|
MRI Lumbar w/o Contrast
|
Facility
|
IP
|
$4,820.00
|
|
|
Service Code
|
CPT 72148 TC
|
| Hospital Charge Code |
3072639
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$2,456.27 |
| Max. Negotiated Rate |
$4,611.78 |
| Rate for Payer: Aetna Commercial |
$4,511.52
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,311.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,656.78
|
| Rate for Payer: Cash Price |
$1,446.00
|
| Rate for Payer: Cigna Commercial |
$4,611.78
|
| Rate for Payer: Health EOS Commercial |
$4,461.39
|
| Rate for Payer: HFN Commercial |
$4,611.78
|
| Rate for Payer: Multiplan Commercial |
$4,010.24
|
| Rate for Payer: Preferred Network Access Commercial |
$4,611.78
|
| Rate for Payer: Quartz Beloit One Network |
$2,456.27
|
| Rate for Payer: Quartz Commercial |
$3,007.68
|
| Rate for Payer: WEA Trust Commercial |
$2,757.04
|
| Rate for Payer: WPS Commercial |
$3,712.85
|
|
|
MRI Lumbar w/o Contrast
|
Facility
|
OP
|
$4,820.00
|
|
|
Service Code
|
CPT 72148 TC
|
| Hospital Charge Code |
3072639
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$489.38 |
| Max. Negotiated Rate |
$4,611.78 |
| Rate for Payer: Aetna Commercial |
$4,511.52
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,311.01
|
| Rate for Payer: Aetna Managed Medicare |
$1,403.58
|
| 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 |
$2,656.78
|
| 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: Cash Price |
$1,446.00
|
| Rate for Payer: Cigna Commercial |
$4,611.78
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,805.24
|
| Rate for Payer: Health EOS Commercial |
$4,461.39
|
| Rate for Payer: HFN Commercial |
$4,611.78
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,759.60
|
| Rate for Payer: Multiplan Commercial |
$4,010.24
|
| Rate for Payer: NAPHCARE Commercial |
$3,007.68
|
| Rate for Payer: Preferred Network Access Commercial |
$4,611.78
|
| Rate for Payer: Quartz Beloit One Network |
$2,456.27
|
| Rate for Payer: Quartz Commercial |
$3,258.32
|
| Rate for Payer: Quartz Medicare Advantage |
$3,007.68
|
| Rate for Payer: The Alliance Commercial |
$489.38
|
| Rate for Payer: United Healthcare PPO |
$3,142.88
|
| Rate for Payer: WEA Trust Commercial |
$2,757.04
|
| Rate for Payer: WPS Commercial |
$856.42
|
|
|
MRI Orbit Face Neck w/wo Con
|
Professional
|
Both
|
$7,100.00
|
|
|
Service Code
|
CPT 70543 TC
|
| Hospital Charge Code |
3072669
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$236.59 |
| Max. Negotiated Rate |
$7,014.80 |
| Rate for Payer: Aetna Commercial |
$7,014.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,350.24
|
| Rate for Payer: Aetna Managed Medicare |
$236.59
|
| Rate for Payer: Anthem Medicare Advantage |
$236.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$236.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$236.59
|
| Rate for Payer: Cash Price |
$2,130.00
|
| Rate for Payer: Cash Price |
$2,130.00
|
| Rate for Payer: Cash Price |
$2,130.00
|
| Rate for Payer: Cigna Commercial |
$7,014.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$3,692.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$236.59
|
| Rate for Payer: Health EOS Commercial |
$6,719.44
|
| Rate for Payer: HFN Commercial |
$7,014.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$979.40
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$979.40
|
| Rate for Payer: Independent Care Health Plan Medicare |
$236.59
|
| Rate for Payer: Multiplan Commercial |
$5,907.20
|
| Rate for Payer: NAPHCARE Commercial |
$354.88
|
| Rate for Payer: Preferred Network Access Commercial |
$7,014.80
|
| Rate for Payer: Quartz Beloit One Network |
$3,248.96
|
| Rate for Payer: Quartz Commercial |
$4,208.88
|
| Rate for Payer: Quartz Medicare Advantage |
$236.59
|
| Rate for Payer: The Alliance Commercial |
$899.04
|
| Rate for Payer: United Healthcare Medicare Advantage |
