|
MRI Wrist w/ + w/o Contrast Left
|
Facility
|
OP
|
$6,421.00
|
|
|
Service Code
|
CPT 73223 LT,TC
|
| Hospital Charge Code |
1611389
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$380.12 |
| Max. Negotiated Rate |
$5,907.32 |
| Rate for Payer: Aetna Commercial |
$5,778.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,522.06
|
| Rate for Payer: Aetna Managed Medicare |
$380.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,496.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,871.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,726.00
|
| Rate for Payer: Anthem Medicare Advantage |
$380.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,403.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$380.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$380.12
|
| Rate for Payer: Cash Price |
$1,926.30
|
| Rate for Payer: Cash Price |
$1,926.30
|
| Rate for Payer: Cash Price |
$1,926.30
|
| Rate for Payer: Cash Price |
$1,926.30
|
| Rate for Payer: Cigna Commercial |
$5,907.32
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$380.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,593.19
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$380.12
|
| Rate for Payer: Health EOS Commercial |
$5,714.69
|
| Rate for Payer: HFN Commercial |
$5,907.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,414.05
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$380.12
|
| Rate for Payer: Independent Care Health Plan Medicare |
$380.12
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$380.12
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$380.12
|
| Rate for Payer: Multiplan Commercial |
$5,136.80
|
| Rate for Payer: NAPHCARE Commercial |
$570.18
|
| Rate for Payer: Preferred Network Access Commercial |
$5,907.32
|
| Rate for Payer: Quartz Beloit One Network |
$3,146.29
|
| Rate for Payer: Quartz Commercial |
$4,173.65
|
| Rate for Payer: Quartz Medicare Advantage |
$380.12
|
| Rate for Payer: The Alliance Commercial |
$1,520.48
|
| Rate for Payer: United Healthcare Medicare Advantage |
$380.12
|
| Rate for Payer: United Healthcare PPO |
$3,022.00
|
| Rate for Payer: WEA Trust Commercial |
$3,531.55
|
| Rate for Payer: Wellcare Medicare |
$380.12
|
| Rate for Payer: WPS Commercial |
$4,756.03
|
|
|
MRI Wrist w/ + w/o Contrast Left
|
Professional
|
Both
|
$6,421.00
|
|
|
Service Code
|
CPT 73223 LT,TC
|
| Hospital Charge Code |
1611389
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,507.24 |
| Max. Negotiated Rate |
$6,099.95 |
| Rate for Payer: Aetna Commercial |
$6,099.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,522.06
|
| Rate for Payer: Cash Price |
$1,926.30
|
| Rate for Payer: Cash Price |
$1,926.30
|
| Rate for Payer: Cash Price |
$1,926.30
|
| Rate for Payer: Cigna Commercial |
$6,099.95
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$3,210.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,852.60
|
| Rate for Payer: Health EOS Commercial |
$5,843.11
|
| Rate for Payer: HFN Commercial |
$6,099.95
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,507.24
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,507.24
|
| Rate for Payer: Multiplan Commercial |
$5,136.80
|
| Rate for Payer: Preferred Network Access Commercial |
$6,099.95
|
| Rate for Payer: Quartz Beloit One Network |
$2,825.24
|
| Rate for Payer: Quartz Commercial |
$3,659.97
|
| Rate for Payer: The Alliance Commercial |
$3,210.50
|
| Rate for Payer: WEA Trust Commercial |
$3,531.55
|
| Rate for Payer: WPS Commercial |
$4,756.03
|
|
|
MRI Wrist w/ + w/o Contrast Left
|
Facility
|
IP
|
$6,421.00
|
|
|
Service Code
|
CPT 73223 LT,TC
|
| Hospital Charge Code |
1611389
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$3,146.29 |
| Max. Negotiated Rate |
$5,907.32 |
| Rate for Payer: Aetna Commercial |
$5,778.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,522.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,403.13
|
| Rate for Payer: Cash Price |
$1,926.30
|
| Rate for Payer: Cigna Commercial |
$5,907.32
|
| Rate for Payer: Health EOS Commercial |
$5,714.69
|
| Rate for Payer: HFN Commercial |
$5,907.32
|
| Rate for Payer: Multiplan Commercial |
$5,136.80
|
| Rate for Payer: NAPHCARE Commercial |
$3,852.60
|
| Rate for Payer: Preferred Network Access Commercial |
$5,907.32
|
| Rate for Payer: Quartz Beloit One Network |
$3,146.29
|
| Rate for Payer: Quartz Commercial |
$3,852.60
|
| Rate for Payer: WEA Trust Commercial |
$3,531.55
|
| Rate for Payer: WPS Commercial |
$4,756.03
|
|
|
MRI Wrist w/ + w/o Contrast Left
|
Professional
|
Both
|
