna Commercial |
$5,139.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,705.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,246.00
|
| Rate for Payer: Health EOS Commercial |
$4,923.10
|
| Rate for Payer: HFN Commercial |
$5,139.50
|
| 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 |
$4,328.00
|
| Rate for Payer: Preferred Network Access Commercial |
$5,139.50
|
| Rate for Payer: Quartz Beloit One Network |
$2,380.40
|
| Rate for Payer: Quartz Commercial |
$3,083.70
|
| Rate for Payer: The Alliance Commercial |
$2,705.00
|
| Rate for Payer: WEA Trust Commercial |
$2,975.50
|
| Rate for Payer: WPS Commercial |
$4,007.19
|
|
|
MRI Spine Thoracic w/o Contrast
|
Facility
|
IP
|
$5,410.00
|
|
|
Service Code
|
CPT 72146 TC
|
| Hospital Charge Code |
3072643
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$2,650.90 |
| Max. Negotiated Rate |
$4,977.20 |
| Rate for Payer: Aetna Commercial |
$4,869.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,652.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,867.30
|
| Rate for Payer: Cash Price |
$1,623.00
|
| Rate for Payer: Cigna Commercial |
$4,977.20
|
| Rate for Payer: Health EOS Commercial |
$4,814.90
|
| Rate for Payer: HFN Commercial |
$4,977.20
|
| Rate for Payer: Multiplan Commercial |
$4,328.00
|
| Rate for Payer: NAPHCARE Commercial |
$3,246.00
|
| Rate for Payer: Preferred Network Access Commercial |
$4,977.20
|
| Rate for Payer: Quartz Beloit One Network |
$2,650.90
|
| Rate for Payer: Quartz Commercial |
$3,246.00
|
| Rate for Payer: WEA Trust Commercial |
$2,975.50
|
| Rate for Payer: WPS Commercial |
$4,007.19
|
|
|
MRI Spine Thoracic w/o Contrast
|
Facility
|
OP
|
$5,410.00
|
|
|
Service Code
|
CPT 72146 TC
|
| Hospital Charge Code |
1611321
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$242.20 |
| Max. Negotiated Rate |
$4,977.20 |
| Rate for Payer: Aetna Commercial |
$4,869.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,652.60
|
| 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 |
$2,867.30
|
| 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 |
$1,623.00
|
| Rate for Payer: Cash Price |
$1,623.00
|
| Rate for Payer: Cash Price |
$1,623.00
|
| Rate for Payer: Cash Price |
$1,623.00
|
| Rate for Payer: Cigna Commercial |
$4,977.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$242.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,027.44
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$242.20
|
| Rate for Payer: Health EOS Commercial |
$4,814.90
|
| Rate for Payer: HFN Commercial |
$4,977.20
|
| 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 |
$4,328.00
|
| Rate for Payer: NAPHCARE Commercial |
$363.30
|
| Rate for Payer: Preferred Network Access Commercial |
$4,977.20
|
| Rate for Payer: Quartz Beloit One Network |
$2,650.90
|
| Rate for Payer: Quartz Commercial |
$3,516.50
|
| 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 |
$2,975.50
|
| Rate for Payer: Wellcare Medicare |
$242.20
|
| Rate for Payer: WPS Commercial |
$4,007.19
|
|
|
MRI Spine Thoracic w/o Contrast
|
Facility
|
IP
|
$5,410.00
|
|
|
Service Code
|
CPT 72146 TC
|
| Hospital Charge Code |
1611321
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$2,650.90 |
| Max. Negotiated Rate |
$4,977.20 |
| Rate for Payer: Aetna Commercial |
$4,869.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,652.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,867.30
|
| Rate for Payer: Cash Price |
$1,623.00
|
| Rate for Payer: Cigna Commercial |
$4,977.20
|
| Rate for Payer: Health EOS Commercial |
$4,814.90
|
| Rate for Payer: HFN Commercial |
$4,977.20
|
| Rate for Payer: Multiplan Commercial |
$4,328.00
|
| Rate for Payer: NAPHCARE Commercial |
$3,246.00
|
| Rate for Payer: Preferred Network Access Commercial |
$4,977.20
|
| Rate for Payer: Quartz Beloit One Network |
$2,650.90
|
| Rate for Payer: Quartz Commercial |
$3,246.00
|
| Rate for Payer: WEA Trust Commercial |
$2,975.50
|
| Rate for Payer: WPS Commercial |
$4,007.19
|
|
|
MRI Spine Thoracic w/o Contrast
|
Professional
|
Both
|
$5,410.00
|
|
|
Service Code
|
CPT 72146 TC
|
| Hospital Charge Code |
3072643
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$474.93 |
| Max. Negotiated Rate |
$5,139.50 |
| Rate for Payer: Aetna Commercial |
$5,139.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,652.60
|
| Rate for Payer: Cash Price |
$1,623.00
|
| Rate for Payer: Cash Price |
$1,623.00
|
| Rate for Payer: Cash Price |
$1,623.00
|
| Rate for Payer: Cigna Commercial |
$5,139.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,705.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,246.00
|
| Rate for Payer: Health EOS Commercial |
$4,923.10
|
