|
MRI Pelvis w/o Contrast
|
Professional
|
Both
|
$4,576.00
|
|
|
Service Code
|
CPT 72195
|
| Hospital Charge Code |
631208
|
| Min. Negotiated Rate |
$226.66 |
| Max. Negotiated Rate |
$4,521.09 |
| Rate for Payer: Aetna Commercial |
$4,521.09
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,092.77
|
| Rate for Payer: Aetna Managed Medicare |
$226.66
|
| Rate for Payer: Anthem Medicare Advantage |
$226.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$226.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$226.66
|
| Rate for Payer: Cash Price |
$1,372.80
|
| Rate for Payer: Cash Price |
$1,372.80
|
| Rate for Payer: Cash Price |
$1,372.80
|
| Rate for Payer: Cigna Commercial |
$4,521.09
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,379.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$226.66
|
| Rate for Payer: Health EOS Commercial |
$4,330.73
|
| Rate for Payer: HFN Commercial |
$4,521.09
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$916.48
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$916.48
|
| Rate for Payer: Independent Care Health Plan Medicare |
$226.66
|
| Rate for Payer: Multiplan Commercial |
$3,807.23
|
| Rate for Payer: NAPHCARE Commercial |
$339.99
|
| Rate for Payer: Preferred Network Access Commercial |
$4,521.09
|
| Rate for Payer: Quartz Beloit One Network |
$2,093.98
|
| Rate for Payer: Quartz Commercial |
$2,712.65
|
| Rate for Payer: Quartz Medicare Advantage |
$226.66
|
| Rate for Payer: The Alliance Commercial |
$861.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$226.66
|
| Rate for Payer: WEA Trust Commercial |
$2,617.47
|
| Rate for Payer: WPS Commercial |
$1,133.29
|
|
|
MRI Pelvis w/ + w/o Contrast
|
Facility
|
OP
|
$6,092.00
|
|
|
Service Code
|
CPT 72197
|
| Hospital Charge Code |
631199
|
| Min. Negotiated Rate |
$367.15 |
| Max. Negotiated Rate |
$5,828.83 |
| Rate for Payer: Aetna Commercial |
$5,702.11
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,448.68
|
| Rate for Payer: Aetna Managed Medicare |
$367.15
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,118.19
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,167.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,041.13
|
| Rate for Payer: Anthem Medicare Advantage |
$367.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,357.91
|
| 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 |
$1,827.60
|
| Rate for Payer: Cash Price |
$1,827.60
|
| Rate for Payer: Cigna Commercial |
$5,828.83
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$367.15
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,545.54
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$367.15
|
| Rate for Payer: Health EOS Commercial |
$5,638.76
|
| Rate for Payer: HFN Commercial |
$5,828.83
|
| 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 |
$5,068.54
|
| Rate for Payer: NAPHCARE Commercial |
$550.73
|
| Rate for Payer: Preferred Network Access Commercial |
$5,828.83
|
| Rate for Payer: Quartz Beloit One Network |
$3,104.48
|
| Rate for Payer: Quartz Commercial |
$4,118.19
|
| 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 |
$3,484.62
|
| Rate for Payer: Wellcare Medicare |
$367.15
|
| Rate for Payer: WPS Commercial |
$4,692.67
|
|
|
MRI Pelvis w/ + w/o Contrast
|
Facility
|
IP
|
$6,092.00
|
|
|
Service Code
|
CPT 72197
|
| Hospital Charge Code |
631199
|
| Min. Negotiated Rate |
$3,104.48 |
| Max. Negotiated Rate |
$5,828.83 |
| Rate for Payer: Aetna Commercial |
$5,702.11
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,448.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,357.91
|
| Rate for Payer: Cash Price |
$1,827.60
|
| Rate for Payer: Cigna Commercial |
$5,828.83
|
| Rate for Payer: Health EOS Commercial |
$5,638.76
|
| Rate for Payer: HFN Commercial |
$5,828.83
|
| Rate for Payer: Multiplan Commercial |
$5,068.54
|
| Rate for Payer: Preferred Network Access Commercial |
$5,828.83
|
| Rate for Payer: Quartz Beloit One Network |