$5,851.00
|
|
|
Service Code
|
CPT 73223
|
| Hospital Charge Code |
631423
|
| Min. Negotiated Rate |
$1,507.24 |
| Max. Negotiated Rate |
$5,558.45 |
| Rate for Payer: Aetna Commercial |
$5,558.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,031.86
|
| Rate for Payer: Cash Price |
$1,755.30
|
| Rate for Payer: Cash Price |
$1,755.30
|
| Rate for Payer: Cash Price |
$1,755.30
|
| Rate for Payer: Cigna Commercial |
$5,558.45
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,925.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,510.60
|
| Rate for Payer: Health EOS Commercial |
$5,324.41
|
| Rate for Payer: HFN Commercial |
$5,558.45
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,507.24
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,507.24
|
| Rate for Payer: Multiplan Commercial |
$4,680.80
|
| Rate for Payer: Preferred Network Access Commercial |
$5,558.45
|
| Rate for Payer: Quartz Beloit One Network |
$2,574.44
|
| Rate for Payer: Quartz Commercial |
$3,335.07
|
| Rate for Payer: The Alliance Commercial |
$2,925.50
|
| Rate for Payer: WEA Trust Commercial |
$3,218.05
|
| Rate for Payer: WPS Commercial |
$4,333.84
|
|
|
MRI Wrist w/ + w/o Contrast Left
|
Facility
|
OP
|
$5,851.00
|
|
|
Service Code
|
CPT 73223
|
| Hospital Charge Code |
631423
|
| Min. Negotiated Rate |
$380.12 |
| Max. Negotiated Rate |
$5,382.92 |
| Rate for Payer: Aetna Commercial |
$5,265.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,031.86
|
| Rate for Payer: Aetna Managed Medicare |
$380.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,803.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,925.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,808.48
|
| Rate for Payer: Anthem Medicare Advantage |
$380.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,101.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$380.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$380.12
|
| Rate for Payer: Cash Price |
$1,755.30
|
| Rate for Payer: Cash Price |
$1,755.30
|
| Rate for Payer: Cigna Commercial |
$5,382.92
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$380.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,274.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$380.12
|
| Rate for Payer: Health EOS Commercial |
$5,207.39
|
| Rate for Payer: HFN Commercial |
$5,382.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,414.05
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$380.12
|
| Rate for Payer: Independent Care Health Plan Medicare |
$380.12
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$380.12
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$380.12
|
| Rate for Payer: Multiplan Commercial |
$4,680.80
|
| Rate for Payer: NAPHCARE Commercial |
$570.18
|
| Rate for Payer: Preferred Network Access Commercial |
$5,382.92
|
| Rate for Payer: Quartz Beloit One Network |
$2,866.99
|
| Rate for Payer: Quartz Commercial |
$3,803.15
|
| Rate for Payer: Quartz Medicare Advantage |
$380.12
|
| Rate for Payer: The Alliance Commercial |
$1,520.48
|
| Rate for Payer: United Healthcare Medicare Advantage |
$380.12
|
| Rate for Payer: WEA Trust Commercial |
$3,218.05
|
| Rate for Payer: Wellcare Medicare |
$380.12
|
| Rate for Payer: WPS Commercial |
$4,333.84
|
|
|
MRI Wrist w/ + w/o Contrast Left
|
Facility
|
IP
|
$5,851.00
|
|
|
Service Code
|
CPT 73223
|
| Hospital Charge Code |
631423
|
| Min. Negotiated Rate |
$2,866.99 |
| Max. Negotiated Rate |
$5,382.92 |
| Rate for Payer: Aetna Commercial |
$5,265.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,031.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,101.03
|
| Rate for Payer: Cash Price |
$1,755.30
|
| Rate for Payer: Cigna Commercial |
$5,382.92
|
| Rate for Payer: Health EOS Commercial |
$5,207.39
|
| Rate for Payer: HFN Commercial |
$5,382.92
|
| Rate for Payer: Multiplan Commercial |
$4,680.80
|
| Rate for Payer: NAPHCARE Commercial |
$3,510.60
|
| Rate for Payer: Preferred Network Access Commercial |
$5,382.92
|
| Rate for Payer: Quartz Beloit One Network |
$2,866.99
|
| Rate for Payer: Quartz Commercial |
$3,510.60
|
| Rate for Payer: WEA Trust Commercial |
$3,218.05
|
| Rate for Payer: WPS Commercial |
$4,333.84
|
|
|
MRI Wrist w/ + w/o Contrast Right
|
Facility
|
OP
|
$5,851.00
|
|
|
Service Code
|
CPT 73223
|
| Hospital Charge Code |
631429
|
| Min. Negotiated Rate |
$380.12 |
| Max. Negotiated Rate |
$5,382.92 |
| Rate for Payer: Aetna Commercial |
$5,265.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,031.86
|
| Rate for Payer: Aetna Managed Medicare |
