|
MRI Humerus w/ + w/o Contrast Right
|
Facility
|
IP
|
$5,479.00
|
|
|
Service Code
|
CPT 73220
|
| Hospital Charge Code |
631027
|
| Min. Negotiated Rate |
$2,792.10 |
| Max. Negotiated Rate |
$5,242.31 |
| Rate for Payer: Aetna Commercial |
$5,128.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,900.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,020.02
|
| Rate for Payer: Cash Price |
$1,643.70
|
| Rate for Payer: Cigna Commercial |
$5,242.31
|
| Rate for Payer: Health EOS Commercial |
$5,071.36
|
| Rate for Payer: HFN Commercial |
$5,242.31
|
| Rate for Payer: Multiplan Commercial |
$4,558.53
|
| Rate for Payer: Preferred Network Access Commercial |
$5,242.31
|
| Rate for Payer: Quartz Beloit One Network |
$2,792.10
|
| Rate for Payer: Quartz Commercial |
$3,418.90
|
| Rate for Payer: WEA Trust Commercial |
$3,133.99
|
| Rate for Payer: WPS Commercial |
$4,220.47
|
|
|
MRI Humerus w/ + w/o Contrast Right
|
Professional
|
Both
|
$6,077.00
|
|
|
Service Code
|
CPT 73220 TC,RT
|
| Hospital Charge Code |
2980037
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,659.96 |
| Max. Negotiated Rate |
$6,004.08 |
| Rate for Payer: Aetna Commercial |
$6,004.08
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,435.27
|
| Rate for Payer: Cash Price |
$1,823.10
|
| Rate for Payer: Cash Price |
$1,823.10
|
| Rate for Payer: Cash Price |
$1,823.10
|
| Rate for Payer: Cigna Commercial |
$6,004.08
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$3,160.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,792.05
|
| Rate for Payer: Health EOS Commercial |
$5,751.27
|
| Rate for Payer: HFN Commercial |
$6,004.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,659.96
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,659.96
|
| Rate for Payer: Multiplan Commercial |
$5,056.06
|
| Rate for Payer: Preferred Network Access Commercial |
$6,004.08
|
| Rate for Payer: Quartz Beloit One Network |
$2,780.84
|
| Rate for Payer: Quartz Commercial |
$3,602.45
|
| Rate for Payer: The Alliance Commercial |
$3,160.04
|
| Rate for Payer: WEA Trust Commercial |
$3,476.04
|
| Rate for Payer: WPS Commercial |
$4,681.11
|
|
|
MRI Humerus w/ + w/o Contrast Right
|
Facility
|
OP
|
$6,077.00
|
|
|
Service Code
|
CPT 73220 TC,RT
|
| Hospital Charge Code |
2980037
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,769.62 |
| Max. Negotiated Rate |
$5,814.47 |
| Rate for Payer: Aetna Commercial |
$5,688.07
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,435.27
|
| Rate for Payer: Aetna Managed Medicare |
$1,769.62
|
| 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 |
$3,349.64
|
| Rate for Payer: Cash Price |
$1,823.10
|
| Rate for Payer: Cash Price |
$1,823.10
|
| Rate for Payer: Cash Price |
$1,823.10
|
| Rate for Payer: Cigna Commercial |
$5,814.47
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,536.81
|
| Rate for Payer: Health EOS Commercial |
$5,624.87
|
| Rate for Payer: HFN Commercial |
$5,814.47
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,740.06
|
| Rate for Payer: Multiplan Commercial |
$5,056.06
|
| Rate for Payer: NAPHCARE Commercial |
$3,792.05
|
| Rate for Payer: Preferred Network Access Commercial |
$5,814.47
|
| Rate for Payer: Quartz Beloit One Network |
$3,096.84
|
| Rate for Payer: Quartz Commercial |
$4,108.05
|
| Rate for Payer: Quartz Medicare Advantage |
$3,792.05
|
| Rate for Payer: The Alliance Commercial |
$3,160.04
|
| Rate for Payer: United Healthcare PPO |
$3,142.88
|
| Rate for Payer: WEA Trust Commercial |
$3,476.04
|
| Rate for Payer: WPS Commercial |
$4,681.11
|
|
|
MRI Humerus w/ + w/o Contrast Right
|
Facility
|
OP
|
$5,479.00
|
|
|
Service Code
|
CPT 73220
|
| Hospital Charge Code |
631027
|
| Min. Negotiated Rate |
$367.15 |
| Max. Negotiated Rate |
$5,242.31 |
| Rate for Payer: Aetna Commercial |
$5,128.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,900.42
|
| Rate for Payer: Aetna Managed Medicare |
$367.15
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,703.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,849.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,735.12
|
| Rate for Payer: Anthem Medicare Advantage |
$367.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,020.02
|
| 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 |
$1,643.70
|