$3,104.48
|
| Rate for Payer: Quartz Commercial |
$3,801.41
|
| Rate for Payer: WEA Trust Commercial |
$3,484.62
|
| Rate for Payer: WPS Commercial |
$4,692.67
|
|
|
MRI Pelvis w/ + w/o Contrast
|
Facility
|
OP
|
$6,946.00
|
|
|
Service Code
|
CPT 72197 TC
|
| Hospital Charge Code |
1611228
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$925.10 |
| Max. Negotiated Rate |
$6,645.93 |
| Rate for Payer: Aetna Commercial |
$6,501.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,212.50
|
| Rate for Payer: Aetna Managed Medicare |
$2,022.68
|
| 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 |
$3,828.64
|
| Rate for Payer: Cash Price |
$2,083.80
|
| Rate for Payer: Cash Price |
$2,083.80
|
| Rate for Payer: Cash Price |
$2,083.80
|
| Rate for Payer: Cash Price |
$2,083.80
|
| Rate for Payer: Cigna Commercial |
$6,645.93
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,042.57
|
| Rate for Payer: Health EOS Commercial |
$6,429.22
|
| Rate for Payer: HFN Commercial |
$6,645.93
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,417.88
|
| Rate for Payer: Multiplan Commercial |
$5,779.07
|
| Rate for Payer: NAPHCARE Commercial |
$4,334.30
|
| Rate for Payer: Preferred Network Access Commercial |
$6,645.93
|
| Rate for Payer: Quartz Beloit One Network |
$3,539.68
|
| Rate for Payer: Quartz Commercial |
$4,695.50
|
| Rate for Payer: Quartz Medicare Advantage |
$4,334.30
|
| Rate for Payer: The Alliance Commercial |
$925.10
|
| Rate for Payer: United Healthcare PPO |
$3,142.88
|
| Rate for Payer: WEA Trust Commercial |
$3,973.11
|
| Rate for Payer: WPS Commercial |
$1,618.93
|
|
|
MRI Pelvis w/ + w/o Contrast
|
Professional
|
Both
|
$6,946.00
|
|
|
Service Code
|
CPT 72197 TC
|
| Hospital Charge Code |
1611228
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$231.28 |
| Max. Negotiated Rate |
$6,862.65 |
| Rate for Payer: Aetna Commercial |
$6,862.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,212.50
|
| Rate for Payer: Aetna Managed Medicare |
$231.28
|
| Rate for Payer: Anthem Medicare Advantage |
$231.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$231.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$231.28
|
| Rate for Payer: Cash Price |
$2,083.80
|
| Rate for Payer: Cash Price |
$2,083.80
|
| Rate for Payer: Cash Price |
$2,083.80
|
| Rate for Payer: Cigna Commercial |
$6,862.65
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$3,611.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$231.28
|
| Rate for Payer: Health EOS Commercial |
$6,573.69
|
| Rate for Payer: HFN Commercial |
$6,862.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$970.95
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$970.95
|
| Rate for Payer: Independent Care Health Plan Medicare |
$231.28
|
| Rate for Payer: Multiplan Commercial |
$5,779.07
|
| Rate for Payer: NAPHCARE Commercial |
$346.91
|
| Rate for Payer: Preferred Network Access Commercial |
$6,862.65
|
| Rate for Payer: Quartz Beloit One Network |
$3,178.49
|
| Rate for Payer: Quartz Commercial |
$4,117.59
|
| Rate for Payer: Quartz Medicare Advantage |
$231.28
|
| Rate for Payer: The Alliance Commercial |
$878.85
|
| Rate for Payer: United Healthcare Medicare Advantage |
$231.28
|
| Rate for Payer: WEA Trust Commercial |
$3,973.11
|
| Rate for Payer: WPS Commercial |
$1,156.38
|
|
|
MRI Pelvis w/ + w/o Contrast
|
Professional
|
Both
|
$6,092.00
|
|
|
Service Code
|
CPT 72197
|
| Hospital Charge Code |
631199
|
| Min. Negotiated Rate |
$332.63 |
| Max. Negotiated Rate |
$6,018.90 |
| Rate for Payer: Aetna Commercial |
$6,018.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,448.68
|
| Rate for Payer: Aetna Managed Medicare |
$332.63
|
| Rate for Payer: Anthem Medicare Advantage |
$332.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$332.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$332.63
|
| Rate for Payer: Cash Price |
$1,827.60
|
| Rate for Payer: Cash Price |
$1,827.60
|
| Rate for Payer: Cash Price |