$236.59
|
| Rate for Payer: WEA Trust Commercial |
$4,061.20
|
| Rate for Payer: WPS Commercial |
$1,182.95
|
|
|
MRI Orbit Face Neck w/wo Con
|
Facility
|
OP
|
$7,100.00
|
|
|
Service Code
|
CPT 70543 TC
|
| Hospital Charge Code |
3072669
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$946.36 |
| Max. Negotiated Rate |
$6,793.28 |
| Rate for Payer: Aetna Commercial |
$6,645.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,350.24
|
| Rate for Payer: Aetna Managed Medicare |
$2,067.52
|
| 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 |
$3,913.52
|
| Rate for Payer: Cash Price |
$2,130.00
|
| Rate for Payer: Cash Price |
$2,130.00
|
| Rate for Payer: Cash Price |
$2,130.00
|
| Rate for Payer: Cash Price |
$2,130.00
|
| Rate for Payer: Cigna Commercial |
$6,793.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,132.20
|
| Rate for Payer: Health EOS Commercial |
$6,571.76
|
| Rate for Payer: HFN Commercial |
$6,793.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,538.00
|
| Rate for Payer: Multiplan Commercial |
$5,907.20
|
| Rate for Payer: NAPHCARE Commercial |
$4,430.40
|
| Rate for Payer: Preferred Network Access Commercial |
$6,793.28
|
| Rate for Payer: Quartz Beloit One Network |
$3,618.16
|
| Rate for Payer: Quartz Commercial |
$4,799.60
|
| Rate for Payer: Quartz Medicare Advantage |
$4,430.40
|
| Rate for Payer: The Alliance Commercial |
$946.36
|
| Rate for Payer: United Healthcare PPO |
$3,142.88
|
| Rate for Payer: WEA Trust Commercial |
$4,061.20
|
| Rate for Payer: WPS Commercial |
$1,656.13
|
|
|
MRI Orbit Face Neck w/wo Con
|
Facility
|
IP
|
$7,100.00
|
|
|
Service Code
|
CPT 70543 TC
|
| Hospital Charge Code |
3072669
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$3,618.16 |
| Max. Negotiated Rate |
$6,793.28 |
| Rate for Payer: Aetna Commercial |
$6,645.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,350.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,913.52
|
| Rate for Payer: Cash Price |
$2,130.00
|
| Rate for Payer: Cigna Commercial |
$6,793.28
|
| Rate for Payer: Health EOS Commercial |
$6,571.76
|
| Rate for Payer: HFN Commercial |
$6,793.28
|
| Rate for Payer: Multiplan Commercial |
$5,907.20
|
| Rate for Payer: Preferred Network Access Commercial |
$6,793.28
|
| Rate for Payer: Quartz Beloit One Network |
$3,618.16
|
| Rate for Payer: Quartz Commercial |
$4,430.40
|
| Rate for Payer: WEA Trust Commercial |
$4,061.20
|
| Rate for Payer: WPS Commercial |
$5,469.13
|
|
|
MRI Pelvis Hydrogel w/o Contrast
|
Professional
|
Both
|
$5,056.00
|
|
|
Service Code
|
CPT 76498 TC
|
| Hospital Charge Code |
5577503
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$2,313.63 |
| Max. Negotiated Rate |
$4,995.33 |
| Rate for Payer: Aetna Commercial |
$4,995.33
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,522.09
|
| Rate for Payer: Cash Price |
$1,516.80
|
| Rate for Payer: Cash Price |
$1,516.80
|
| Rate for Payer: Cigna Commercial |
$4,995.33
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,629.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,154.94
|
| Rate for Payer: Health EOS Commercial |
$4,785.00
|
| Rate for Payer: HFN Commercial |
$4,995.33
|
| Rate for Payer: Multiplan Commercial |
$4,206.59
|
| Rate for Payer: Preferred Network Access Commercial |
$4,995.33
|
| Rate for Payer: Quartz Beloit One Network |
$2,313.63
|
| Rate for Payer: Quartz Commercial |
$2,997.20
|
| Rate for Payer: The Alliance Commercial |
$2,629.12
|
| Rate for Payer: WEA Trust Commercial |
$2,892.03
|
| Rate for Payer: WPS Commercial |
$3,894.64
|
|
|
MRI Pelvis Hydrogel w/o Contrast
|
Facility
|
OP
|
$5,056.00
|
|
|
Service Code
|
CPT 76498 TC
|
| Hospital Charge Code |
5577503
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,472.31 |
| Max. Negotiated Rate |
$4,837.58 |
| Rate for Payer: Aetna Commercial |