| Rate for Payer: Cash Price |
$1,643.70
|
| Rate for Payer: Cigna Commercial |
$5,242.31
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$367.15
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,188.78
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$367.15
|
| Rate for Payer: Health EOS Commercial |
$5,071.36
|
| Rate for Payer: HFN Commercial |
$5,242.31
|
| 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 |
$4,558.53
|
| Rate for Payer: NAPHCARE Commercial |
$550.73
|
| Rate for Payer: Preferred Network Access Commercial |
$5,242.31
|
| Rate for Payer: Quartz Beloit One Network |
$2,792.10
|
| Rate for Payer: Quartz Commercial |
$3,703.80
|
| 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 |
$3,133.99
|
| Rate for Payer: Wellcare Medicare |
$367.15
|
| Rate for Payer: WPS Commercial |
$4,220.47
|
|
|
MRI IAC w + w/o Contrast
|
Professional
|
Both
|
$6,115.00
|
|
|
Service Code
|
CPT 70553 TC
|
| Hospital Charge Code |
5382962
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$210.31 |
| Max. Negotiated Rate |
$6,041.62 |
| Rate for Payer: Aetna Commercial |
$6,041.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,469.26
|
| Rate for Payer: Aetna Managed Medicare |
$210.31
|
| Rate for Payer: Anthem Medicare Advantage |
$210.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$210.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$210.31
|
| Rate for Payer: Cash Price |
$1,834.50
|
| Rate for Payer: Cash Price |
$1,834.50
|
| Rate for Payer: Cash Price |
$1,834.50
|
| Rate for Payer: Cigna Commercial |
$6,041.62
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$3,179.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$210.31
|
| Rate for Payer: Health EOS Commercial |
$5,787.24
|
| Rate for Payer: HFN Commercial |
$6,041.62
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$862.37
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$862.37
|
| Rate for Payer: Independent Care Health Plan Medicare |
$210.31
|
| Rate for Payer: Multiplan Commercial |
$5,087.68
|
| Rate for Payer: NAPHCARE Commercial |
$315.46
|
| Rate for Payer: Preferred Network Access Commercial |
$6,041.62
|
| Rate for Payer: Quartz Beloit One Network |
$2,798.22
|
| Rate for Payer: Quartz Commercial |
$3,624.97
|
| Rate for Payer: Quartz Medicare Advantage |
$210.31
|
| Rate for Payer: The Alliance Commercial |
$799.17
|
| Rate for Payer: United Healthcare Medicare Advantage |
$210.31
|
| Rate for Payer: WEA Trust Commercial |
$3,497.78
|
| Rate for Payer: WPS Commercial |
$1,051.54
|
|
|
MRI IAC w + w/o Contrast
|
Facility
|
OP
|
$6,115.00
|
|
|
Service Code
|
CPT 70553 TC
|
| Hospital Charge Code |
5382962
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$841.24 |
| Max. Negotiated Rate |
$5,850.83 |
| Rate for Payer: Aetna Commercial |
$5,723.64
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,469.26
|
| Rate for Payer: Aetna Managed Medicare |
$1,780.69
|
| 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 |
$3,370.59
|
| Rate for Payer: Cash Price |
$1,834.50
|
| Rate for Payer: Cash Price |
$1,834.50
|
| Rate for Payer: Cash Price |
$1,834.50
|
| Rate for Payer: Cash Price |
$1,834.50
|
| Rate for Payer: Cigna Commercial |
$5,850.83
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,558.93
|
| Rate for Payer: Health EOS Commercial |
$5,660.04
|
| Rate for Payer: HFN Commercial |
$5,850.83
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,769.70
|
| Rate for Payer: Multiplan Commercial |
$5,087.68
|
| Rate for Payer: NAPHCARE Commercial |
$3,815.76
|
| Rate for Payer: Preferred Network Access Commercial |
$5,850.83
|
| Rate for Payer: Quartz Beloit One Network |
$3,116.20
|
| Rate for Payer: Quartz Commercial |
$4,133.74
|
| Rate for Payer: Quartz Medicare Advantage |
$3,815.76
|
| Rate for Payer: The Alliance Commercial |
$841.24
|
| Rate for Payer: United Healthcare PPO |
$3,142.88
|
| Rate for Payer: WEA Trust Commercial |
$3,497.78
|
| Rate for Payer: WPS Commercial |
$1,472.16
|
|
|
MRI IAC w + w/o Contrast
|
Facility
|
IP
|
$6,115.00
|
|
|
Service Code
|
CPT 70553 TC
|
| Hospital Charge Code |
5382962
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$3,116.20 |
| Max. Negotiated Rate |
$5,850.83 |
| Rate for Payer: Aetna Commercial |
$5,723.64