$1,827.60
|
| Rate for Payer: Cigna Commercial |
$6,018.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$3,167.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$332.63
|
| Rate for Payer: Health EOS Commercial |
$5,765.47
|
| Rate for Payer: HFN Commercial |
$6,018.90
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,351.89
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,351.89
|
| Rate for Payer: Independent Care Health Plan Medicare |
$332.63
|
| Rate for Payer: Multiplan Commercial |
$5,068.54
|
| Rate for Payer: NAPHCARE Commercial |
$498.95
|
| Rate for Payer: Preferred Network Access Commercial |
$6,018.90
|
| Rate for Payer: Quartz Beloit One Network |
$2,787.70
|
| Rate for Payer: Quartz Commercial |
$3,611.34
|
| Rate for Payer: Quartz Medicare Advantage |
$332.63
|
| Rate for Payer: The Alliance Commercial |
$1,264.01
|
| Rate for Payer: United Healthcare Medicare Advantage |
$332.63
|
| Rate for Payer: WEA Trust Commercial |
$3,484.62
|
| Rate for Payer: WPS Commercial |
$1,663.17
|
|
|
MRI Pelvis w/ + w/o Contrast
|
Facility
|
OP
|
$6,946.00
|
|
|
Service Code
|
CPT 72197 TC
|
| Hospital Charge Code |
3072693
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$925.10 |
| Max. Negotiated Rate |
$6,645.93 |
| Rate for Payer: Aetna Commercial |
$6,501.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,212.50
|
| Rate for Payer: Aetna Managed Medicare |
$2,022.68
|
| 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 |
$3,828.64
|
| Rate for Payer: Cash Price |
$2,083.80
|
| Rate for Payer: Cash Price |
$2,083.80
|
| Rate for Payer: Cash Price |
$2,083.80
|
| Rate for Payer: Cash Price |
$2,083.80
|
| Rate for Payer: Cigna Commercial |
$6,645.93
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,042.57
|
| Rate for Payer: Health EOS Commercial |
$6,429.22
|
| Rate for Payer: HFN Commercial |
$6,645.93
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,417.88
|
| Rate for Payer: Multiplan Commercial |
$5,779.07
|
| Rate for Payer: NAPHCARE Commercial |
$4,334.30
|
| Rate for Payer: Preferred Network Access Commercial |
$6,645.93
|
| Rate for Payer: Quartz Beloit One Network |
$3,539.68
|
| Rate for Payer: Quartz Commercial |
$4,695.50
|
| Rate for Payer: Quartz Medicare Advantage |
$4,334.30
|
| Rate for Payer: The Alliance Commercial |
$925.10
|
| Rate for Payer: United Healthcare PPO |
$3,142.88
|
| Rate for Payer: WEA Trust Commercial |
$3,973.11
|
| Rate for Payer: WPS Commercial |
$1,618.93
|
|
|
MRI Pelvis w/ + w/o Contrast
|
Facility
|
IP
|
$6,946.00
|
|
|
Service Code
|
CPT 72197 TC
|
| Hospital Charge Code |
3072693
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$3,539.68 |
| Max. Negotiated Rate |
$6,645.93 |
| Rate for Payer: Aetna Commercial |
$6,501.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,212.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,828.64
|
| Rate for Payer: Cash Price |
$2,083.80
|
| Rate for Payer: Cigna Commercial |
$6,645.93
|
| Rate for Payer: Health EOS Commercial |
$6,429.22
|
| Rate for Payer: HFN Commercial |
$6,645.93
|
| Rate for Payer: Multiplan Commercial |
$5,779.07
|
| Rate for Payer: Preferred Network Access Commercial |
$6,645.93
|
| Rate for Payer: Quartz Beloit One Network |
$3,539.68
|
| Rate for Payer: Quartz Commercial |
$4,334.30
|
| Rate for Payer: WEA Trust Commercial |
$3,973.11
|
| Rate for Payer: WPS Commercial |
$5,350.50
|
|
|
MRI Pelvis w/ + w/o Contrast
|
Facility
|
IP
|
$6,946.00
|
|
|
Service Code
|
CPT 72197 TC
|
| Hospital Charge Code |
1611228
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$3,539.68 |
| Max. Negotiated Rate |
$6,645.93 |
| Rate for Payer: Aetna Commercial |
$6,501.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,212.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,828.64
|
| Rate for Payer: Cash Price |
$2,083.80
|
| Rate for Payer: Cigna Commercial |
$6,645.93
|
| Rate for Payer: Health EOS Commercial |
$6,429.22
|