$4,732.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,522.09
|
| Rate for Payer: Aetna Managed Medicare |
$1,472.31
|
| 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 |
$2,786.87
|
| Rate for Payer: Cash Price |
$1,516.80
|
| Rate for Payer: Cash Price |
$1,516.80
|
| Rate for Payer: Cash Price |
$1,516.80
|
| Rate for Payer: Cigna Commercial |
$4,837.58
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,942.59
|
| Rate for Payer: Health EOS Commercial |
$4,679.83
|
| Rate for Payer: HFN Commercial |
$4,837.58
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,943.68
|
| Rate for Payer: Multiplan Commercial |
$4,206.59
|
| Rate for Payer: NAPHCARE Commercial |
$3,154.94
|
| Rate for Payer: Preferred Network Access Commercial |
$4,837.58
|
| Rate for Payer: Quartz Beloit One Network |
$2,576.54
|
| Rate for Payer: Quartz Commercial |
$3,417.86
|
| Rate for Payer: Quartz Medicare Advantage |
$3,154.94
|
| Rate for Payer: The Alliance Commercial |
$2,629.12
|
| Rate for Payer: United Healthcare PPO |
$3,142.88
|
| Rate for Payer: WEA Trust Commercial |
$2,892.03
|
| Rate for Payer: WPS Commercial |
$3,894.64
|
|
|
MRI Pelvis Hydrogel w/o Contrast
|
Facility
|
IP
|
$5,056.00
|
|
|
Service Code
|
CPT 76498 TC
|
| Hospital Charge Code |
5577503
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$2,576.54 |
| Max. Negotiated Rate |
$4,837.58 |
| Rate for Payer: Aetna Commercial |
$4,732.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,522.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,786.87
|
| Rate for Payer: Cash Price |
$1,516.80
|
| Rate for Payer: Cigna Commercial |
$4,837.58
|
| Rate for Payer: Health EOS Commercial |
$4,679.83
|
| Rate for Payer: HFN Commercial |
$4,837.58
|
| Rate for Payer: Multiplan Commercial |
$4,206.59
|
| Rate for Payer: Preferred Network Access Commercial |
$4,837.58
|
| Rate for Payer: Quartz Beloit One Network |
$2,576.54
|
| Rate for Payer: Quartz Commercial |
$3,154.94
|
| Rate for Payer: WEA Trust Commercial |
$2,892.03
|
| Rate for Payer: WPS Commercial |
$3,894.64
|
|
|
MRI Pelvis w/ Contrast
|
Facility
|
IP
|
$5,965.00
|
|
|
Service Code
|
CPT 72196 TC
|
| Hospital Charge Code |
3072732
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$3,039.76 |
| Max. Negotiated Rate |
$5,707.31 |
| Rate for Payer: Aetna Commercial |
$5,583.24
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,335.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,287.91
|
| Rate for Payer: Cash Price |
$1,789.50
|
| Rate for Payer: Cigna Commercial |
$5,707.31
|
| Rate for Payer: Health EOS Commercial |
$5,521.20
|
| Rate for Payer: HFN Commercial |
$5,707.31
|
| Rate for Payer: Multiplan Commercial |
$4,962.88
|
| Rate for Payer: Preferred Network Access Commercial |
$5,707.31
|
| Rate for Payer: Quartz Beloit One Network |
$3,039.76
|
| Rate for Payer: Quartz Commercial |
$3,722.16
|
| Rate for Payer: WEA Trust Commercial |
$3,411.98
|
| Rate for Payer: WPS Commercial |
$4,594.84
|
|
|
MRI Pelvis w/ Contrast
|
Professional
|
Both
|
$6,080.00
|
|
|
Service Code
|
CPT 72196
|
| Hospital Charge Code |
631203
|
| Min. Negotiated Rate |
$266.98 |
| 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 |
$266.98
|
| Rate for Payer: Anthem Medicare Advantage |
$266.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$266.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$266.98
|
| 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 |
$266.98
|
| 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 |
$1,075.30
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,075.30
|
| Rate for Payer: Independent Care Health Plan Medicare |
$266.98
|
| Rate for Payer: Multiplan Commercial |
$5,058.56
|
| Rate for Payer: NAPHCARE Commercial |
$400.47
|
| 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 |
$266.98
|
