|
MRI LE Non Joint w/ + w/o Contrast Bilat
|
Facility
|
IP
|
$12,160.00
|
|
|
Service Code
|
CPT 73720
|
| Hospital Charge Code |
631155
|
| Min. Negotiated Rate |
$6,196.74 |
| Max. Negotiated Rate |
$11,634.69 |
| Rate for Payer: Aetna Commercial |
$11,381.76
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,875.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,702.59
|
| Rate for Payer: Cash Price |
$3,648.00
|
| Rate for Payer: Cigna Commercial |
$11,634.69
|
| Rate for Payer: Health EOS Commercial |
$11,255.30
|
| Rate for Payer: HFN Commercial |
$11,634.69
|
| Rate for Payer: Multiplan Commercial |
$10,117.12
|
| Rate for Payer: Preferred Network Access Commercial |
$11,634.69
|
| Rate for Payer: Quartz Beloit One Network |
$6,196.74
|
| Rate for Payer: Quartz Commercial |
$7,587.84
|
| Rate for Payer: WEA Trust Commercial |
$6,955.52
|
| Rate for Payer: WPS Commercial |
$9,366.85
|
|
|
MRI LE Non Joint w/ + w/o Contrast Bilat
|
Facility
|
OP
|
$12,160.00
|
|
|
Service Code
|
CPT 73720
|
| Hospital Charge Code |
631155
|
| Min. Negotiated Rate |
$367.15 |
| Max. Negotiated Rate |
$11,634.69 |
| Rate for Payer: Aetna Commercial |
$11,381.76
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,875.90
|
| Rate for Payer: Aetna Managed Medicare |
$367.15
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$8,220.16
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$6,323.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$6,070.27
|
| Rate for Payer: Anthem Medicare Advantage |
$367.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,702.59
|
| 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 |
$3,648.00
|
| Rate for Payer: Cash Price |
$3,648.00
|
| Rate for Payer: Cigna Commercial |
$11,634.69
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$367.15
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$7,077.12
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$367.15
|
| Rate for Payer: Health EOS Commercial |
$11,255.30
|
| Rate for Payer: HFN Commercial |
$11,634.69
|
| 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 |
$10,117.12
|
| Rate for Payer: NAPHCARE Commercial |
$550.73
|
| Rate for Payer: Preferred Network Access Commercial |
$11,634.69
|
| Rate for Payer: Quartz Beloit One Network |
$6,196.74
|
| Rate for Payer: Quartz Commercial |
$8,220.16
|
| 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 |
$6,955.52
|
| Rate for Payer: Wellcare Medicare |
$367.15
|
| Rate for Payer: WPS Commercial |
$9,366.85
|
|
|
MRI LE Non Joint w/ + w/o Contrast Bilat
|
Professional
|
Both
|
$12,160.00
|
|
|
Service Code
|
CPT 73720
|
| Hospital Charge Code |
631155
|
| Min. Negotiated Rate |
$333.46 |
| Max. Negotiated Rate |
$12,014.08 |
| Rate for Payer: Aetna Commercial |
$12,014.08
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,875.90
|
| Rate for Payer: Aetna Managed Medicare |
$333.46
|
| Rate for Payer: Anthem Medicare Advantage |
$333.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$333.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$333.46
|
| Rate for Payer: Cash Price |
$3,648.00
|
| Rate for Payer: Cash Price |
$3,648.00
|
| Rate for Payer: Cash Price |
$3,648.00
|
| Rate for Payer: Cigna Commercial |
$12,014.08
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$6,323.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$333.46
|
| Rate for Payer: Health EOS Commercial |
$11,508.22
|
| Rate for Payer: HFN Commercial |
$12,014.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,351.51
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,351.51
|
| Rate for Payer: Independent Care Health Plan Medicare |
$333.46
|
| Rate for Payer: Multiplan Commercial |
$10,117.12
|
| Rate for Payer: NAPHCARE Commercial |
$500.18
|