$380.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,803.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,925.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,808.48
|
| Rate for Payer: Anthem Medicare Advantage |
$380.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,101.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$380.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$380.12
|
| Rate for Payer: Cash Price |
$1,755.30
|
| Rate for Payer: Cash Price |
$1,755.30
|
| Rate for Payer: Cigna Commercial |
$5,382.92
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$380.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,274.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$380.12
|
| Rate for Payer: Health EOS Commercial |
$5,207.39
|
| Rate for Payer: HFN Commercial |
$5,382.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,414.05
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$380.12
|
| Rate for Payer: Independent Care Health Plan Medicare |
$380.12
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$380.12
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$380.12
|
| Rate for Payer: Multiplan Commercial |
$4,680.80
|
| Rate for Payer: NAPHCARE Commercial |
$570.18
|
| Rate for Payer: Preferred Network Access Commercial |
$5,382.92
|
| Rate for Payer: Quartz Beloit One Network |
$2,866.99
|
| Rate for Payer: Quartz Commercial |
$3,803.15
|
| Rate for Payer: Quartz Medicare Advantage |
$380.12
|
| Rate for Payer: The Alliance Commercial |
$1,520.48
|
| Rate for Payer: United Healthcare Medicare Advantage |
$380.12
|
| Rate for Payer: WEA Trust Commercial |
$3,218.05
|
| Rate for Payer: Wellcare Medicare |
$380.12
|
| Rate for Payer: WPS Commercial |
$4,333.84
|
|
|
MRI Wrist w/ + w/o Contrast Right
|
Professional
|
Both
|
$5,851.00
|
|
|
Service Code
|
CPT 73223
|
| Hospital Charge Code |
631429
|
| Min. Negotiated Rate |
$1,507.24 |
| Max. Negotiated Rate |
$5,558.45 |
| Rate for Payer: Aetna Commercial |
$5,558.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,031.86
|
| Rate for Payer: Cash Price |
$1,755.30
|
| Rate for Payer: Cash Price |
$1,755.30
|
| Rate for Payer: Cash Price |
$1,755.30
|
| Rate for Payer: Cigna Commercial |
$5,558.45
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,925.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,510.60
|
| Rate for Payer: Health EOS Commercial |
$5,324.41
|
| Rate for Payer: HFN Commercial |
$5,558.45
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,507.24
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,507.24
|
| Rate for Payer: Multiplan Commercial |
$4,680.80
|
| Rate for Payer: Preferred Network Access Commercial |
$5,558.45
|
| Rate for Payer: Quartz Beloit One Network |
$2,574.44
|
| Rate for Payer: Quartz Commercial |
$3,335.07
|
| Rate for Payer: The Alliance Commercial |
$2,925.50
|
| Rate for Payer: WEA Trust Commercial |
$3,218.05
|
| Rate for Payer: WPS Commercial |
$4,333.84
|
|
|
MRI Wrist w/ + w/o Contrast Right
|
Facility
|
OP
|
$6,397.00
|
|
|
Service Code
|
CPT 73223 RT,TC
|
| Hospital Charge Code |
1611391
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$380.12 |
| Max. Negotiated Rate |
$5,885.24 |
| Rate for Payer: Aetna Commercial |
$5,757.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,501.42
|
| Rate for Payer: Aetna Managed Medicare |
$380.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,496.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,871.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,726.00
|
| Rate for Payer: Anthem Medicare Advantage |
$380.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,390.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$380.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$380.12
|
| Rate for Payer: Cash Price |
$1,919.10
|
| Rate for Payer: Cash Price |
$1,919.10
|
| Rate for Payer: Cash Price |
$1,919.10
|
| Rate for Payer: Cash Price |
$1,919.10
|
| Rate for Payer: Cigna Commercial |
$5,885.24
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$380.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,579.76
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$380.12
|
| Rate for Payer: Health EOS Commercial |
$5,693.33
|
| Rate for Payer: HFN Commercial |
$5,885.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,414.05
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$380.12
|
| Rate for Payer: Independent Care Health Plan Medicare |
$380.12
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$380.12
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$380.12