| Rate for Payer: The Alliance Commercial |
$1,014.52
|
| Rate for Payer: United Healthcare Medicare Advantage |
$266.98
|
| Rate for Payer: WEA Trust Commercial |
$3,477.76
|
| Rate for Payer: WPS Commercial |
$1,334.89
|
|
|
MRI Pelvis w/ Contrast
|
Facility
|
OP
|
$6,080.00
|
|
|
Service Code
|
CPT 72196
|
| Hospital Charge Code |
631203
|
| 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 Pelvis w/ Contrast
|
Professional
|
Both
|
$5,965.00
|
|
|
Service Code
|
CPT 72196 TC
|
| Hospital Charge Code |
3072732
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$187.35 |
| Max. Negotiated Rate |
$5,893.42 |
| Rate for Payer: Aetna Commercial |
$5,893.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,335.10
|
| Rate for Payer: Aetna Managed Medicare |
$187.35
|
| Rate for Payer: Anthem Medicare Advantage |
$187.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$187.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$187.35
|
| Rate for Payer: Cash Price |
$1,789.50
|
| Rate for Payer: Cash Price |
$1,789.50
|
| Rate for Payer: Cash Price |
$1,789.50
|
| Rate for Payer: Cigna Commercial |
$5,893.42
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$3,101.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$187.35
|
| Rate for Payer: Health EOS Commercial |
$5,645.28
|
| Rate for Payer: HFN Commercial |
$5,893.42
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$774.26
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$774.26
|
| Rate for Payer: Independent Care Health Plan Medicare |
$187.35
|
| Rate for Payer: Multiplan Commercial |
$4,962.88
|
| Rate for Payer: NAPHCARE Commercial |
$281.02
|
| Rate for Payer: Preferred Network Access Commercial |
$5,893.42
|
| Rate for Payer: Quartz Beloit One Network |
$2,729.58
|
| Rate for Payer: Quartz Commercial |
$3,536.05
|
| Rate for Payer: Quartz Medicare Advantage |
$187.35
|
| Rate for Payer: The Alliance Commercial |
$711.91
|
| Rate for Payer: United Healthcare Medicare Advantage |
$187.35
|
| Rate for Payer: WEA Trust Commercial |
$3,411.98
|
| Rate for Payer: WPS Commercial |
$936.73
|
|
|
MRI Pelvis w/ Contrast
|
Professional
|
Both
|
$5,965.00
|
|
|
Service Code
|
CPT 72196 TC
|
| Hospital Charge Code |
1611230
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$187.35 |
| Max. Negotiated Rate |
$5,893.42 |
| Rate for Payer: Aetna Commercial |
$5,893.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,335.10
|
| Rate for Payer: Aetna Managed Medicare |
$187.35
|
| Rate for Payer: Anthem Medicare Advantage |
$187.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$187.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$187.35
|
| Rate for Payer: Cash Price |
$1,789.50
|
| Rate for Payer: Cash Price |
$1,789.50
|
| Rate for Payer: Cash Price |
$1,789.50
|
| Rate for Payer: Cigna Commercial |
$5,893.42
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$3,101.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$187.35
|
| Rate for Payer: Health EOS Commercial |
$5,645.28
|
| Rate for Payer: HFN Commercial |
$5,893.42
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$774.26
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$774.26
|
| Rate for Payer: Independent Care Health Plan Medicare |
$187.35
|
| Rate for Payer: Multiplan Commercial |
$4,962.88
|
| Rate for Payer: NAPHCARE Commercial |
$281.02
|
| Rate for Payer: Preferred Network Access Commercial |
$5,893.42
|
| Rate for Payer: Quartz Beloit One Network |
$2,729.58
|
| Rate for Payer: Quartz Commercial |
$3,536.05
|
| Rate for Payer: Quartz Medicare Advantage |
$187.35
|
| Rate for Payer: The Alliance Commercial |
$711.91
|
| Rate for Payer: United Healthcare Medicare Advantage |
$187.35
|
| Rate for Payer: WEA Trust Commercial |
$3,411.98
|
| Rate for Payer: WPS Commercial |
$936.73
|
|
|
MRI Pelvis w/ Contrast
|
Facility
|
OP
|
$5,965.00
