|
MRI Spine Cervical w/o Contrast
|
Facility
|
IP
|
$5,058.00
|
|
|
Service Code
|
CPT 72141 TC
|
| Hospital Charge Code |
3072640
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$2,577.56 |
| Max. Negotiated Rate |
$4,839.49 |
| Rate for Payer: Aetna Commercial |
$4,734.29
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,523.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,787.97
|
| Rate for Payer: Cash Price |
$1,517.40
|
| Rate for Payer: Cigna Commercial |
$4,839.49
|
| Rate for Payer: Health EOS Commercial |
$4,681.68
|
| Rate for Payer: HFN Commercial |
$4,839.49
|
| Rate for Payer: Multiplan Commercial |
$4,208.26
|
| Rate for Payer: Preferred Network Access Commercial |
$4,839.49
|
| Rate for Payer: Quartz Beloit One Network |
$2,577.56
|
| Rate for Payer: Quartz Commercial |
$3,156.19
|
| Rate for Payer: WEA Trust Commercial |
$2,893.18
|
| Rate for Payer: WPS Commercial |
$3,896.18
|
|
|
MRI Spine Cervical w/o Contrast
|
Professional
|
Both
|
$5,058.00
|
|
|
Service Code
|
CPT 72141 TC
|
| Hospital Charge Code |
1611267
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$4,997.30 |
| Rate for Payer: Aetna Commercial |
$4,997.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,523.88
|
| Rate for Payer: Aetna Managed Medicare |
$121.68
|
| Rate for Payer: Anthem Medicare Advantage |
$121.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$121.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$121.68
|
| Rate for Payer: Cash Price |
$1,517.40
|
| Rate for Payer: Cash Price |
$1,517.40
|
| Rate for Payer: Cash Price |
$1,517.40
|
| Rate for Payer: Cigna Commercial |
$4,997.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,630.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$121.68
|
| Rate for Payer: Health EOS Commercial |
$4,786.89
|
| Rate for Payer: HFN Commercial |
$4,997.30
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$493.93
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$493.93
|
| Rate for Payer: Independent Care Health Plan Medicare |
$121.68
|
| Rate for Payer: Multiplan Commercial |
$4,208.26
|
| Rate for Payer: NAPHCARE Commercial |
$182.52
|
| Rate for Payer: Preferred Network Access Commercial |
$4,997.30
|
| Rate for Payer: Quartz Beloit One Network |
$2,314.54
|
| Rate for Payer: Quartz Commercial |
$2,998.38
|
| Rate for Payer: Quartz Medicare Advantage |
$121.68
|
| Rate for Payer: The Alliance Commercial |
$462.38
|
| Rate for Payer: United Healthcare Medicare Advantage |
$121.68
|
| Rate for Payer: WEA Trust Commercial |
$2,893.18
|
| Rate for Payer: WPS Commercial |
$608.40
|
|
|
MRI Spine Cervical w/o Contrast
|
Facility
|
OP
|
$4,633.00
|
|
|
Service Code
|
CPT 72141
|
| Hospital Charge Code |
629598
|
| Min. Negotiated Rate |
$251.10 |
| Max. Negotiated Rate |
$4,432.85 |
| Rate for Payer: Aetna Commercial |
$4,336.49
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,143.76
|
| Rate for Payer: Aetna Managed Medicare |
$251.10
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,131.91
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,409.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,312.79
|
| Rate for Payer: Anthem Medicare Advantage |
$251.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,553.71
|
| 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 |
$1,389.90
|
| Rate for Payer: Cash Price |
$1,389.90
|
| Rate for Payer: Cigna Commercial |
$4,432.85
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$251.10
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,696.41
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$251.10
|
| Rate for Payer: Health EOS Commercial |
$4,288.30
|
| Rate for Payer: HFN Commercial |
$4,432.85
|
| 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 |
$3,854.66
|
| Rate for Payer: NAPHCARE Commercial |
$376.65
|
| Rate for Payer: Preferred Network Access Commercial |
$4,432.85
|
| Rate for Payer: Quartz Beloit One Network |
$2,360.98
|
| Rate for Payer: Quartz Commercial |
$3,131.91
|
| 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 |
$2,650.08
|
| Rate for Payer: Wellcare Medicare |
$251.10
|
| Rate for Payer: WPS Commercial |
$3,568.80
|
|
|
MRI Spine Cervical w/o Contrast
|
Facility
|
IP
|
$4,633.00
|
|
|
Service Code
|
CPT 72141
|
| Hospital Charge Code |
629598
|
| Min. Negotiated Rate |
$2,360.98 |
| Max. Negotiated Rate |