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,469.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,370.59
|
| Rate for Payer: Cash Price |
$1,834.50
|
| Rate for Payer: Cigna Commercial |
$5,850.83
|
| Rate for Payer: Health EOS Commercial |
$5,660.04
|
| Rate for Payer: HFN Commercial |
$5,850.83
|
| Rate for Payer: Multiplan Commercial |
$5,087.68
|
| Rate for Payer: Preferred Network Access Commercial |
$5,850.83
|
| Rate for Payer: Quartz Beloit One Network |
$3,116.20
|
| Rate for Payer: Quartz Commercial |
$3,815.76
|
| Rate for Payer: WEA Trust Commercial |
$3,497.78
|
| Rate for Payer: WPS Commercial |
$4,710.38
|
|
|
MRI Knee w/ Contrast Bilateral
|
Facility
|
OP
|
$10,169.00
|
|
|
Service Code
|
CPT 73722
|
| Hospital Charge Code |
631093
|
| Min. Negotiated Rate |
$824.99 |
| Max. Negotiated Rate |
$9,729.70 |
| Rate for Payer: Aetna Commercial |
$9,518.18
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,095.15
|
| Rate for Payer: Aetna Managed Medicare |
$824.99
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,874.24
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,287.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,076.36
|
| Rate for Payer: Anthem Medicare Advantage |
$824.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,605.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$824.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$824.99
|
| Rate for Payer: Cash Price |
$3,050.70
|
| Rate for Payer: Cash Price |
$3,050.70
|
| Rate for Payer: Cigna Commercial |
$9,729.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$824.99
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,918.36
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$824.99
|
| Rate for Payer: Health EOS Commercial |
$9,412.43
|
| Rate for Payer: HFN Commercial |
$9,729.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,068.96
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$824.99
|
| Rate for Payer: Independent Care Health Plan Medicare |
$824.99
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$824.99
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$824.99
|
| Rate for Payer: Multiplan Commercial |
$8,460.61
|
| Rate for Payer: NAPHCARE Commercial |
$1,237.49
|
| Rate for Payer: Preferred Network Access Commercial |
$9,729.70
|
| Rate for Payer: Quartz Beloit One Network |
$5,182.12
|
| Rate for Payer: Quartz Commercial |
$6,874.24
|
| Rate for Payer: Quartz Medicare Advantage |
$824.99
|
| Rate for Payer: The Alliance Commercial |
$3,299.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$824.99
|
| Rate for Payer: WEA Trust Commercial |
$5,816.67
|
| Rate for Payer: Wellcare Medicare |
$824.99
|
| Rate for Payer: WPS Commercial |
$7,833.18
|
|
|
MRI Knee w/ Contrast Bilateral
|
Professional
|
Both
|
$10,169.00
|
|
|
Service Code
|
CPT 73722
|
| Hospital Charge Code |
631093
|
| Min. Negotiated Rate |
$313.63 |
| Max. Negotiated Rate |
$10,046.97 |
| Rate for Payer: Aetna Commercial |
$10,046.97
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,095.15
|
| Rate for Payer: Aetna Managed Medicare |
$313.63
|
| Rate for Payer: Anthem Medicare Advantage |
$313.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$313.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$313.63
|
| Rate for Payer: Cash Price |
$3,050.70
|
| Rate for Payer: Cash Price |
$3,050.70
|
| Rate for Payer: Cash Price |
$3,050.70
|
| Rate for Payer: Cigna Commercial |
$10,046.97
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$5,287.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$313.63
|
| Rate for Payer: Health EOS Commercial |
$9,623.94
|
| Rate for Payer: HFN Commercial |
$10,046.97
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,271.19
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,271.19
|
| Rate for Payer: Independent Care Health Plan Medicare |
$313.63
|
| Rate for Payer: Multiplan Commercial |
$8,460.61
|
| Rate for Payer: NAPHCARE Commercial |
$470.45
|
| Rate for Payer: Preferred Network Access Commercial |
$10,046.97
|
| Rate for Payer: Quartz Beloit One Network |
$4,653.33
|
| Rate for Payer: Quartz Commercial |
$6,028.18
|
| Rate for Payer: Quartz Medicare Advantage |
$313.63
|
| Rate for Payer: The Alliance Commercial |
$1,191.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$313.63
|
| Rate for Payer: WEA Trust Commercial |