| Rate for Payer: HFN Commercial |
$5,139.50
|
| 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 |
$4,328.00
|
| Rate for Payer: Preferred Network Access Commercial |
$5,139.50
|
| Rate for Payer: Quartz Beloit One Network |
$2,380.40
|
| Rate for Payer: Quartz Commercial |
$3,083.70
|
| Rate for Payer: The Alliance Commercial |
$2,705.00
|
| Rate for Payer: WEA Trust Commercial |
$2,975.50
|
| Rate for Payer: WPS Commercial |
$4,007.19
|
|
|
MRI Spine Thoracic w/ + w/o Contrast
|
Facility
|
OP
|
$6,670.00
|
|
|
Service Code
|
CPT 72157 TC
|
| Hospital Charge Code |
3072644
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$380.12 |
| Max. Negotiated Rate |
$6,136.40 |
| Rate for Payer: Aetna Commercial |
$6,003.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,736.20
|
| 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 |
$3,535.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$380.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$380.12
|
| Rate for Payer: Cash Price |
$2,001.00
|
| Rate for Payer: Cash Price |
$2,001.00
|
| Rate for Payer: Cash Price |
$2,001.00
|
| Rate for Payer: Cash Price |
$2,001.00
|
| Rate for Payer: Cigna Commercial |
$6,136.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$380.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,732.53
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$380.12
|
| Rate for Payer: Health EOS Commercial |
$5,936.30
|
| Rate for Payer: HFN Commercial |
$6,136.40
|
| 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 |
$5,336.00
|
| Rate for Payer: NAPHCARE Commercial |
$570.18
|
| Rate for Payer: Preferred Network Access Commercial |
$6,136.40
|
| Rate for Payer: Quartz Beloit One Network |
$3,268.30
|
| Rate for Payer: Quartz Commercial |
$4,335.50
|
| 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 |
$3,668.50
|
| Rate for Payer: Wellcare Medicare |
$380.12
|
| Rate for Payer: WPS Commercial |
$4,940.47
|
|
|
MRI Spine Thoracic w/ + w/o Contrast
|
Facility
|
IP
|
$6,235.00
|
|
|
Service Code
|
CPT 72157
|
| Hospital Charge Code |
631293
|
| 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 Thoracic w/ + w/o Contrast
|
Facility
|
IP
|
$6,670.00
|
|
|
Service Code
|
CPT 72157 TC
|
| Hospital Charge Code |
3072644
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$3,268.30 |
| Max. Negotiated Rate |
$6,136.40 |
| Rate for Payer: Aetna Commercial |
$6,003.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,736.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,535.10
|
| Rate for Payer: Cash Price |
$2,001.00
|
| Rate for Payer: Cigna Commercial |
$6,136.40
|
| Rate for Payer: Health EOS Commercial |
$5,936.30
|
| Rate for Payer: HFN Commercial |
$6,136.40
|
| Rate for Payer: Multiplan Commercial |
$5,336.00
|
| Rate for Payer: NAPHCARE Commercial |
$4,002.00
|
| Rate for Payer: Preferred Network Access Commercial |
$6,136.40
|
| Rate for Payer: Quartz Beloit One Network |
$3,268.30
|
| Rate for Payer: Quartz Commercial |
$4,002.00
|
| Rate for Payer: WEA Trust Commercial |
$3,668.50
|
| Rate for Payer: WPS Commercial |
$4,940.47
|
|
|
MRI Spine Thoracic w/ + w/o Contrast
|
Facility
|
OP
|
$6,235.00
|
|
|
Service Code
|
CPT 72157
|
| Hospital Charge Code |
631293
|
| Min. Negotiated Rate |
$380.12 |
| 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: Aetna Managed Medicare |
$380.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,052.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,117.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,992.80
|
| Rate for Payer: Anthem Medicare Advantage |
$380.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,304.55
|
| 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 |
$1,870.50
|
| Rate for Payer: Cash Price |
$1,870.50
|
| Rate for Payer: Cigna Commercial |
$5,736.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$380.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,489.11
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$380.12
|
| Rate for Payer: Health EOS Commercial |
$5,549.15
|
| Rate for Payer: HFN Commercial |
$5,736.20
|
| 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 |
$4,988.00
|
| Rate for Payer: NAPHCARE Commercial |
$570.18
|
| 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 |
$4,052.75
|
| 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 |
$3,429.25
|
| Rate for Payer: Wellcare Medicare |
$380.12
|
| Rate for Payer: WPS Commercial |
$4,618.26
|
|
|
MRI Spine Thoracic w/ + w/o Contrast
|
Professional
|
Both
|
$6,670.00
|
|
|
Service Code
|
CPT 72157 TC
|
| Hospital Charge Code |
3072644
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$843.11 |
| Max. Negotiated Rate |
$6,336.50 |