| Rate for Payer: HFN Commercial |
$6,645.93
|
| Rate for Payer: Multiplan Commercial |
$5,779.07
|
| Rate for Payer: Preferred Network Access Commercial |
$6,645.93
|
| Rate for Payer: Quartz Beloit One Network |
$3,539.68
|
| Rate for Payer: Quartz Commercial |
$4,334.30
|
| Rate for Payer: WEA Trust Commercial |
$3,973.11
|
| Rate for Payer: WPS Commercial |
$5,350.50
|
|
|
MRI Pelvis w/ + w/o Contrast
|
Professional
|
Both
|
$6,946.00
|
|
|
Service Code
|
CPT 72197 TC
|
| Hospital Charge Code |
3072693
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$231.28 |
| Max. Negotiated Rate |
$6,862.65 |
| Rate for Payer: Aetna Commercial |
$6,862.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,212.50
|
| Rate for Payer: Aetna Managed Medicare |
$231.28
|
| Rate for Payer: Anthem Medicare Advantage |
$231.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$231.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$231.28
|
| Rate for Payer: Cash Price |
$2,083.80
|
| Rate for Payer: Cash Price |
$2,083.80
|
| Rate for Payer: Cash Price |
$2,083.80
|
| Rate for Payer: Cigna Commercial |
$6,862.65
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$3,611.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$231.28
|
| Rate for Payer: Health EOS Commercial |
$6,573.69
|
| Rate for Payer: HFN Commercial |
$6,862.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$970.95
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$970.95
|
| Rate for Payer: Independent Care Health Plan Medicare |
$231.28
|
| Rate for Payer: Multiplan Commercial |
$5,779.07
|
| Rate for Payer: NAPHCARE Commercial |
$346.91
|
| Rate for Payer: Preferred Network Access Commercial |
$6,862.65
|
| Rate for Payer: Quartz Beloit One Network |
$3,178.49
|
| Rate for Payer: Quartz Commercial |
$4,117.59
|
| Rate for Payer: Quartz Medicare Advantage |
$231.28
|
| Rate for Payer: The Alliance Commercial |
$878.85
|
| Rate for Payer: United Healthcare Medicare Advantage |
$231.28
|
| Rate for Payer: WEA Trust Commercial |
$3,973.11
|
| Rate for Payer: WPS Commercial |
$1,156.38
|
|
|
MRI Penile/Scrotum w/o Contrast
|
Facility
|
IP
|
$5,248.00
|
|
|
Service Code
|
CPT 72195 TC
|
| Hospital Charge Code |
6230680
|
|
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 Penile/Scrotum w/o Contrast
|
Professional
|
Both
|
$5,248.00
|
|
|
Service Code
|
CPT 72195 TC
|
| Hospital Charge Code |
6230680
|
|
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 Penile/Scrotum w/o Contrast
|
Facility
|
OP
|
$5,248.00
|
|
|
Service Code
|
CPT 72195 TC
|
| Hospital Charge Code |
6230680
|
|
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 Penile/Scrotum w/ + w/o Contrast
|
Facility
|
IP
|
$6,946.00
|
|
|
Service Code
|
CPT 72197 TC
|
| Hospital Charge Code |
6230677
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$3,539.68 |
| Max. Negotiated Rate |
$6,645.93 |
| Rate for Payer: Aetna Commercial |
$6,501.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,212.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,828.64
|
| Rate for Payer: Cash Price |
$2,083.80
|
| Rate for Payer: Cigna Commercial |
$6,645.93
|
| Rate for Payer: Health EOS Commercial |
$6,429.22
|
| Rate for Payer: HFN Commercial |
$6,645.93
|
| Rate for Payer: Multiplan Commercial |
$5,779.07
|
| Rate for Payer: Preferred Network Access Commercial |
$6,645.93
|
| Rate for Payer: Quartz Beloit One Network |
$3,539.68
|
| Rate for Payer: Quartz Commercial |
$4,334.30
|
| Rate for Payer: WEA Trust Commercial |
$3,973.11
|
| Rate for Payer: WPS Commercial |
$5,350.50
|
|
|
MRI Penile/Scrotum w/ + w/o Contrast
|
Professional
|
Both
|
$6,946.00
|
|
|
Service Code
|
CPT 72197 TC
|
| Hospital Charge Code |
6230677
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$231.28 |
| Max. Negotiated Rate |
$6,862.65 |
| Rate for Payer: Aetna Commercial |
$6,862.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,212.50
|
| Rate for Payer: Aetna Managed Medicare |
$231.28
|