| Rate for Payer: Preferred Network Access Commercial |
$12,014.08
|
| Rate for Payer: Quartz Beloit One Network |
$5,564.42
|
| Rate for Payer: Quartz Commercial |
$7,208.45
|
| Rate for Payer: Quartz Medicare Advantage |
$333.46
|
| Rate for Payer: The Alliance Commercial |
$1,267.13
|
| Rate for Payer: United Healthcare Medicare Advantage |
$333.46
|
| Rate for Payer: WEA Trust Commercial |
$6,955.52
|
| Rate for Payer: WPS Commercial |
$1,667.28
|
|
|
MRI LE Non Joint w/ + w/o Contrast Bilat
|
Facility
|
IP
|
$6,194.00
|
|
|
Service Code
|
CPT 73720 TC,LT
|
| Hospital Charge Code |
1611207
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$3,156.46 |
| Max. Negotiated Rate |
$5,926.42 |
| Rate for Payer: Aetna Commercial |
$5,797.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,539.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,414.13
|
| Rate for Payer: Cash Price |
$1,858.20
|
| Rate for Payer: Cigna Commercial |
$5,926.42
|
| Rate for Payer: Health EOS Commercial |
$5,733.17
|
| Rate for Payer: HFN Commercial |
$5,926.42
|
| Rate for Payer: Multiplan Commercial |
$5,153.41
|
| Rate for Payer: Preferred Network Access Commercial |
$5,926.42
|
| Rate for Payer: Quartz Beloit One Network |
$3,156.46
|
| Rate for Payer: Quartz Commercial |
$3,865.06
|
| Rate for Payer: WEA Trust Commercial |
$3,542.97
|
| Rate for Payer: WPS Commercial |
$4,771.24
|
|
|
MRI LE Non Joint w/ + w/o Contrast Bilat
|
Professional
|
Both
|
$6,194.00
|
|
|
Service Code
|
CPT 73720 TC,LT
|
| Hospital Charge Code |
1611207
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,351.51 |
| Max. Negotiated Rate |
$6,119.67 |
| Rate for Payer: Aetna Commercial |
$6,119.67
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,539.91
|
| 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 |
$6,119.67
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$3,220.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,865.06
|
| Rate for Payer: Health EOS Commercial |
$5,862.00
|
| Rate for Payer: HFN Commercial |
$6,119.67
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,351.51
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,351.51
|
| Rate for Payer: Multiplan Commercial |
$5,153.41
|
| Rate for Payer: Preferred Network Access Commercial |
$6,119.67
|
| Rate for Payer: Quartz Beloit One Network |
$2,834.37
|
| Rate for Payer: Quartz Commercial |
$3,671.80
|
| Rate for Payer: The Alliance Commercial |
$3,220.88
|
| Rate for Payer: WEA Trust Commercial |
$3,542.97
|
| Rate for Payer: WPS Commercial |
$4,771.24
|
|
|
MRI LE Non Joint w/ + w/o Contrast Bilat
|
Facility
|
OP
|
$6,194.00
|
|
|
Service Code
|
CPT 73720 TC,LT
|
| Hospital Charge Code |
1611207
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,803.69 |
| Max. Negotiated Rate |
$5,926.42 |
| Rate for Payer: Aetna Commercial |
$5,797.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,539.91
|
| Rate for Payer: Aetna Managed Medicare |
$1,803.69
|
| 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 |
$3,414.13
|
| 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 |
$5,926.42
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,604.91
|
| Rate for Payer: Health EOS Commercial |
$5,733.17
|
| Rate for Payer: HFN Commercial |
$5,926.42
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,831.32
|
| Rate for Payer: Multiplan Commercial |
$5,153.41
|
| Rate for Payer: NAPHCARE Commercial |
$3,865.06
|
| Rate for Payer: Preferred Network Access Commercial |
$5,926.42
|
| Rate for Payer: Quartz Beloit One Network |
$3,156.46
|
| Rate for Payer: Quartz Commercial |
$4,187.14
|
| Rate for Payer: Quartz Medicare Advantage |
$3,865.06
|
| Rate for Payer: The Alliance Commercial |
$3,220.88
|
| Rate for Payer: United Healthcare PPO |
$3,142.88
|
| Rate for Payer: WEA Trust Commercial |