|
| Rate for Payer: Multiplan Commercial |
$5,117.60
|
| Rate for Payer: NAPHCARE Commercial |
$570.18
|
| Rate for Payer: Preferred Network Access Commercial |
$5,885.24
|
| Rate for Payer: Quartz Beloit One Network |
$3,134.53
|
| Rate for Payer: Quartz Commercial |
$4,158.05
|
| Rate for Payer: Quartz Medicare Advantage |
$380.12
|
| Rate for Payer: The Alliance Commercial |
$1,520.48
|
| Rate for Payer: United Healthcare Medicare Advantage |
$380.12
|
| Rate for Payer: United Healthcare PPO |
$3,022.00
|
| Rate for Payer: WEA Trust Commercial |
$3,518.35
|
| Rate for Payer: Wellcare Medicare |
$380.12
|
| Rate for Payer: WPS Commercial |
$4,738.26
|
|
|
MRI Wrist w/ + w/o Contrast Right
|
Professional
|
Both
|
$6,397.00
|
|
|
Service Code
|
CPT 73223 RT,TC
|
| Hospital Charge Code |
1611391
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,507.24 |
| Max. Negotiated Rate |
$6,077.15 |
| Rate for Payer: Aetna Commercial |
$6,077.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,501.42
|
| Rate for Payer: Cash Price |
$1,919.10
|
| Rate for Payer: Cash Price |
$1,919.10
|
| Rate for Payer: Cash Price |
$1,919.10
|
| Rate for Payer: Cigna Commercial |
$6,077.15
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$3,198.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,838.20
|
| Rate for Payer: Health EOS Commercial |
$5,821.27
|
| Rate for Payer: HFN Commercial |
$6,077.15
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,507.24
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,507.24
|
| Rate for Payer: Multiplan Commercial |
$5,117.60
|
| Rate for Payer: Preferred Network Access Commercial |
$6,077.15
|
| Rate for Payer: Quartz Beloit One Network |
$2,814.68
|
| Rate for Payer: Quartz Commercial |
$3,646.29
|
| Rate for Payer: The Alliance Commercial |
$3,198.50
|
| Rate for Payer: WEA Trust Commercial |
$3,518.35
|
| Rate for Payer: WPS Commercial |
$4,738.26
|
|
|
MRI Wrist w/ + w/o Contrast Right
|
Facility
|
IP
|
$6,397.00
|
|
|
Service Code
|
CPT 73223 TC,RT
|
| Hospital Charge Code |
2980050
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$3,134.53 |
| Max. Negotiated Rate |
$5,885.24 |
| Rate for Payer: Aetna Commercial |
$5,757.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,501.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,390.41
|
| Rate for Payer: Cash Price |
$1,919.10
|
| Rate for Payer: Cigna Commercial |
$5,885.24
|
| Rate for Payer: Health EOS Commercial |
$5,693.33
|
| Rate for Payer: HFN Commercial |
$5,885.24
|
| Rate for Payer: Multiplan Commercial |
$5,117.60
|
| Rate for Payer: NAPHCARE Commercial |
$3,838.20
|
| Rate for Payer: Preferred Network Access Commercial |
$5,885.24
|
| Rate for Payer: Quartz Beloit One Network |
$3,134.53
|
| Rate for Payer: Quartz Commercial |
$3,838.20
|
| Rate for Payer: WEA Trust Commercial |
$3,518.35
|
| Rate for Payer: WPS Commercial |
$4,738.26
|
|
|
MRI Wrist w/ + w/o Contrast Right
|
Facility
|
IP
|
$6,397.00
|
|
|
Service Code
|
CPT 73223 RT,TC
|
| Hospital Charge Code |
1611391
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$3,134.53 |
| Max. Negotiated Rate |
$5,885.24 |
| Rate for Payer: Aetna Commercial |
$5,757.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,501.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,390.41
|
| Rate for Payer: Cash Price |
$1,919.10
|
| Rate for Payer: Cigna Commercial |
$5,885.24
|
| Rate for Payer: Health EOS Commercial |
$5,693.33
|
| Rate for Payer: HFN Commercial |
$5,885.24
|
| Rate for Payer: Multiplan Commercial |
$5,117.60
|
| Rate for Payer: NAPHCARE Commercial |
$3,838.20
|
| Rate for Payer: Preferred Network Access Commercial |
$5,885.24
|
| Rate for Payer: Quartz Beloit One Network |
$3,134.53
|
| Rate for Payer: Quartz Commercial |
$3,838.20
|
| Rate for Payer: WEA Trust Commercial |
$3,518.35
|
| Rate for Payer: WPS Commercial |
$4,738.26
|
|
|
MRI Wrist w/ + w/o Contrast Right
|
Facility
|
IP
|
$5,851.00
|
|
|
Service Code
|
CPT 73223
|
| Hospital Charge Code |
631429
|
| Min. Negotiated Rate |
$2,866.99 |
| Max. Negotiated Rate |
$5,382.92 |
| Rate for Payer: Aetna Commercial |
$5,265.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,031.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,101.03
|
| Rate for Payer: Cash Price |
$1,755.30
|
| Rate for Payer: Cigna Commercial |
$5,382.92
|
| Rate for Payer: Health EOS Commercial |
$5,207.39
|
| Rate for Payer: HFN Commercial |
$5,382.92
|
| Rate for Payer: Multiplan Commercial |
$4,680.80
|
| Rate for Payer: NAPHCARE Commercial |
$3,510.60
|