| Rate for Payer: Anthem Medicare Advantage |
$231.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$231.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$231.28
|
| Rate for Payer: Cash Price |
$2,083.80
|
| Rate for Payer: Cash Price |
$2,083.80
|
| Rate for Payer: Cash Price |
$2,083.80
|
| Rate for Payer: Cigna Commercial |
$6,862.65
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$3,611.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$231.28
|
| Rate for Payer: Health EOS Commercial |
$6,573.69
|
| Rate for Payer: HFN Commercial |
$6,862.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$970.95
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$970.95
|
| Rate for Payer: Independent Care Health Plan Medicare |
$231.28
|
| Rate for Payer: Multiplan Commercial |
$5,779.07
|
| Rate for Payer: NAPHCARE Commercial |
$346.91
|
| Rate for Payer: Preferred Network Access Commercial |
$6,862.65
|
| Rate for Payer: Quartz Beloit One Network |
$3,178.49
|
| Rate for Payer: Quartz Commercial |
$4,117.59
|
| Rate for Payer: Quartz Medicare Advantage |
$231.28
|
| Rate for Payer: The Alliance Commercial |
$878.85
|
| Rate for Payer: United Healthcare Medicare Advantage |
$231.28
|
| Rate for Payer: WEA Trust Commercial |
$3,973.11
|
| Rate for Payer: WPS Commercial |
$1,156.38
|
|
|
MRI Penile/Scrotum w/ + w/o Contrast
|
Facility
|
OP
|
$6,946.00
|
|
|
Service Code
|
CPT 72197 TC
|
| Hospital Charge Code |
6230677
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$925.10 |
| Max. Negotiated Rate |
$6,645.93 |
| Rate for Payer: Aetna Commercial |
$6,501.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,212.50
|
| Rate for Payer: Aetna Managed Medicare |
$2,022.68
|
| 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 |
$3,828.64
|
| Rate for Payer: Cash Price |
$2,083.80
|
| Rate for Payer: Cash Price |
$2,083.80
|
| Rate for Payer: Cash Price |
$2,083.80
|
| Rate for Payer: Cash Price |
$2,083.80
|
| Rate for Payer: Cigna Commercial |
$6,645.93
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,042.57
|
| Rate for Payer: Health EOS Commercial |
$6,429.22
|
| Rate for Payer: HFN Commercial |
$6,645.93
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,417.88
|
| Rate for Payer: Multiplan Commercial |
$5,779.07
|
| Rate for Payer: NAPHCARE Commercial |
$4,334.30
|
| Rate for Payer: Preferred Network Access Commercial |
$6,645.93
|
| Rate for Payer: Quartz Beloit One Network |
$3,539.68
|
| Rate for Payer: Quartz Commercial |
$4,695.50
|
| Rate for Payer: Quartz Medicare Advantage |
$4,334.30
|
| Rate for Payer: The Alliance Commercial |
$925.10
|
| Rate for Payer: United Healthcare PPO |
$3,142.88
|
| Rate for Payer: WEA Trust Commercial |
$3,973.11
|
| Rate for Payer: WPS Commercial |
$1,618.93
|
|
|
MRI Prostate w/o Contrast
|
Professional
|
Both
|
$5,248.00
|
|
|
Service Code
|
CPT 72195 TC
|
| Hospital Charge Code |
6230686
|
|
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 Prostate w/o Contrast
|
Facility
|
IP
|
$5,248.00
|
|
|
Service Code
|
CPT 72195 TC
|
| Hospital Charge Code |
6230686
|
|
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 Prostate w/o Contrast
|
Facility
|
OP
|
$5,248.00
|
|
|
Service Code
|
CPT 72195 TC
|
| Hospital Charge Code |
6230686
|
|
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 Prostate w/ + w/o Contrast
|
Facility
|
OP
|
$6,946.00
|
|
|
Service Code
|
CPT 72197 TC
|
| Hospital Charge Code |
6230683
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$925.10 |
| Max. Negotiated Rate |
$6,645.93 |
| Rate for Payer: Aetna Commercial |
$6,501.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,212.50
|
| Rate for Payer: Aetna Managed Medicare |
$2,022.68
|
| 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 |
$3,828.64
|
| Rate for Payer: Cash Price |
$2,083.80
|
| Rate for Payer: Cash Price |
$2,083.80
|
| Rate for Payer: Cash Price |
$2,083.80
|
| Rate for Payer: Cash Price |
$2,083.80
|