|
|
|
Service Code
|
CPT 72196 TC
|
| Hospital Charge Code |
3072732
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$749.38 |
| Max. Negotiated Rate |
$5,707.31 |
| Rate for Payer: Aetna Commercial |
$5,583.24
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,335.10
|
| Rate for Payer: Aetna Managed Medicare |
$1,737.01
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,635.84
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,985.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,835.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,287.91
|
| Rate for Payer: Cash Price |
$1,789.50
|
| Rate for Payer: Cash Price |
$1,789.50
|
| Rate for Payer: Cash Price |
$1,789.50
|
| Rate for Payer: Cash Price |
$1,789.50
|
| Rate for Payer: Cigna Commercial |
$5,707.31
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,471.63
|
| Rate for Payer: Health EOS Commercial |
$5,521.20
|
| Rate for Payer: HFN Commercial |
$5,707.31
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,652.70
|
| Rate for Payer: Multiplan Commercial |
$4,962.88
|
| Rate for Payer: NAPHCARE Commercial |
$3,722.16
|
| Rate for Payer: Preferred Network Access Commercial |
$5,707.31
|
| Rate for Payer: Quartz Beloit One Network |
$3,039.76
|
| Rate for Payer: Quartz Commercial |
$4,032.34
|
| Rate for Payer: Quartz Medicare Advantage |
$3,722.16
|
| Rate for Payer: The Alliance Commercial |
$749.38
|
| Rate for Payer: United Healthcare PPO |
$3,142.88
|
| Rate for Payer: WEA Trust Commercial |
$3,411.98
|
| Rate for Payer: WPS Commercial |
$1,311.42
|
|
|
MRI Pelvis w/ Contrast
|
Facility
|
IP
|
$6,080.00
|
|
|
Service Code
|
CPT 72196
|
| Hospital Charge Code |
631203
|
| 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 Pelvis w/ Contrast
|
Facility
|
IP
|
$5,965.00
|
|
|
Service Code
|
CPT 72196 TC
|
| Hospital Charge Code |
1611230
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$3,039.76 |
| Max. Negotiated Rate |
$5,707.31 |
| Rate for Payer: Aetna Commercial |
$5,583.24
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,335.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,287.91
|
| Rate for Payer: Cash Price |
$1,789.50
|
| Rate for Payer: Cigna Commercial |
$5,707.31
|
| Rate for Payer: Health EOS Commercial |
$5,521.20
|
| Rate for Payer: HFN Commercial |
$5,707.31
|
| Rate for Payer: Multiplan Commercial |
$4,962.88
|
| Rate for Payer: Preferred Network Access Commercial |
$5,707.31
|
| Rate for Payer: Quartz Beloit One Network |
$3,039.76
|
| Rate for Payer: Quartz Commercial |
$3,722.16
|
| Rate for Payer: WEA Trust Commercial |
$3,411.98
|
| Rate for Payer: WPS Commercial |
$4,594.84
|
|
|
MRI Pelvis w/ Contrast
|
Facility
|
OP
|
$5,965.00
|
|
|
Service Code
|
CPT 72196 TC
|
| Hospital Charge Code |
1611230
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$749.38 |
| Max. Negotiated Rate |
$5,707.31 |
| Rate for Payer: Aetna Commercial |
$5,583.24
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,335.10
|
| Rate for Payer: Aetna Managed Medicare |
$1,737.01
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,635.84
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,985.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,835.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,287.91
|
| Rate for Payer: Cash Price |
$1,789.50
|
| Rate for Payer: Cash Price |
$1,789.50
|
| Rate for Payer: Cash Price |
$1,789.50
|
| Rate for Payer: Cash Price |
$1,789.50
|
| Rate for Payer: Cigna Commercial |
$5,707.31
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,471.63
|
| Rate for Payer: Health EOS Commercial |
$5,521.20
|
| Rate for Payer: HFN Commercial |
$5,707.31
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,652.70
|
| Rate for Payer: Multiplan Commercial |
$4,962.88
|
| Rate for Payer: NAPHCARE Commercial |
$3,722.16
|