$3,542.97
|
| Rate for Payer: WPS Commercial |
$4,771.24
|
|
|
MRI LE Non Joint w/ + w/o Contrast Left
|
Professional
|
Both
|
$6,194.00
|
|
|
Service Code
|
CPT 73720 TC,LT
|
| Hospital Charge Code |
1611209
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,351.51 |
| Max. Negotiated Rate |
$6,119.67 |
| Rate for Payer: Aetna Commercial |
$6,119.67
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,539.91
|
| 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 |
$6,119.67
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$3,220.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,865.06
|
| Rate for Payer: Health EOS Commercial |
$5,862.00
|
| Rate for Payer: HFN Commercial |
$6,119.67
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,351.51
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,351.51
|
| Rate for Payer: Multiplan Commercial |
$5,153.41
|
| Rate for Payer: Preferred Network Access Commercial |
$6,119.67
|
| Rate for Payer: Quartz Beloit One Network |
$2,834.37
|
| Rate for Payer: Quartz Commercial |
$3,671.80
|
| Rate for Payer: The Alliance Commercial |
$3,220.88
|
| Rate for Payer: WEA Trust Commercial |
$3,542.97
|
| Rate for Payer: WPS Commercial |
$4,771.24
|
|
|
MRI LE Non Joint w/ + w/o Contrast Left
|
Facility
|
OP
|
$6,194.00
|
|
|
Service Code
|
CPT 73720 TC,LT
|
| Hospital Charge Code |
1611209
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,803.69 |
| Max. Negotiated Rate |
$5,926.42 |
| Rate for Payer: Aetna Commercial |
$5,797.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,539.91
|
| Rate for Payer: Aetna Managed Medicare |
$1,803.69
|
| 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 |
$3,414.13
|
| 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 |
$5,926.42
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,604.91
|
| Rate for Payer: Health EOS Commercial |
$5,733.17
|
| Rate for Payer: HFN Commercial |
$5,926.42
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,831.32
|
| Rate for Payer: Multiplan Commercial |
$5,153.41
|
| Rate for Payer: NAPHCARE Commercial |
$3,865.06
|
| Rate for Payer: Preferred Network Access Commercial |
$5,926.42
|
| Rate for Payer: Quartz Beloit One Network |
$3,156.46
|
| Rate for Payer: Quartz Commercial |
$4,187.14
|
| Rate for Payer: Quartz Medicare Advantage |
$3,865.06
|
| Rate for Payer: The Alliance Commercial |
$3,220.88
|
| Rate for Payer: United Healthcare PPO |
$3,142.88
|
| Rate for Payer: WEA Trust Commercial |
$3,542.97
|
| Rate for Payer: WPS Commercial |
$4,771.24
|
|
|
MRI LE Non Joint w/ + w/o Contrast Left
|
Facility
|
OP
|
$6,080.00
|
|
|
Service Code
|
CPT 73720
|
| Hospital Charge Code |
631159
|
| 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 LE Non Joint w/ + w/o Contrast Left
|
Facility
|
IP
|
$6,080.00
|
|
|
Service Code
|
CPT 73720
|
| Hospital Charge Code |
631159
|
| 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 LE Non Joint w/ + w/o Contrast Left
|
Facility
|
IP
|
$6,194.00
|
|
|
Service Code
|
CPT 73720 TC,LT
|
| Hospital Charge Code |
1611209
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$3,156.46 |
| Max. Negotiated Rate |
$5,926.42 |
| Rate for Payer: Aetna Commercial |
$5,797.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,539.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,414.13
|
| Rate for Payer: Cash Price |
$1,858.20
|
| Rate for Payer: Cigna Commercial |
$5,926.42
|
| Rate for Payer: Health EOS Commercial |
$5,733.17
|
| Rate for Payer: HFN Commercial |
$5,926.42
|
| Rate for Payer: Multiplan Commercial |
$5,153.41
|
| Rate for Payer: Preferred Network Access Commercial |
$5,926.42
|
| Rate for Payer: Quartz Beloit One Network |
$3,156.46
|
| Rate for Payer: Quartz Commercial |
$3,865.06
|