| Rate for Payer: Cigna Commercial |
$6,645.93
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,042.57
|
| Rate for Payer: Health EOS Commercial |
$6,429.22
|
| Rate for Payer: HFN Commercial |
$6,645.93
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,417.88
|
| Rate for Payer: Multiplan Commercial |
$5,779.07
|
| Rate for Payer: NAPHCARE Commercial |
$4,334.30
|
| Rate for Payer: Preferred Network Access Commercial |
$6,645.93
|
| Rate for Payer: Quartz Beloit One Network |
$3,539.68
|
| Rate for Payer: Quartz Commercial |
$4,695.50
|
| Rate for Payer: Quartz Medicare Advantage |
$4,334.30
|
| Rate for Payer: The Alliance Commercial |
$925.10
|
| Rate for Payer: United Healthcare PPO |
$3,142.88
|
| Rate for Payer: WEA Trust Commercial |
$3,973.11
|
| Rate for Payer: WPS Commercial |
$1,618.93
|
|
|
MRI Prostate w/ + w/o Contrast
|
Professional
|
Both
|
$6,946.00
|
|
|
Service Code
|
CPT 72197 TC
|
| Hospital Charge Code |
6230683
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$231.28 |
| Max. Negotiated Rate |
$6,862.65 |
| Rate for Payer: Aetna Commercial |
$6,862.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,212.50
|
| Rate for Payer: Aetna Managed Medicare |
$231.28
|
| Rate for Payer: Anthem Medicare Advantage |
$231.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$231.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$231.28
|
| Rate for Payer: Cash Price |
$2,083.80
|
| Rate for Payer: Cash Price |
$2,083.80
|
| Rate for Payer: Cash Price |
$2,083.80
|
| Rate for Payer: Cigna Commercial |
$6,862.65
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$3,611.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$231.28
|
| Rate for Payer: Health EOS Commercial |
$6,573.69
|
| Rate for Payer: HFN Commercial |
$6,862.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$970.95
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$970.95
|
| Rate for Payer: Independent Care Health Plan Medicare |
$231.28
|
| Rate for Payer: Multiplan Commercial |
$5,779.07
|
| Rate for Payer: NAPHCARE Commercial |
$346.91
|
| Rate for Payer: Preferred Network Access Commercial |
$6,862.65
|
| Rate for Payer: Quartz Beloit One Network |
$3,178.49
|
| Rate for Payer: Quartz Commercial |
$4,117.59
|
| Rate for Payer: Quartz Medicare Advantage |
$231.28
|
| Rate for Payer: The Alliance Commercial |
$878.85
|
| Rate for Payer: United Healthcare Medicare Advantage |
$231.28
|
| Rate for Payer: WEA Trust Commercial |
$3,973.11
|
| Rate for Payer: WPS Commercial |
$1,156.38
|
|
|
MRI Prostate w/ + w/o Contrast
|
Facility
|
IP
|
$6,946.00
|
|
|
Service Code
|
CPT 72197 TC
|
| Hospital Charge Code |
6230683
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$3,539.68 |
| Max. Negotiated Rate |
$6,645.93 |
| Rate for Payer: Aetna Commercial |
$6,501.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,212.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,828.64
|
| Rate for Payer: Cash Price |
$2,083.80
|
| Rate for Payer: Cigna Commercial |
$6,645.93
|
| Rate for Payer: Health EOS Commercial |
$6,429.22
|
| Rate for Payer: HFN Commercial |
$6,645.93
|
| Rate for Payer: Multiplan Commercial |
$5,779.07
|
| Rate for Payer: Preferred Network Access Commercial |
$6,645.93
|
| Rate for Payer: Quartz Beloit One Network |
$3,539.68
|
| Rate for Payer: Quartz Commercial |
$4,334.30
|
| Rate for Payer: WEA Trust Commercial |
$3,973.11
|
| Rate for Payer: WPS Commercial |
$5,350.50
|
|
|
MRI Sacrum/ SI Joint w
|
Facility
|
OP
|
$6,080.00
|
|
|
Service Code
|
CPT 72196
|
| Hospital Charge Code |
1608825
|
| 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 Sacrum/ SI Joint w
|
Professional
|
Both
|
$6,080.00
|
|
|
Service Code
|
CPT 72196
|
| Hospital Charge Code |
1608825
|
| 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 Sacrum/ SI Joint w
|
Facility
|
IP
|
$6,080.00
|
|
|
Service Code
|
CPT 72196
|
| Hospital Charge Code |
1608825
|
| 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
|
|