| Rate for Payer: Preferred Network Access Commercial |
$5,707.31
|
| Rate for Payer: Quartz Beloit One Network |
$3,039.76
|
| Rate for Payer: Quartz Commercial |
$4,032.34
|
| Rate for Payer: Quartz Medicare Advantage |
$3,722.16
|
| Rate for Payer: The Alliance Commercial |
$749.38
|
| Rate for Payer: United Healthcare PPO |
$3,142.88
|
| Rate for Payer: WEA Trust Commercial |
$3,411.98
|
| Rate for Payer: WPS Commercial |
$1,311.42
|
|
|
MRI Pelvis w/o Contrast
|
Facility
|
OP
|
$5,248.00
|
|
|
Service Code
|
CPT 72195 TC
|
| Hospital Charge Code |
1611232
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$638.48 |
| Max. Negotiated Rate |
$5,021.29 |
| Rate for Payer: Aetna Commercial |
$4,912.13
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,693.81
|
| Rate for Payer: Aetna Managed Medicare |
$1,528.22
|
| 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 |
$2,892.70
|
| Rate for Payer: Cash Price |
$1,574.40
|
| Rate for Payer: Cash Price |
$1,574.40
|
| Rate for Payer: Cash Price |
$1,574.40
|
| Rate for Payer: Cash Price |
$1,574.40
|
| Rate for Payer: Cigna Commercial |
$5,021.29
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,054.34
|
| Rate for Payer: Health EOS Commercial |
$4,857.55
|
| Rate for Payer: HFN Commercial |
$5,021.29
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,093.44
|
| Rate for Payer: Multiplan Commercial |
$4,366.34
|
| Rate for Payer: NAPHCARE Commercial |
$3,274.75
|
| Rate for Payer: Preferred Network Access Commercial |
$5,021.29
|
| Rate for Payer: Quartz Beloit One Network |
$2,674.38
|
| Rate for Payer: Quartz Commercial |
$3,547.65
|
| Rate for Payer: Quartz Medicare Advantage |
$3,274.75
|
| Rate for Payer: The Alliance Commercial |
$638.48
|
| Rate for Payer: United Healthcare PPO |
$3,142.88
|
| Rate for Payer: WEA Trust Commercial |
$3,001.86
|
| Rate for Payer: WPS Commercial |
$1,117.33
|
|
|
MRI Pelvis w/o Contrast
|
Professional
|
Both
|
$5,248.00
|
|
|
Service Code
|
CPT 72195 TC
|
| Hospital Charge Code |
3072671
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$159.62 |
| Max. Negotiated Rate |
$5,185.02 |
| Rate for Payer: Aetna Commercial |
$5,185.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,693.81
|
| Rate for Payer: Aetna Managed Medicare |
$159.62
|
| Rate for Payer: Anthem Medicare Advantage |
$159.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$159.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$159.62
|
| Rate for Payer: Cash Price |
$1,574.40
|
| Rate for Payer: Cash Price |
$1,574.40
|
| Rate for Payer: Cash Price |
$1,574.40
|
| Rate for Payer: Cigna Commercial |
$5,185.02
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,728.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$159.62
|
| Rate for Payer: Health EOS Commercial |
$4,966.71
|
| Rate for Payer: HFN Commercial |
$5,185.02
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$663.24
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$663.24
|
| Rate for Payer: Independent Care Health Plan Medicare |
$159.62
|
| Rate for Payer: Multiplan Commercial |
$4,366.34
|
| Rate for Payer: NAPHCARE Commercial |
$239.43
|
| Rate for Payer: Preferred Network Access Commercial |
$5,185.02
|
| Rate for Payer: Quartz Beloit One Network |
$2,401.48
|
| Rate for Payer: Quartz Commercial |
$3,111.01
|
| Rate for Payer: Quartz Medicare Advantage |
$159.62
|
| Rate for Payer: The Alliance Commercial |
$606.55
|
| Rate for Payer: United Healthcare Medicare Advantage |
$159.62
|
| Rate for Payer: WEA Trust Commercial |
$3,001.86
|
| Rate for Payer: WPS Commercial |
$798.10
|
|
|
MRI Pelvis w/o Contrast
|
Facility
|
OP
|
$5,248.00
|
|
|
Service Code
|
CPT 72195 TC
|
| Hospital Charge Code |
3072671
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$638.48 |
| Max. Negotiated Rate |
$5,021.29 |
| Rate for Payer: Aetna Commercial |
$4,912.13