| Rate for Payer: WEA Trust Commercial |
$3,542.97
|
| Rate for Payer: WPS Commercial |
$4,771.24
|
|
|
MRI LE Non Joint w/ + w/o Contrast Left
|
Professional
|
Both
|
$6,080.00
|
|
|
Service Code
|
CPT 73720
|
| Hospital Charge Code |
631159
|
| Min. Negotiated Rate |
$333.46 |
| 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 |
$333.46
|
| Rate for Payer: Anthem Medicare Advantage |
$333.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$333.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$333.46
|
| 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 |
$333.46
|
| 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 |
$1,351.51
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,351.51
|
| Rate for Payer: Independent Care Health Plan Medicare |
$333.46
|
| Rate for Payer: Multiplan Commercial |
$5,058.56
|
| Rate for Payer: NAPHCARE Commercial |
$500.18
|
| 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 |
$333.46
|
| Rate for Payer: The Alliance Commercial |
$1,267.13
|
| Rate for Payer: United Healthcare Medicare Advantage |
$333.46
|
| Rate for Payer: WEA Trust Commercial |
$3,477.76
|
| Rate for Payer: WPS Commercial |
$1,667.28
|
|
|
MRI LE Non Joint w/ + w/o Contrast Right
|
Facility
|
IP
|
$6,080.00
|
|
|
Service Code
|
CPT 73720
|
| Hospital Charge Code |
631166
|
| 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 LE Non Joint w/ + w/o Contrast Right
|
Facility
|
OP
|
$6,080.00
|
|
|
Service Code
|
CPT 73720
|
| Hospital Charge Code |
631166
|
| 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 LE Non Joint w/ + w/o Contrast Right
|
Facility
|
OP
|
$6,194.00
|
|
|
Service Code
|
CPT 73720 TC,RT
|
| Hospital Charge Code |
2980101
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,803.69 |
| Max. Negotiated Rate |
$5,926.42 |
| Rate for Payer: Aetna Commercial |
$5,797.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,539.91
|
| Rate for Payer: Aetna Managed Medicare |
$1,803.69
|
| 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 |
$3,414.13
|
| 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 |
$5,926.42
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,604.91
|
| Rate for Payer: Health EOS Commercial |
$5,733.17
|
| Rate for Payer: HFN Commercial |
$5,926.42
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,831.32
|
| Rate for Payer: Multiplan Commercial |
$5,153.41
|
| Rate for Payer: NAPHCARE Commercial |
$3,865.06
|
| Rate for Payer: Preferred Network Access Commercial |
$5,926.42
|
| Rate for Payer: Quartz Beloit One Network |
$3,156.46
|
| Rate for Payer: Quartz Commercial |
$4,187.14
|
| Rate for Payer: Quartz Medicare Advantage |
$3,865.06
|
| Rate for Payer: The Alliance Commercial |
$3,220.88
|
| Rate for Payer: United Healthcare PPO |
$3,142.88
|
| Rate for Payer: WEA Trust Commercial |
$3,542.97
|
| Rate for Payer: WPS Commercial |
$4,771.24
|
|
|
MRI LE Non Joint w/ + w/o Contrast Right
|
Facility
|
IP
|
$6,194.00
|
|
|
Service Code
|
CPT 73720 TC,RT
|
| Hospital Charge Code |
2980101
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$3,156.46 |
| Max. Negotiated Rate |
$5,926.42 |
| Rate for Payer: Aetna Commercial |
$5,797.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,539.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,414.13
|
| Rate for Payer: Cash Price |
$1,858.20
|
| Rate for Payer: Cigna Commercial |
$5,926.42
|
| Rate for Payer: Health EOS Commercial |
$5,733.17
|
| Rate for Payer: HFN Commercial |
$5,926.42
|
| Rate for Payer: Multiplan Commercial |
$5,153.41
|
| Rate for Payer: Preferred Network Access Commercial |
$5,926.42
|
| Rate for Payer: Quartz Beloit One Network |
$3,156.46
|
| Rate for Payer: Quartz Commercial |
$3,865.06
|
| Rate for Payer: WEA Trust Commercial |
$3,542.97
|
| Rate for Payer: WPS Commercial |