$5,816.67
|
| Rate for Payer: WPS Commercial |
$1,568.16
|
|
|
MRI Knee w/ Contrast Bilateral
|
Facility
|
IP
|
$10,169.00
|
|
|
Service Code
|
CPT 73722
|
| Hospital Charge Code |
631093
|
| Min. Negotiated Rate |
$5,182.12 |
| Max. Negotiated Rate |
$9,729.70 |
| Rate for Payer: Aetna Commercial |
$9,518.18
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,095.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,605.15
|
| Rate for Payer: Cash Price |
$3,050.70
|
| Rate for Payer: Cigna Commercial |
$9,729.70
|
| Rate for Payer: Health EOS Commercial |
$9,412.43
|
| Rate for Payer: HFN Commercial |
$9,729.70
|
| Rate for Payer: Multiplan Commercial |
$8,460.61
|
| Rate for Payer: Preferred Network Access Commercial |
$9,729.70
|
| Rate for Payer: Quartz Beloit One Network |
$5,182.12
|
| Rate for Payer: Quartz Commercial |
$6,345.46
|
| Rate for Payer: WEA Trust Commercial |
$5,816.67
|
| Rate for Payer: WPS Commercial |
$7,833.18
|
|
|
MRI Knee w/ Contrast Bilateral
|
Facility
|
OP
|
$4,988.00
|
|
|
Service Code
|
CPT 73722 TC,LT
|
| Hospital Charge Code |
1611177
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,452.51 |
| Max. Negotiated Rate |
$4,772.52 |
| Rate for Payer: Aetna Commercial |
$4,668.77
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,461.27
|
| Rate for Payer: Aetna Managed Medicare |
$1,452.51
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,635.84
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,985.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,835.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,749.39
|
| Rate for Payer: Cash Price |
$1,496.40
|
| Rate for Payer: Cash Price |
$1,496.40
|
| Rate for Payer: Cash Price |
$1,496.40
|
| Rate for Payer: Cigna Commercial |
$4,772.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,903.02
|
| Rate for Payer: Health EOS Commercial |
$4,616.89
|
| Rate for Payer: HFN Commercial |
$4,772.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,890.64
|
| Rate for Payer: Multiplan Commercial |
$4,150.02
|
| Rate for Payer: NAPHCARE Commercial |
$3,112.51
|
| Rate for Payer: Preferred Network Access Commercial |
$4,772.52
|
| Rate for Payer: Quartz Beloit One Network |
$2,541.88
|
| Rate for Payer: Quartz Commercial |
$3,371.89
|
| Rate for Payer: Quartz Medicare Advantage |
$3,112.51
|
| Rate for Payer: The Alliance Commercial |
$2,593.76
|
| Rate for Payer: United Healthcare PPO |
$3,142.88
|
| Rate for Payer: WEA Trust Commercial |
$2,853.14
|
| Rate for Payer: WPS Commercial |
$3,842.26
|
|
|
MRI Knee w/ Contrast Bilateral
|
Facility
|
IP
|
$4,988.00
|
|
|
Service Code
|
CPT 73722 TC,LT
|
| Hospital Charge Code |
1611177
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$2,541.88 |
| Max. Negotiated Rate |
$4,772.52 |
| Rate for Payer: Aetna Commercial |
$4,668.77
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,461.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,749.39
|
| Rate for Payer: Cash Price |
$1,496.40
|
| Rate for Payer: Cigna Commercial |
$4,772.52
|
| Rate for Payer: Health EOS Commercial |
$4,616.89
|
| Rate for Payer: HFN Commercial |
$4,772.52
|
| Rate for Payer: Multiplan Commercial |
$4,150.02
|
| Rate for Payer: Preferred Network Access Commercial |
$4,772.52
|
| Rate for Payer: Quartz Beloit One Network |
$2,541.88
|
| Rate for Payer: Quartz Commercial |
$3,112.51
|
| Rate for Payer: WEA Trust Commercial |
$2,853.14
|
| Rate for Payer: WPS Commercial |
$3,842.26
|
|
|
MRI Knee w/ Contrast Bilateral
|
Professional
|
Both
|
$4,988.00
|
|
|
Service Code
|
CPT 73722 TC,LT
|
| Hospital Charge Code |
1611177
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,271.19 |
| Max. Negotiated Rate |
$4,928.14 |
| Rate for Payer: Aetna Commercial |
$4,928.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,461.27
|
| Rate for Payer: Cash Price |
$1,496.40
|
| Rate for Payer: Cash Price |
$1,496.40
|
| Rate for Payer: Cash Price |
$1,496.40
|
| Rate for Payer: Cigna Commercial |
$4,928.14
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,593.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,112.51
|
| Rate for Payer: Health EOS Commercial |
$4,720.64
|
| Rate for Payer: HFN Commercial |
$4,928.14
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,271.19