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,693.81
|
| Rate for Payer: Aetna Managed Medicare |
$1,528.22
|
| 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 |
$2,892.70
|
| Rate for Payer: Cash Price |
$1,574.40
|
| Rate for Payer: Cash Price |
$1,574.40
|
| Rate for Payer: Cash Price |
$1,574.40
|
| Rate for Payer: Cash Price |
$1,574.40
|
| Rate for Payer: Cigna Commercial |
$5,021.29
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,054.34
|
| Rate for Payer: Health EOS Commercial |
$4,857.55
|
| Rate for Payer: HFN Commercial |
$5,021.29
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,093.44
|
| Rate for Payer: Multiplan Commercial |
$4,366.34
|
| Rate for Payer: NAPHCARE Commercial |
$3,274.75
|
| Rate for Payer: Preferred Network Access Commercial |
$5,021.29
|
| Rate for Payer: Quartz Beloit One Network |
$2,674.38
|
| Rate for Payer: Quartz Commercial |
$3,547.65
|
| Rate for Payer: Quartz Medicare Advantage |
$3,274.75
|
| Rate for Payer: The Alliance Commercial |
$638.48
|
| Rate for Payer: United Healthcare PPO |
$3,142.88
|
| Rate for Payer: WEA Trust Commercial |
$3,001.86
|
| Rate for Payer: WPS Commercial |
$1,117.33
|
|
|
MRI Pelvis w/o Contrast
|
Facility
|
OP
|
$4,576.00
|
|
|
Service Code
|
CPT 72195
|
| Hospital Charge Code |
631208
|
| Min. Negotiated Rate |
$251.10 |
| Max. Negotiated Rate |
$4,378.32 |
| Rate for Payer: Aetna Commercial |
$4,283.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,092.77
|
| Rate for Payer: Aetna Managed Medicare |
$251.10
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,093.38
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,379.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,284.34
|
| Rate for Payer: Anthem Medicare Advantage |
$251.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,522.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$251.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$251.10
|
| Rate for Payer: Cash Price |
$1,372.80
|
| Rate for Payer: Cash Price |
$1,372.80
|
| Rate for Payer: Cigna Commercial |
$4,378.32
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$251.10
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,663.23
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$251.10
|
| Rate for Payer: Health EOS Commercial |
$4,235.55
|
| Rate for Payer: HFN Commercial |
$4,378.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$934.08
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$251.10
|
| Rate for Payer: Independent Care Health Plan Medicare |
$251.10
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$251.10
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$251.10
|
| Rate for Payer: Multiplan Commercial |
$3,807.23
|
| Rate for Payer: NAPHCARE Commercial |
$376.65
|
| Rate for Payer: Preferred Network Access Commercial |
$4,378.32
|
| Rate for Payer: Quartz Beloit One Network |
$2,331.93
|
| Rate for Payer: Quartz Commercial |
$3,093.38
|
| Rate for Payer: Quartz Medicare Advantage |
$251.10
|
| Rate for Payer: The Alliance Commercial |
$1,004.39
|
| Rate for Payer: United Healthcare Medicare Advantage |
$251.10
|
| Rate for Payer: WEA Trust Commercial |
$2,617.47
|
| Rate for Payer: Wellcare Medicare |
$251.10
|
| Rate for Payer: WPS Commercial |
$3,524.89
|
|
|
MRI Pelvis w/o Contrast
|
Facility
|
IP
|
$5,248.00
|
|
|
Service Code
|
CPT 72195 TC
|
| Hospital Charge Code |
1611232
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$2,674.38 |
| Max. Negotiated Rate |
$5,021.29 |
| Rate for Payer: Aetna Commercial |
$4,912.13
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,693.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,892.70
|
| Rate for Payer: Cash Price |
$1,574.40
|
| Rate for Payer: Cigna Commercial |
$5,021.29
|
| Rate for Payer: Health EOS Commercial |
$4,857.55
|
| Rate for Payer: HFN Commercial |