$4,771.24
|
|
|
MRI LE Non Joint w/ + w/o Contrast Right
|
Facility
|
IP
|
$6,194.00
|
|
|
Service Code
|
CPT 73720 TC,RT
|
| Hospital Charge Code |
1611211
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$3,156.46 |
| Max. Negotiated Rate |
$5,926.42 |
| Rate for Payer: Aetna Commercial |
$5,797.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,539.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,414.13
|
| Rate for Payer: Cash Price |
$1,858.20
|
| Rate for Payer: Cigna Commercial |
$5,926.42
|
| Rate for Payer: Health EOS Commercial |
$5,733.17
|
| Rate for Payer: HFN Commercial |
$5,926.42
|
| Rate for Payer: Multiplan Commercial |
$5,153.41
|
| Rate for Payer: Preferred Network Access Commercial |
$5,926.42
|
| Rate for Payer: Quartz Beloit One Network |
$3,156.46
|
| Rate for Payer: Quartz Commercial |
$3,865.06
|
| Rate for Payer: WEA Trust Commercial |
$3,542.97
|
| Rate for Payer: WPS Commercial |
$4,771.24
|
|
|
MRI LE Non Joint w/ + w/o Contrast Right
|
Professional
|
Both
|
$6,194.00
|
|
|
Service Code
|
CPT 73720 TC,RT
|
| Hospital Charge Code |
1611211
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,351.51 |
| Max. Negotiated Rate |
$6,119.67 |
| Rate for Payer: Aetna Commercial |
$6,119.67
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,539.91
|
| 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 |
$6,119.67
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$3,220.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,865.06
|
| Rate for Payer: Health EOS Commercial |
$5,862.00
|
| Rate for Payer: HFN Commercial |
$6,119.67
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,351.51
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,351.51
|
| Rate for Payer: Multiplan Commercial |
$5,153.41
|
| Rate for Payer: Preferred Network Access Commercial |
$6,119.67
|
| Rate for Payer: Quartz Beloit One Network |
$2,834.37
|
| Rate for Payer: Quartz Commercial |
$3,671.80
|
| Rate for Payer: The Alliance Commercial |
$3,220.88
|
| Rate for Payer: WEA Trust Commercial |
$3,542.97
|
| Rate for Payer: WPS Commercial |
$4,771.24
|
|
|
MRI LE Non Joint w/ + w/o Contrast Right
|
Professional
|
Both
|
$6,194.00
|
|
|
Service Code
|
CPT 73720 TC,RT
|
| Hospital Charge Code |
2980101
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,351.51 |
| Max. Negotiated Rate |
$6,119.67 |
| Rate for Payer: Aetna Commercial |
$6,119.67
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,539.91
|
| 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 |
$6,119.67
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$3,220.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,865.06
|
| Rate for Payer: Health EOS Commercial |
$5,862.00
|
| Rate for Payer: HFN Commercial |
$6,119.67
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,351.51
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,351.51
|
| Rate for Payer: Multiplan Commercial |
$5,153.41
|
| Rate for Payer: Preferred Network Access Commercial |
$6,119.67
|
| Rate for Payer: Quartz Beloit One Network |
$2,834.37
|
| Rate for Payer: Quartz Commercial |
$3,671.80
|
| Rate for Payer: The Alliance Commercial |
$3,220.88
|
| Rate for Payer: WEA Trust Commercial |
$3,542.97
|
| Rate for Payer: WPS Commercial |
$4,771.24
|
|
|
MRI LE Non Joint w/ + w/o Contrast Right
|
Professional
|
Both
|
$6,080.00
|
|
|
Service Code
|
CPT 73720
|
| Hospital Charge Code |
631166
|
| Min. Negotiated Rate |
$333.46 |
| 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 |
$333.46
|
| Rate for Payer: Anthem Medicare Advantage |
$333.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$333.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$333.46
|
| 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 |
$333.46
|