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,271.19
|
| Rate for Payer: Multiplan Commercial |
$4,150.02
|
| Rate for Payer: Preferred Network Access Commercial |
$4,928.14
|
| Rate for Payer: Quartz Beloit One Network |
$2,282.51
|
| Rate for Payer: Quartz Commercial |
$2,956.89
|
| Rate for Payer: The Alliance Commercial |
$2,593.76
|
| Rate for Payer: WEA Trust Commercial |
$2,853.14
|
| Rate for Payer: WPS Commercial |
$3,842.26
|
|
|
MRI Knee w/ Contrast Left
|
Professional
|
Both
|
$5,085.00
|
|
|
Service Code
|
CPT 73722
|
| Hospital Charge Code |
631097
|
| Min. Negotiated Rate |
$313.63 |
| Max. Negotiated Rate |
$5,023.98 |
| Rate for Payer: Aetna Commercial |
$5,023.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,548.02
|
| Rate for Payer: Aetna Managed Medicare |
$313.63
|
| Rate for Payer: Anthem Medicare Advantage |
$313.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$313.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$313.63
|
| Rate for Payer: Cash Price |
$1,525.50
|
| Rate for Payer: Cash Price |
$1,525.50
|
| Rate for Payer: Cash Price |
$1,525.50
|
| Rate for Payer: Cigna Commercial |
$5,023.98
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,644.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$313.63
|
| Rate for Payer: Health EOS Commercial |
$4,812.44
|
| Rate for Payer: HFN Commercial |
$5,023.98
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,271.19
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,271.19
|
| Rate for Payer: Independent Care Health Plan Medicare |
$313.63
|
| Rate for Payer: Multiplan Commercial |
$4,230.72
|
| Rate for Payer: NAPHCARE Commercial |
$470.45
|
| Rate for Payer: Preferred Network Access Commercial |
$5,023.98
|
| Rate for Payer: Quartz Beloit One Network |
$2,326.90
|
| Rate for Payer: Quartz Commercial |
$3,014.39
|
| Rate for Payer: Quartz Medicare Advantage |
$313.63
|
| Rate for Payer: The Alliance Commercial |
$1,191.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$313.63
|
| Rate for Payer: WEA Trust Commercial |
$2,908.62
|
| Rate for Payer: WPS Commercial |
$1,568.16
|
|
|
MRI Knee w/ Contrast Left
|
Facility
|
IP
|
$5,085.00
|
|
|
Service Code
|
CPT 73722
|
| Hospital Charge Code |
631097
|
| Min. Negotiated Rate |
$2,591.32 |
| Max. Negotiated Rate |
$4,865.33 |
| Rate for Payer: Aetna Commercial |
$4,759.56
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,548.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,802.85
|
| Rate for Payer: Cash Price |
$1,525.50
|
| Rate for Payer: Cigna Commercial |
$4,865.33
|
| Rate for Payer: Health EOS Commercial |
$4,706.68
|
| Rate for Payer: HFN Commercial |
$4,865.33
|
| Rate for Payer: Multiplan Commercial |
$4,230.72
|
| Rate for Payer: Preferred Network Access Commercial |
$4,865.33
|
| Rate for Payer: Quartz Beloit One Network |
$2,591.32
|
| Rate for Payer: Quartz Commercial |
$3,173.04
|
| Rate for Payer: WEA Trust Commercial |
$2,908.62
|
| Rate for Payer: WPS Commercial |
$3,916.98
|
|
|
MRI Knee w/ Contrast Left
|
Facility
|
OP
|
$4,988.00
|
|
|
Service Code
|
CPT 73722 TC,LT
|
| Hospital Charge Code |
1611179
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,452.51 |
| Max. Negotiated Rate |
$4,772.52 |
| Rate for Payer: Aetna Commercial |
$4,668.77
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,461.27
|
| Rate for Payer: Aetna Managed Medicare |
$1,452.51
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,635.84
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,985.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,835.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,749.39
|
| Rate for Payer: Cash Price |
$1,496.40
|
| Rate for Payer: Cash Price |
$1,496.40
|
| Rate for Payer: Cash Price |
$1,496.40
|
| Rate for Payer: Cigna Commercial |
$4,772.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,903.02
|
| Rate for Payer: Health EOS Commercial |
$4,616.89
|
| Rate for Payer: HFN Commercial |
$4,772.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,890.64
|
| Rate for Payer: Multiplan Commercial |
$4,150.02
|
| Rate for Payer: NAPHCARE Commercial |
$3,112.51
|
| Rate for Payer: Preferred Network Access Commercial |
$4,772.52
|
| Rate for Payer: Quartz Beloit One Network |
$2,541.88
|
| Rate for Payer: Quartz Commercial |
$3,371.89
|