| Rate for Payer: Preferred Network Access Commercial |
$5,382.92
|
| Rate for Payer: Quartz Beloit One Network |
$2,866.99
|
| Rate for Payer: Quartz Commercial |
$3,510.60
|
| Rate for Payer: WEA Trust Commercial |
$3,218.05
|
| Rate for Payer: WPS Commercial |
$4,333.84
|
|
|
MRI Wrist w/ + w/o Contrast Right
|
Professional
|
Both
|
$6,397.00
|
|
|
Service Code
|
CPT 73223 TC,RT
|
| Hospital Charge Code |
2980050
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,507.24 |
| Max. Negotiated Rate |
$6,077.15 |
| Rate for Payer: Aetna Commercial |
$6,077.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,501.42
|
| Rate for Payer: Cash Price |
$1,919.10
|
| Rate for Payer: Cash Price |
$1,919.10
|
| Rate for Payer: Cash Price |
$1,919.10
|
| Rate for Payer: Cigna Commercial |
$6,077.15
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$3,198.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,838.20
|
| Rate for Payer: Health EOS Commercial |
$5,821.27
|
| Rate for Payer: HFN Commercial |
$6,077.15
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,507.24
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,507.24
|
| Rate for Payer: Multiplan Commercial |
$5,117.60
|
| Rate for Payer: Preferred Network Access Commercial |
$6,077.15
|
| Rate for Payer: Quartz Beloit One Network |
$2,814.68
|
| Rate for Payer: Quartz Commercial |
$3,646.29
|
| Rate for Payer: The Alliance Commercial |
$3,198.50
|
| Rate for Payer: WEA Trust Commercial |
$3,518.35
|
| Rate for Payer: WPS Commercial |
$4,738.26
|
|
|
MRI Wrist w/ + w/o Contrast Right
|
Facility
|
OP
|
$6,397.00
|
|
|
Service Code
|
CPT 73223 TC,RT
|
| Hospital Charge Code |
2980050
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$380.12 |
| Max. Negotiated Rate |
$5,885.24 |
| Rate for Payer: Aetna Commercial |
$5,757.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,501.42
|
| Rate for Payer: Aetna Managed Medicare |
$380.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,496.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,871.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,726.00
|
| Rate for Payer: Anthem Medicare Advantage |
$380.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,390.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$380.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$380.12
|
| Rate for Payer: Cash Price |
$1,919.10
|
| Rate for Payer: Cash Price |
$1,919.10
|
| Rate for Payer: Cash Price |
$1,919.10
|
| Rate for Payer: Cash Price |
$1,919.10
|
| Rate for Payer: Cigna Commercial |
$5,885.24
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$380.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,579.76
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$380.12
|
| Rate for Payer: Health EOS Commercial |
$5,693.33
|
| Rate for Payer: HFN Commercial |
$5,885.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,414.05
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$380.12
|
| Rate for Payer: Independent Care Health Plan Medicare |
$380.12
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$380.12
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$380.12
|
| Rate for Payer: Multiplan Commercial |
$5,117.60
|
| Rate for Payer: NAPHCARE Commercial |
$570.18
|
| Rate for Payer: Preferred Network Access Commercial |
$5,885.24
|
| Rate for Payer: Quartz Beloit One Network |
$3,134.53
|
| Rate for Payer: Quartz Commercial |
$4,158.05
|
| Rate for Payer: Quartz Medicare Advantage |
$380.12
|
| Rate for Payer: The Alliance Commercial |
$1,520.48
|
| Rate for Payer: United Healthcare Medicare Advantage |
$380.12
|
| Rate for Payer: United Healthcare PPO |
$3,022.00
|
| Rate for Payer: WEA Trust Commercial |
$3,518.35
|
| Rate for Payer: Wellcare Medicare |
$380.12
|
| Rate for Payer: WPS Commercial |
$4,738.26
|
|
|
MRI Zimmer w/o Contrast Left
|
Facility
|
IP
|
$4,732.00
|
|
|
Service Code
|
CPT 73721 TC,LT
|
| Hospital Charge Code |
5452630
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$2,318.68 |
| Max. Negotiated Rate |
$4,353.44 |
| Rate for Payer: Aetna Commercial |
$4,258.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,069.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,507.96
|
| Rate for Payer: Cash Price |
$1,419.60
|
| Rate for Payer: Cigna Commercial |
$4,353.44
|
| Rate for Payer: Health EOS Commercial |
$4,211.48
|
| Rate for Payer: HFN Commercial |
$4,353.44
|
| Rate for Payer: Multiplan Commercial |
$3,785.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,839.20
|
| Rate for Payer: Preferred Network Access Commercial |
$4,353.44
|