| 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 |
$1,351.51
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,351.51
|
| Rate for Payer: Independent Care Health Plan Medicare |
$333.46
|
| Rate for Payer: Multiplan Commercial |
$5,058.56
|
| Rate for Payer: NAPHCARE Commercial |
$500.18
|
| 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 |
$333.46
|
| Rate for Payer: The Alliance Commercial |
$1,267.13
|
| Rate for Payer: United Healthcare Medicare Advantage |
$333.46
|
| Rate for Payer: WEA Trust Commercial |
$3,477.76
|
| Rate for Payer: WPS Commercial |
$1,667.28
|
|
|
MRI LE Non Joint w/ + w/o Contrast Right
|
Facility
|
OP
|
$6,194.00
|
|
|
Service Code
|
CPT 73720 TC,RT
|
| Hospital Charge Code |
1611211
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,803.69 |
| Max. Negotiated Rate |
$5,926.42 |
| Rate for Payer: Aetna Commercial |
$5,797.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,539.91
|
| Rate for Payer: Aetna Managed Medicare |
$1,803.69
|
| 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 |
$3,414.13
|
| 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 |
$5,926.42
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,604.91
|
| Rate for Payer: Health EOS Commercial |
$5,733.17
|
| Rate for Payer: HFN Commercial |
$5,926.42
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,831.32
|
| Rate for Payer: Multiplan Commercial |
$5,153.41
|
| Rate for Payer: NAPHCARE Commercial |
$3,865.06
|
| Rate for Payer: Preferred Network Access Commercial |
$5,926.42
|
| Rate for Payer: Quartz Beloit One Network |
$3,156.46
|
| Rate for Payer: Quartz Commercial |
$4,187.14
|
| Rate for Payer: Quartz Medicare Advantage |
$3,865.06
|
| Rate for Payer: The Alliance Commercial |
$3,220.88
|
| Rate for Payer: United Healthcare PPO |
$3,142.88
|
| Rate for Payer: WEA Trust Commercial |
$3,542.97
|
| Rate for Payer: WPS Commercial |
$4,771.24
|
|
|
MRI Lumbar Combined
|
Facility
|
IP
|
$6,351.00
|
|
|
Service Code
|
CPT 72158 TC
|
| Hospital Charge Code |
3072657
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$3,236.47 |
| Max. Negotiated Rate |
$6,076.64 |
| Rate for Payer: Aetna Commercial |
$5,944.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,680.33
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,500.67
|
| Rate for Payer: Cash Price |
$1,905.30
|
| Rate for Payer: Cigna Commercial |
$6,076.64
|
| Rate for Payer: Health EOS Commercial |
$5,878.49
|
| Rate for Payer: HFN Commercial |
$6,076.64
|
| Rate for Payer: Multiplan Commercial |
$5,284.03
|
| Rate for Payer: Preferred Network Access Commercial |
$6,076.64
|
| Rate for Payer: Quartz Beloit One Network |
$3,236.47
|
| Rate for Payer: Quartz Commercial |
$3,963.02
|
| Rate for Payer: WEA Trust Commercial |
$3,632.77
|
| Rate for Payer: WPS Commercial |
$4,892.18
|
|
|
MRI Lumbar Combined
|
Facility
|
OP
|
$6,351.00
|
|
|
Service Code
|
CPT 72158 TC
|
| Hospital Charge Code |
3072657
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$845.23 |
| Max. Negotiated Rate |
$6,076.64 |
| Rate for Payer: Aetna Commercial |
$5,944.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,680.33
|
| Rate for Payer: Aetna Managed Medicare |
$1,849.41
|
| 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 |
$3,500.67
|
| Rate for Payer: Cash Price |
$1,905.30
|
| Rate for Payer: Cash Price |
$1,905.30
|
| Rate for Payer: Cash Price |
$1,905.30
|
| Rate for Payer: Cash Price |
$1,905.30
|
| Rate for Payer: Cigna Commercial |
$6,076.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,696.28
|
| Rate for Payer: Health EOS Commercial |
$5,878.49
|
| Rate for Payer: HFN Commercial |
$6,076.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,953.78
|
| Rate for Payer: Multiplan Commercial |
$5,284.03
|
| Rate for Payer: NAPHCARE Commercial |