| Rate for Payer: Quartz Medicare Advantage |
$3,112.51
|
| Rate for Payer: The Alliance Commercial |
$2,593.76
|
| Rate for Payer: United Healthcare PPO |
$3,142.88
|
| Rate for Payer: WEA Trust Commercial |
$2,853.14
|
| Rate for Payer: WPS Commercial |
$3,842.26
|
|
|
MRI Knee w/ Contrast Left
|
Facility
|
IP
|
$4,988.00
|
|
|
Service Code
|
CPT 73722 TC,LT
|
| Hospital Charge Code |
1611179
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$2,541.88 |
| Max. Negotiated Rate |
$4,772.52 |
| Rate for Payer: Aetna Commercial |
$4,668.77
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,461.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,749.39
|
| Rate for Payer: Cash Price |
$1,496.40
|
| Rate for Payer: Cigna Commercial |
$4,772.52
|
| Rate for Payer: Health EOS Commercial |
$4,616.89
|
| Rate for Payer: HFN Commercial |
$4,772.52
|
| Rate for Payer: Multiplan Commercial |
$4,150.02
|
| Rate for Payer: Preferred Network Access Commercial |
$4,772.52
|
| Rate for Payer: Quartz Beloit One Network |
$2,541.88
|
| Rate for Payer: Quartz Commercial |
$3,112.51
|
| Rate for Payer: WEA Trust Commercial |
$2,853.14
|
| Rate for Payer: WPS Commercial |
$3,842.26
|
|
|
MRI Knee w/ Contrast Left
|
Facility
|
OP
|
$5,085.00
|
|
|
Service Code
|
CPT 73722
|
| Hospital Charge Code |
631097
|
| Min. Negotiated Rate |
$824.99 |
| Max. Negotiated Rate |
$4,865.33 |
| Rate for Payer: Aetna Commercial |
$4,759.56
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,548.02
|
| Rate for Payer: Aetna Managed Medicare |
$824.99
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,437.46
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,644.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,538.43
|
| Rate for Payer: Anthem Medicare Advantage |
$824.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,802.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$824.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$824.99
|
| Rate for Payer: Cash Price |
$1,525.50
|
| Rate for Payer: Cash Price |
$1,525.50
|
| Rate for Payer: Cigna Commercial |
$4,865.33
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$824.99
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,959.47
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$824.99
|
| Rate for Payer: Health EOS Commercial |
$4,706.68
|
| Rate for Payer: HFN Commercial |
$4,865.33
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,068.96
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$824.99
|
| Rate for Payer: Independent Care Health Plan Medicare |
$824.99
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$824.99
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$824.99
|
| Rate for Payer: Multiplan Commercial |
$4,230.72
|
| Rate for Payer: NAPHCARE Commercial |
$1,237.49
|
| Rate for Payer: Preferred Network Access Commercial |
$4,865.33
|
| Rate for Payer: Quartz Beloit One Network |
$2,591.32
|
| Rate for Payer: Quartz Commercial |
$3,437.46
|
| Rate for Payer: Quartz Medicare Advantage |
$824.99
|
| Rate for Payer: The Alliance Commercial |
$3,299.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$824.99
|
| Rate for Payer: WEA Trust Commercial |
$2,908.62
|
| Rate for Payer: Wellcare Medicare |
$824.99
|
| Rate for Payer: WPS Commercial |
$3,916.98
|
|
|
MRI Knee w/ Contrast Left
|
Professional
|
Both
|
$4,988.00
|
|
|
Service Code
|
CPT 73722 TC,LT
|
| Hospital Charge Code |
1611179
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,271.19 |
| Max. Negotiated Rate |
$4,928.14 |
| Rate for Payer: Aetna Commercial |
$4,928.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,461.27
|
| Rate for Payer: Cash Price |
$1,496.40
|
| Rate for Payer: Cash Price |
$1,496.40
|
| Rate for Payer: Cash Price |
$1,496.40
|
| Rate for Payer: Cigna Commercial |
$4,928.14
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,593.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,112.51
|
| Rate for Payer: Health EOS Commercial |
$4,720.64
|
| Rate for Payer: HFN Commercial |
$4,928.14
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,271.19
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,271.19
|
| Rate for Payer: Multiplan Commercial |
$4,150.02
|
| Rate for Payer: Preferred Network Access Commercial |
$4,928.14
|
| Rate for Payer: Quartz Beloit One Network |
$2,282.51