| Rate for Payer: Quartz Beloit One Network |
$2,318.68
|
| Rate for Payer: Quartz Commercial |
$2,839.20
|
| Rate for Payer: WEA Trust Commercial |
$2,602.60
|
| Rate for Payer: WPS Commercial |
$3,504.99
|
|
|
MRI Zimmer w/o Contrast Left
|
Facility
|
OP
|
$4,732.00
|
|
|
Service Code
|
CPT 73721 TC,LT
|
| Hospital Charge Code |
5452630
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$242.20 |
| Max. Negotiated Rate |
$4,353.44 |
| Rate for Payer: Aetna Commercial |
$4,258.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,069.52
|
| Rate for Payer: Aetna Managed Medicare |
$242.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,496.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,871.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,726.00
|
| Rate for Payer: Anthem Medicare Advantage |
$242.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,507.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$242.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$242.20
|
| Rate for Payer: Cash Price |
$1,419.60
|
| Rate for Payer: Cash Price |
$1,419.60
|
| Rate for Payer: Cash Price |
$1,419.60
|
| Rate for Payer: Cash Price |
$1,419.60
|
| Rate for Payer: Cigna Commercial |
$4,353.44
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$242.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,648.03
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$242.20
|
| Rate for Payer: Health EOS Commercial |
$4,211.48
|
| Rate for Payer: HFN Commercial |
$4,353.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$900.98
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$242.20
|
| Rate for Payer: Independent Care Health Plan Medicare |
$242.20
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$242.20
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$242.20
|
| Rate for Payer: Multiplan Commercial |
$3,785.60
|
| Rate for Payer: NAPHCARE Commercial |
$363.30
|
| Rate for Payer: Preferred Network Access Commercial |
$4,353.44
|
| Rate for Payer: Quartz Beloit One Network |
$2,318.68
|
| Rate for Payer: Quartz Commercial |
$3,075.80
|
| Rate for Payer: Quartz Medicare Advantage |
$242.20
|
| Rate for Payer: The Alliance Commercial |
$968.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$242.20
|
| Rate for Payer: United Healthcare PPO |
$3,022.00
|
| Rate for Payer: WEA Trust Commercial |
$2,602.60
|
| Rate for Payer: Wellcare Medicare |
$242.20
|
| Rate for Payer: WPS Commercial |
$3,504.99
|
|
|
MRI Zimmer w/o Contrast Left
|
Professional
|
Both
|
$4,732.00
|
|
|
Service Code
|
CPT 73721 TC,LT
|
| Hospital Charge Code |
5452630
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$762.09 |
| Max. Negotiated Rate |
$4,495.40 |
| Rate for Payer: Aetna Commercial |
$4,495.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,069.52
|
| Rate for Payer: Cash Price |
$1,419.60
|
| Rate for Payer: Cash Price |
$1,419.60
|
| Rate for Payer: Cash Price |
$1,419.60
|
| Rate for Payer: Cigna Commercial |
$4,495.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,366.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,839.20
|
| Rate for Payer: Health EOS Commercial |
$4,306.12
|
| Rate for Payer: HFN Commercial |
$4,495.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$762.09
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$762.09
|
| Rate for Payer: Multiplan Commercial |
$3,785.60
|
| Rate for Payer: Preferred Network Access Commercial |
$4,495.40
|
| Rate for Payer: Quartz Beloit One Network |
$2,082.08
|
| Rate for Payer: Quartz Commercial |
$2,697.24
|
| Rate for Payer: The Alliance Commercial |
$2,366.00
|
| Rate for Payer: WEA Trust Commercial |
$2,602.60
|
| Rate for Payer: WPS Commercial |
$3,504.99
|
|
|
MRI Zimmer w/o Contrast Right
|
Facility
|
OP
|
$4,732.00
|
|
|
Service Code
|
CPT 73721 TC,RT
|
| Hospital Charge Code |
5452633
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$242.20 |
| Max. Negotiated Rate |
$4,353.44 |
| Rate for Payer: Aetna Commercial |
$4,258.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,069.52
|
| Rate for Payer: Aetna Managed Medicare |
$242.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,496.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,871.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,726.00
|
| Rate for Payer: Anthem Medicare Advantage |
$242.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,507.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$242.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$242.20
|
| Rate for Payer: Cash Price |
$1,419.60
|
| Rate for Payer: Cash Price |