$3,963.02
|
| Rate for Payer: Preferred Network Access Commercial |
$6,076.64
|
| Rate for Payer: Quartz Beloit One Network |
$3,236.47
|
| Rate for Payer: Quartz Commercial |
$4,293.28
|
| Rate for Payer: Quartz Medicare Advantage |
$3,963.02
|
| Rate for Payer: The Alliance Commercial |
$845.23
|
| Rate for Payer: United Healthcare PPO |
$3,142.88
|
| Rate for Payer: WEA Trust Commercial |
$3,632.77
|
| Rate for Payer: WPS Commercial |
$1,479.15
|
|
|
MRI Lumbar Combined
|
Professional
|
Both
|
$6,351.00
|
|
|
Service Code
|
CPT 72158 TC
|
| Hospital Charge Code |
3072657
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$211.31 |
| Max. Negotiated Rate |
$6,274.79 |
| Rate for Payer: Aetna Commercial |
$6,274.79
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,680.33
|
| Rate for Payer: Aetna Managed Medicare |
$211.31
|
| Rate for Payer: Anthem Medicare Advantage |
$211.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$211.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$211.31
|
| 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 |
$6,274.79
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$3,302.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$211.31
|
| Rate for Payer: Health EOS Commercial |
$6,010.59
|
| Rate for Payer: HFN Commercial |
$6,274.79
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$872.02
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$872.02
|
| Rate for Payer: Independent Care Health Plan Medicare |
$211.31
|
| Rate for Payer: Multiplan Commercial |
$5,284.03
|
| Rate for Payer: NAPHCARE Commercial |
$316.96
|
| Rate for Payer: Preferred Network Access Commercial |
$6,274.79
|
| Rate for Payer: Quartz Beloit One Network |
$2,906.22
|
| Rate for Payer: Quartz Commercial |
$3,764.87
|
| Rate for Payer: Quartz Medicare Advantage |
$211.31
|
| Rate for Payer: The Alliance Commercial |
$802.97
|
| Rate for Payer: United Healthcare Medicare Advantage |
$211.31
|
| Rate for Payer: WEA Trust Commercial |
$3,632.77
|
| Rate for Payer: WPS Commercial |
$1,056.54
|
|
|
MRI Lumbar w/o Contrast
|
Professional
|
Both
|
$4,820.00
|
|
|
Service Code
|
CPT 72148 TC
|
| Hospital Charge Code |
3072639
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$122.35 |
| Max. Negotiated Rate |
$4,762.16 |
| Rate for Payer: Aetna Commercial |
$4,762.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,311.01
|
| Rate for Payer: Aetna Managed Medicare |
$122.35
|
| Rate for Payer: Anthem Medicare Advantage |
$122.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$122.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$122.35
|
| Rate for Payer: Cash Price |
$1,446.00
|
| Rate for Payer: Cash Price |
$1,446.00
|
| Rate for Payer: Cash Price |
$1,446.00
|
| Rate for Payer: Cigna Commercial |
$4,762.16
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,506.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$122.35
|
| Rate for Payer: Health EOS Commercial |
$4,561.65
|
| Rate for Payer: HFN Commercial |
$4,762.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$495.13
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$495.13
|
| Rate for Payer: Independent Care Health Plan Medicare |
$122.35
|
| Rate for Payer: Multiplan Commercial |
$4,010.24
|
| Rate for Payer: NAPHCARE Commercial |
$183.52
|
| Rate for Payer: Preferred Network Access Commercial |
$4,762.16
|
| Rate for Payer: Quartz Beloit One Network |
$2,205.63
|
| Rate for Payer: Quartz Commercial |
$2,857.30
|
| Rate for Payer: Quartz Medicare Advantage |
$122.35
|
| Rate for Payer: The Alliance Commercial |
$464.91
|
| Rate for Payer: United Healthcare Medicare Advantage |
$122.35
|
| Rate for Payer: WEA Trust Commercial |
$2,757.04
|
| Rate for Payer: WPS Commercial |
$611.73
|
|