|
| Rate for Payer: Quartz Commercial |
$2,956.89
|
| Rate for Payer: The Alliance Commercial |
$2,593.76
|
| Rate for Payer: WEA Trust Commercial |
$2,853.14
|
| Rate for Payer: WPS Commercial |
$3,842.26
|
|
|
MRI Knee w/ Contrast Right
|
Facility
|
IP
|
$4,988.00
|
|
|
Service Code
|
CPT 73722 TC,RT
|
| Hospital Charge Code |
1611181
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$2,541.88 |
| Max. Negotiated Rate |
$4,772.52 |
| Rate for Payer: Aetna Commercial |
$4,668.77
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,461.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,749.39
|
| Rate for Payer: Cash Price |
$1,496.40
|
| Rate for Payer: Cigna Commercial |
$4,772.52
|
| Rate for Payer: Health EOS Commercial |
$4,616.89
|
| Rate for Payer: HFN Commercial |
$4,772.52
|
| Rate for Payer: Multiplan Commercial |
$4,150.02
|
| Rate for Payer: Preferred Network Access Commercial |
$4,772.52
|
| Rate for Payer: Quartz Beloit One Network |
$2,541.88
|
| Rate for Payer: Quartz Commercial |
$3,112.51
|
| Rate for Payer: WEA Trust Commercial |
$2,853.14
|
| Rate for Payer: WPS Commercial |
$3,842.26
|
|
|
MRI Knee w/ Contrast Right
|
Facility
|
OP
|
$4,988.00
|
|
|
Service Code
|
CPT 73722 TC,RT
|
| Hospital Charge Code |
1611181
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,452.51 |
| Max. Negotiated Rate |
$4,772.52 |
| Rate for Payer: Aetna Commercial |
$4,668.77
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,461.27
|
| Rate for Payer: Aetna Managed Medicare |
$1,452.51
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,635.84
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,985.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,835.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,749.39
|
| Rate for Payer: Cash Price |
$1,496.40
|
| Rate for Payer: Cash Price |
$1,496.40
|
| Rate for Payer: Cash Price |
$1,496.40
|
| Rate for Payer: Cigna Commercial |
$4,772.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,903.02
|
| Rate for Payer: Health EOS Commercial |
$4,616.89
|
| Rate for Payer: HFN Commercial |
$4,772.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,890.64
|
| Rate for Payer: Multiplan Commercial |
$4,150.02
|
| Rate for Payer: NAPHCARE Commercial |
$3,112.51
|
| Rate for Payer: Preferred Network Access Commercial |
$4,772.52
|
| Rate for Payer: Quartz Beloit One Network |
$2,541.88
|
| Rate for Payer: Quartz Commercial |
$3,371.89
|
| Rate for Payer: Quartz Medicare Advantage |
$3,112.51
|
| Rate for Payer: The Alliance Commercial |
$2,593.76
|
| Rate for Payer: United Healthcare PPO |
$3,142.88
|
| Rate for Payer: WEA Trust Commercial |
$2,853.14
|
| Rate for Payer: WPS Commercial |
$3,842.26
|
|
|
MRI Knee w/ Contrast Right
|
Professional
|
Both
|
$4,988.00
|
|
|
Service Code
|
CPT 73722 TC,RT
|
| Hospital Charge Code |
1611181
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,271.19 |
| Max. Negotiated Rate |
$4,928.14 |
| Rate for Payer: Aetna Commercial |
$4,928.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,461.27
|
| Rate for Payer: Cash Price |
$1,496.40
|
| Rate for Payer: Cash Price |
$1,496.40
|
| Rate for Payer: Cash Price |
$1,496.40
|
| Rate for Payer: Cigna Commercial |
$4,928.14
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,593.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,112.51
|
| Rate for Payer: Health EOS Commercial |
$4,720.64
|
| Rate for Payer: HFN Commercial |
$4,928.14
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,271.19
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,271.19
|
| Rate for Payer: Multiplan Commercial |
$4,150.02
|
| Rate for Payer: Preferred Network Access Commercial |
$4,928.14
|
| Rate for Payer: Quartz Beloit One Network |
$2,282.51
|
| Rate for Payer: Quartz Commercial |
$2,956.89
|
| Rate for Payer: The Alliance Commercial |
$2,593.76
|
| Rate for Payer: WEA Trust Commercial |
$2,853.14
|
| Rate for Payer: WPS Commercial |
$3,842.26
|
|
|
MRI Knee w/ Contrast Right
|
Facility
|
IP
|
$5,085.00
|
|
|
Service Code
|
CPT 73722
|
| Hospital Charge Code |
631101
|
| Min. Negotiated Rate |
$2,591.32 |
| Max. Negotiated Rate |
$4,865.33 |
| Rate for Payer: Aetna Commercial |
$4,759.56
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,548.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,802.85