| Rate for Payer: Aetna Commercial |
$6,336.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,736.20
|
| Rate for Payer: Cash Price |
$2,001.00
|
| Rate for Payer: Cash Price |
$2,001.00
|
| Rate for Payer: Cash Price |
$2,001.00
|
| Rate for Payer: Cigna Commercial |
$6,336.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$3,335.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,002.00
|
| Rate for Payer: Health EOS Commercial |
$6,069.70
|
| Rate for Payer: HFN Commercial |
$6,336.50
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$843.11
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$843.11
|
| Rate for Payer: Multiplan Commercial |
$5,336.00
|
| Rate for Payer: Preferred Network Access Commercial |
$6,336.50
|
| Rate for Payer: Quartz Beloit One Network |
$2,934.80
|
| Rate for Payer: Quartz Commercial |
$3,801.90
|
| Rate for Payer: The Alliance Commercial |
$3,335.00
|
| Rate for Payer: WEA Trust Commercial |
$3,668.50
|
| Rate for Payer: WPS Commercial |
$4,940.47
|
|
|
MRI Spine Thoracic w/ + w/o Contrast
|
Facility
|
IP
|
$6,670.00
|
|
|
Service Code
|
CPT 72157 TC
|
| Hospital Charge Code |
1611317
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$3,268.30 |
| Max. Negotiated Rate |
$6,136.40 |
| Rate for Payer: Aetna Commercial |
$6,003.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,736.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,535.10
|
| Rate for Payer: Cash Price |
$2,001.00
|
| Rate for Payer: Cigna Commercial |
$6,136.40
|
| Rate for Payer: Health EOS Commercial |
$5,936.30
|
| Rate for Payer: HFN Commercial |
$6,136.40
|
| Rate for Payer: Multiplan Commercial |
$5,336.00
|
| Rate for Payer: NAPHCARE Commercial |
$4,002.00
|
| Rate for Payer: Preferred Network Access Commercial |
$6,136.40
|
| Rate for Payer: Quartz Beloit One Network |
$3,268.30
|
| Rate for Payer: Quartz Commercial |
$4,002.00
|
| Rate for Payer: WEA Trust Commercial |
$3,668.50
|
| Rate for Payer: WPS Commercial |
$4,940.47
|
|
|
MRI Spine Thoracic w/ + w/o Contrast
|
Facility
|
OP
|
$6,670.00
|
|
|
Service Code
|
CPT 72157 TC
|
| Hospital Charge Code |
1611317
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$380.12 |
| Max. Negotiated Rate |
$6,136.40 |
| Rate for Payer: Aetna Commercial |
$6,003.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,736.20
|
| 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 |
$3,535.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$380.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$380.12
|
| Rate for Payer: Cash Price |
$2,001.00
|
| Rate for Payer: Cash Price |
$2,001.00
|
| Rate for Payer: Cash Price |
$2,001.00
|
| Rate for Payer: Cash Price |
$2,001.00
|
| Rate for Payer: Cigna Commercial |
$6,136.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$380.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,732.53
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$380.12
|
| Rate for Payer: Health EOS Commercial |
$5,936.30
|
| Rate for Payer: HFN Commercial |
$6,136.40
|
| 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 |
$5,336.00
|
| Rate for Payer: NAPHCARE Commercial |
$570.18
|
| Rate for Payer: Preferred Network Access Commercial |
$6,136.40
|
| Rate for Payer: Quartz Beloit One Network |
$3,268.30
|
| Rate for Payer: Quartz Commercial |
$4,335.50
|
| 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 |
$3,668.50
|
| Rate for Payer: Wellcare Medicare |
$380.12
|
| Rate for Payer: WPS Commercial |
$4,940.47
|
|
|
MRI Spine Thoracic w/ + w/o Contrast
|
Professional
|
Both
|
$6,235.00
|
|
|
Service Code
|
CPT 72157
|
| Hospital Charge Code |
631293
|
| Min. Negotiated Rate |
$1,225.47 |
| Max. Negotiated Rate |
$5,923.25 |
| Rate for Payer: Aetna Commercial |
$5,923.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,362.10
|
| Rate for Payer: Cash Price |
$1,870.50
|
| Rate for Payer: Cash Price |
$1,870.50
|
| Rate for Payer: Cash Price |
$1,870.50
|
| Rate for Payer: Cigna Commercial |
$5,923.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$3,117.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,741.00
|
| Rate for Payer: Health EOS Commercial |
$5,673.85
|
| Rate for Payer: HFN Commercial |
$5,923.25
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,225.47
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,225.47
|
| Rate for Payer: Multiplan Commercial |
$4,988.00
|
| Rate for Payer: Preferred Network Access Commercial |
$5,923.25
|
| Rate for Payer: Quartz Beloit One Network |
$2,743.40
|
| Rate for Payer: Quartz Commercial |
$3,553.95
|
| Rate for Payer: The Alliance Commercial |
$3,117.50
|
| Rate for Payer: WEA Trust Commercial |
$3,429.25
|
| Rate for Payer: WPS Commercial |
$4,618.26
|
|