$1,419.60
|
| Rate for Payer: Cash Price |
$1,419.60
|
| Rate for Payer: Cash Price |
$1,419.60
|
| Rate for Payer: Cigna Commercial |
$4,353.44
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$242.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,648.03
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$242.20
|
| Rate for Payer: Health EOS Commercial |
$4,211.48
|
| Rate for Payer: HFN Commercial |
$4,353.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$900.98
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$242.20
|
| Rate for Payer: Independent Care Health Plan Medicare |
$242.20
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$242.20
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$242.20
|
| Rate for Payer: Multiplan Commercial |
$3,785.60
|
| Rate for Payer: NAPHCARE Commercial |
$363.30
|
| Rate for Payer: Preferred Network Access Commercial |
$4,353.44
|
| Rate for Payer: Quartz Beloit One Network |
$2,318.68
|
| Rate for Payer: Quartz Commercial |
$3,075.80
|
| Rate for Payer: Quartz Medicare Advantage |
$242.20
|
| Rate for Payer: The Alliance Commercial |
$968.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$242.20
|
| Rate for Payer: United Healthcare PPO |
$3,022.00
|
| Rate for Payer: WEA Trust Commercial |
$2,602.60
|
| Rate for Payer: Wellcare Medicare |
$242.20
|
| Rate for Payer: WPS Commercial |
$3,504.99
|
|
|
MRI Zimmer w/o Contrast Right
|
Facility
|
IP
|
$4,732.00
|
|
|
Service Code
|
CPT 73721 TC,RT
|
| Hospital Charge Code |
5452633
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$2,318.68 |
| Max. Negotiated Rate |
$4,353.44 |
| Rate for Payer: Aetna Commercial |
$4,258.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,069.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,507.96
|
| Rate for Payer: Cash Price |
$1,419.60
|
| Rate for Payer: Cigna Commercial |
$4,353.44
|
| Rate for Payer: Health EOS Commercial |
$4,211.48
|
| Rate for Payer: HFN Commercial |
$4,353.44
|
| Rate for Payer: Multiplan Commercial |
$3,785.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,839.20
|
| Rate for Payer: Preferred Network Access Commercial |
$4,353.44
|
| Rate for Payer: Quartz Beloit One Network |
$2,318.68
|
| Rate for Payer: Quartz Commercial |
$2,839.20
|
| Rate for Payer: WEA Trust Commercial |
$2,602.60
|
| Rate for Payer: WPS Commercial |
$3,504.99
|
|
|
MRI Zimmer w/o Contrast Right
|
Professional
|
Both
|
$4,732.00
|
|
|
Service Code
|
CPT 73721 TC,RT
|
| Hospital Charge Code |
5452633
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$762.09 |
| Max. Negotiated Rate |
$4,495.40 |
| Rate for Payer: Aetna Commercial |
$4,495.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,069.52
|
| Rate for Payer: Cash Price |
$1,419.60
|
| Rate for Payer: Cash Price |
$1,419.60
|
| Rate for Payer: Cash Price |
$1,419.60
|
| Rate for Payer: Cigna Commercial |
$4,495.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,366.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,839.20
|
| Rate for Payer: Health EOS Commercial |
$4,306.12
|
| Rate for Payer: HFN Commercial |
$4,495.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$762.09
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$762.09
|
| Rate for Payer: Multiplan Commercial |
$3,785.60
|
| Rate for Payer: Preferred Network Access Commercial |
$4,495.40
|
| Rate for Payer: Quartz Beloit One Network |
$2,082.08
|
| Rate for Payer: Quartz Commercial |
$2,697.24
|
| Rate for Payer: The Alliance Commercial |
$2,366.00
|
| Rate for Payer: WEA Trust Commercial |
$2,602.60
|
| Rate for Payer: WPS Commercial |
$3,504.99
|
|
|
MRSA, PCR
|
Professional
|
Both
|
$168.00
|
|
|
Service Code
|
CPT 87641
|
| Hospital Charge Code |
4291332
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$73.92 |
| Max. Negotiated Rate |
$159.60 |
| Rate for Payer: Aetna Commercial |
$159.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$144.48
|
| Rate for Payer: Cash Price |
$50.40
|
| Rate for Payer: Cash Price |
$50.40
|
| Rate for Payer: Cigna Commercial |
$159.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$84.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$100.80
|
| Rate for Payer: Health EOS Commercial |
$152.88
|
| Rate for Payer: HFN Commercial |
$159.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$123.87
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$123.87
|
| Rate for Payer: Multiplan Commercial |
$134.40
|
| Rate for Payer: Preferred Network Access Commercial |
$159.60
|
| Rate for Payer: Quartz Beloit One Network |
$73.92
|