|
| Rate for Payer: Cash Price |
$1,525.50
|
| Rate for Payer: Cigna Commercial |
$4,865.33
|
| Rate for Payer: Health EOS Commercial |
$4,706.68
|
| Rate for Payer: HFN Commercial |
$4,865.33
|
| Rate for Payer: Multiplan Commercial |
$4,230.72
|
| Rate for Payer: Preferred Network Access Commercial |
$4,865.33
|
| Rate for Payer: Quartz Beloit One Network |
$2,591.32
|
| Rate for Payer: Quartz Commercial |
$3,173.04
|
| Rate for Payer: WEA Trust Commercial |
$2,908.62
|
| Rate for Payer: WPS Commercial |
$3,916.98
|
|
|
MRI Knee w/ Contrast Right
|
Facility
|
OP
|
$5,085.00
|
|
|
Service Code
|
CPT 73722
|
| Hospital Charge Code |
631101
|
| Min. Negotiated Rate |
$824.99 |
| Max. Negotiated Rate |
$4,865.33 |
| Rate for Payer: Aetna Commercial |
$4,759.56
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,548.02
|
| Rate for Payer: Aetna Managed Medicare |
$824.99
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,437.46
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,644.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,538.43
|
| Rate for Payer: Anthem Medicare Advantage |
$824.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,802.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$824.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$824.99
|
| Rate for Payer: Cash Price |
$1,525.50
|
| Rate for Payer: Cash Price |
$1,525.50
|
| Rate for Payer: Cigna Commercial |
$4,865.33
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$824.99
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,959.47
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$824.99
|
| Rate for Payer: Health EOS Commercial |
$4,706.68
|
| Rate for Payer: HFN Commercial |
$4,865.33
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,068.96
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$824.99
|
| Rate for Payer: Independent Care Health Plan Medicare |
$824.99
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$824.99
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$824.99
|
| Rate for Payer: Multiplan Commercial |
$4,230.72
|
| Rate for Payer: NAPHCARE Commercial |
$1,237.49
|
| Rate for Payer: Preferred Network Access Commercial |
$4,865.33
|
| Rate for Payer: Quartz Beloit One Network |
$2,591.32
|
| Rate for Payer: Quartz Commercial |
$3,437.46
|
| Rate for Payer: Quartz Medicare Advantage |
$824.99
|
| Rate for Payer: The Alliance Commercial |
$3,299.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$824.99
|
| Rate for Payer: WEA Trust Commercial |
$2,908.62
|
| Rate for Payer: Wellcare Medicare |
$824.99
|
| Rate for Payer: WPS Commercial |
$3,916.98
|
|
|
MRI Knee w/ Contrast Right
|
Professional
|
Both
|
$5,085.00
|
|
|
Service Code
|
CPT 73722
|
| Hospital Charge Code |
631101
|
| Min. Negotiated Rate |
$313.63 |
| Max. Negotiated Rate |
$5,023.98 |
| Rate for Payer: Aetna Commercial |
$5,023.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,548.02
|
| Rate for Payer: Aetna Managed Medicare |
$313.63
|
| Rate for Payer: Anthem Medicare Advantage |
$313.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$313.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$313.63
|
| Rate for Payer: Cash Price |
$1,525.50
|
| Rate for Payer: Cash Price |
$1,525.50
|
| Rate for Payer: Cash Price |
$1,525.50
|
| Rate for Payer: Cigna Commercial |
$5,023.98
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,644.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$313.63
|
| Rate for Payer: Health EOS Commercial |
$4,812.44
|
| Rate for Payer: HFN Commercial |
$5,023.98
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,271.19
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,271.19
|
| Rate for Payer: Independent Care Health Plan Medicare |
$313.63
|
| Rate for Payer: Multiplan Commercial |
$4,230.72
|
| Rate for Payer: NAPHCARE Commercial |
$470.45
|
| Rate for Payer: Preferred Network Access Commercial |
$5,023.98
|
| Rate for Payer: Quartz Beloit One Network |
$2,326.90
|
| Rate for Payer: Quartz Commercial |
$3,014.39
|
| Rate for Payer: Quartz Medicare Advantage |
$313.63
|
| Rate for Payer: The Alliance Commercial |
$1,191.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$313.63
|
| Rate for Payer: WEA Trust Commercial |
$2,908.62
|
| Rate for Payer: WPS Commercial |
$1,568.16
|
|