$5,021.29
|
| Rate for Payer: Multiplan Commercial |
$4,366.34
|
| Rate for Payer: Preferred Network Access Commercial |
$5,021.29
|
| Rate for Payer: Quartz Beloit One Network |
$2,674.38
|
| Rate for Payer: Quartz Commercial |
$3,274.75
|
| Rate for Payer: WEA Trust Commercial |
$3,001.86
|
| Rate for Payer: WPS Commercial |
$4,042.53
|
|
|
MRI Pelvis w/o Contrast
|
Facility
|
IP
|
$4,576.00
|
|
|
Service Code
|
CPT 72195
|
| Hospital Charge Code |
631208
|
| Min. Negotiated Rate |
$2,331.93 |
| Max. Negotiated Rate |
$4,378.32 |
| Rate for Payer: Aetna Commercial |
$4,283.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,092.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,522.29
|
| Rate for Payer: Cash Price |
$1,372.80
|
| Rate for Payer: Cigna Commercial |
$4,378.32
|
| Rate for Payer: Health EOS Commercial |
$4,235.55
|
| Rate for Payer: HFN Commercial |
$4,378.32
|
| Rate for Payer: Multiplan Commercial |
$3,807.23
|
| Rate for Payer: Preferred Network Access Commercial |
$4,378.32
|
| Rate for Payer: Quartz Beloit One Network |
$2,331.93
|
| Rate for Payer: Quartz Commercial |
$2,855.42
|
| Rate for Payer: WEA Trust Commercial |
$2,617.47
|
| Rate for Payer: WPS Commercial |
$3,524.89
|
|
|
MRI Pelvis w/o Contrast
|
Professional
|
Both
|
$5,248.00
|
|
|
Service Code
|
CPT 72195 TC
|
| Hospital Charge Code |
1611232
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$159.62 |
| Max. Negotiated Rate |
$5,185.02 |
| Rate for Payer: Aetna Commercial |
$5,185.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,693.81
|
| Rate for Payer: Aetna Managed Medicare |
$159.62
|
| Rate for Payer: Anthem Medicare Advantage |
$159.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$159.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$159.62
|
| Rate for Payer: Cash Price |
$1,574.40
|
| Rate for Payer: Cash Price |
$1,574.40
|
| Rate for Payer: Cash Price |
$1,574.40
|
| Rate for Payer: Cigna Commercial |
$5,185.02
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,728.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$159.62
|
| Rate for Payer: Health EOS Commercial |
$4,966.71
|
| Rate for Payer: HFN Commercial |
$5,185.02
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$663.24
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$663.24
|
| Rate for Payer: Independent Care Health Plan Medicare |
$159.62
|
| Rate for Payer: Multiplan Commercial |
$4,366.34
|
| Rate for Payer: NAPHCARE Commercial |
$239.43
|
| Rate for Payer: Preferred Network Access Commercial |
$5,185.02
|
| Rate for Payer: Quartz Beloit One Network |
$2,401.48
|
| Rate for Payer: Quartz Commercial |
$3,111.01
|
| Rate for Payer: Quartz Medicare Advantage |
$159.62
|
| Rate for Payer: The Alliance Commercial |
$606.55
|
| Rate for Payer: United Healthcare Medicare Advantage |
$159.62
|
| Rate for Payer: WEA Trust Commercial |
$3,001.86
|
| Rate for Payer: WPS Commercial |
$798.10
|
|
|
MRI Pelvis w/o Contrast
|
Facility
|
IP
|
$5,248.00
|
|
|
Service Code
|
CPT 72195 TC
|
| Hospital Charge Code |
3072671
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$2,674.38 |
| Max. Negotiated Rate |
$5,021.29 |
| Rate for Payer: Aetna Commercial |
$4,912.13
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,693.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,892.70
|
| Rate for Payer: Cash Price |
$1,574.40
|
| Rate for Payer: Cigna Commercial |
$5,021.29
|
| Rate for Payer: Health EOS Commercial |
$4,857.55
|
| Rate for Payer: HFN Commercial |
$5,021.29
|
| Rate for Payer: Multiplan Commercial |
$4,366.34
|
| Rate for Payer: Preferred Network Access Commercial |
$5,021.29
|
| Rate for Payer: Quartz Beloit One Network |
$2,674.38
|
| Rate for Payer: Quartz Commercial |
$3,274.75
|
| Rate for Payer: WEA Trust Commercial |
$3,001.86
|
| Rate for Payer: WPS Commercial |
$4,042.53
|
|