| Rate for Payer: Quartz Commercial |
$95.76
|
| Rate for Payer: The Alliance Commercial |
$84.00
|
| Rate for Payer: WEA Trust Commercial |
$92.40
|
| Rate for Payer: WPS Commercial |
$124.44
|
|
|
MRSA, PCR
|
Facility
|
OP
|
$168.00
|
|
|
Service Code
|
CPT 87641
|
| Hospital Charge Code |
4291332
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$35.09 |
| Max. Negotiated Rate |
$154.56 |
| Rate for Payer: Aetna Commercial |
$151.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$144.48
|
| Rate for Payer: Aetna Managed Medicare |
$35.09
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$131.59
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$61.41
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$58.25
|
| Rate for Payer: Anthem Medicaid |
$36.26
|
| Rate for Payer: Anthem Medicare Advantage |
$35.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$89.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$35.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$35.09
|
| Rate for Payer: Cash Price |
$50.40
|
| Rate for Payer: Cash Price |
$50.40
|
| Rate for Payer: Cigna Commercial |
$154.56
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$35.09
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$36.26
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$94.01
|
| Rate for Payer: Dean Health Medicaid |
$36.26
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$35.09
|
| Rate for Payer: Health EOS Commercial |
$149.52
|
| Rate for Payer: HFN Commercial |
$154.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$130.53
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$35.09
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$36.26
|
| Rate for Payer: Independent Care Health Plan Medicare |
$35.09
|
| Rate for Payer: Managed Health Services Medicaid |
$37.71
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$35.09
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$35.09
|
| Rate for Payer: Multiplan Commercial |
$134.40
|
| Rate for Payer: NAPHCARE Commercial |
$52.64
|
| Rate for Payer: Preferred Network Access Commercial |
$154.56
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$36.26
|
| Rate for Payer: Quartz Beloit One Network |
$82.32
|
| Rate for Payer: Quartz Commercial |
$109.20
|
| Rate for Payer: Quartz Medicare Advantage |
$35.09
|
| Rate for Payer: The Alliance Commercial |
$140.36
|
| Rate for Payer: United Healthcare Medicaid |
$36.26
|
| Rate for Payer: United Healthcare Medicare Advantage |
$35.09
|
| Rate for Payer: United Healthcare PPO |
$126.00
|
| Rate for Payer: WEA Trust Commercial |
$92.40
|
| Rate for Payer: Wellcare Medicare |
$35.09
|
| Rate for Payer: WMAP Medicaid |
$36.26
|
| Rate for Payer: WPS Commercial |
$124.44
|
|
|
MRSA, PCR
|
Facility
|
IP
|
$168.00
|
|
|
Service Code
|
CPT 87641
|
| Hospital Charge Code |
4291332
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$82.32 |
| Max. Negotiated Rate |
$154.56 |
| Rate for Payer: Aetna Commercial |
$151.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$144.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$89.04
|
| Rate for Payer: Cash Price |
$50.40
|
| Rate for Payer: Cigna Commercial |
$154.56
|
| Rate for Payer: Health EOS Commercial |
$149.52
|
| Rate for Payer: HFN Commercial |
$154.56
|
| Rate for Payer: Multiplan Commercial |
$134.40
|
| Rate for Payer: NAPHCARE Commercial |
$100.80
|
| Rate for Payer: Preferred Network Access Commercial |
$154.56
|
| Rate for Payer: Quartz Beloit One Network |
$82.32
|
| Rate for Payer: Quartz Commercial |
$100.80
|
| Rate for Payer: WEA Trust Commercial |
$92.40
|
| Rate for Payer: WPS Commercial |
$124.44
|
|
|
MRSA, PCR - Nares
|
Facility
|
IP
|
$136.00
|
|
|
Service Code
|
CPT 87641
|
| Hospital Charge Code |
4109348
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$66.64 |
| Max. Negotiated Rate |
$125.12 |
| Rate for Payer: Aetna Commercial |
$122.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$116.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$72.08
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cigna Commercial |
$125.12
|
| Rate for Payer: Health EOS Commercial |
$121.04
|
| Rate for Payer: HFN Commercial |
$125.12
|
| Rate for Payer: Multiplan Commercial |
$108.80
|
| Rate for Payer: NAPHCARE Commercial |
$81.60
|
| Rate for Payer: Preferred Network Access Commercial |
$125.12
|
| Rate for Payer: Quartz Beloit One Network |
$66.64
|
| Rate for Payer: Quartz Commercial |
$81.60
|
| Rate for Payer: WEA Trust Commercial |
$74.80
|
| Rate for Payer: WPS Commercial |
$100.74
|
|