$4,432.85 |
| Rate for Payer: Aetna Commercial |
$4,336.49
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,143.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,553.71
|
| Rate for Payer: Cash Price |
$1,389.90
|
| Rate for Payer: Cigna Commercial |
$4,432.85
|
| Rate for Payer: Health EOS Commercial |
$4,288.30
|
| Rate for Payer: HFN Commercial |
$4,432.85
|
| Rate for Payer: Multiplan Commercial |
$3,854.66
|
| Rate for Payer: Preferred Network Access Commercial |
$4,432.85
|
| Rate for Payer: Quartz Beloit One Network |
$2,360.98
|
| Rate for Payer: Quartz Commercial |
$2,890.99
|
| Rate for Payer: WEA Trust Commercial |
$2,650.08
|
| Rate for Payer: WPS Commercial |
$3,568.80
|
|
|
MRI Spine Cervical w/o Contrast
|
Professional
|
Both
|
$4,633.00
|
|
|
Service Code
|
CPT 72141
|
| Hospital Charge Code |
629598
|
| Min. Negotiated Rate |
$189.86 |
| Max. Negotiated Rate |
$4,577.40 |
| Rate for Payer: Aetna Commercial |
$4,577.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,143.76
|
| Rate for Payer: Aetna Managed Medicare |
$189.86
|
| Rate for Payer: Anthem Medicare Advantage |
$189.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$189.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$189.86
|
| Rate for Payer: Cash Price |
$1,389.90
|
| Rate for Payer: Cash Price |
$1,389.90
|
| Rate for Payer: Cash Price |
$1,389.90
|
| Rate for Payer: Cigna Commercial |
$4,577.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,409.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$189.86
|
| Rate for Payer: Health EOS Commercial |
$4,384.67
|
| Rate for Payer: HFN Commercial |
$4,577.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$750.94
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$750.94
|
| Rate for Payer: Independent Care Health Plan Medicare |
$189.86
|
| Rate for Payer: Multiplan Commercial |
$3,854.66
|
| Rate for Payer: NAPHCARE Commercial |
$284.79
|
| Rate for Payer: Preferred Network Access Commercial |
$4,577.40
|
| Rate for Payer: Quartz Beloit One Network |
$2,120.06
|
| Rate for Payer: Quartz Commercial |
$2,746.44
|
| Rate for Payer: Quartz Medicare Advantage |
$189.86
|
| Rate for Payer: The Alliance Commercial |
$721.48
|
| Rate for Payer: United Healthcare Medicare Advantage |
$189.86
|
| Rate for Payer: WEA Trust Commercial |
$2,650.08
|
| Rate for Payer: WPS Commercial |
$949.31
|
|
|
MRI Spine Cervical w/o Contrast
|
Facility
|
IP
|
$5,058.00
|
|
|
Service Code
|
CPT 72141 TC
|
| Hospital Charge Code |
1611267
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$2,577.56 |
| Max. Negotiated Rate |
$4,839.49 |
| Rate for Payer: Aetna Commercial |
$4,734.29
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,523.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,787.97
|
| Rate for Payer: Cash Price |
$1,517.40
|
| Rate for Payer: Cigna Commercial |
$4,839.49
|
| Rate for Payer: Health EOS Commercial |
$4,681.68
|
| Rate for Payer: HFN Commercial |
$4,839.49
|
| Rate for Payer: Multiplan Commercial |
$4,208.26
|
| Rate for Payer: Preferred Network Access Commercial |
$4,839.49
|
| Rate for Payer: Quartz Beloit One Network |
$2,577.56
|
| Rate for Payer: Quartz Commercial |
$3,156.19
|
| Rate for Payer: WEA Trust Commercial |
$2,893.18
|
| Rate for Payer: WPS Commercial |
$3,896.18
|
|
|
MRI Spine Cervical w/o Contrast
|
Facility
|
OP
|
$5,058.00
|
|
|
Service Code
|
CPT 72141 TC
|
| Hospital Charge Code |
1611267
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$486.72 |
| Max. Negotiated Rate |
$4,839.49 |
| Rate for Payer: Aetna Commercial |
$4,734.29
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,523.88
|
| Rate for Payer: Aetna Managed Medicare |
$1,472.89
|
| 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 |
$2,787.97
|
| Rate for Payer: Cash Price |
$1,517.40
|
| Rate for Payer: Cash Price |
$1,517.40
|
| Rate for Payer: Cash Price |
$1,517.40
|
| Rate for Payer: Cash Price |
$1,517.40
|
| Rate for Payer: Cigna Commercial |
$4,839.49
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,943.76
|
| Rate for Payer: Health EOS Commercial |
$4,681.68
|
| Rate for Payer: HFN Commercial |
$4,839.49
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,945.24
|
| Rate for Payer: Multiplan Commercial |
$4,208.26
|
| Rate for Payer: NAPHCARE Commercial |
$3,156.19
|
| Rate for Payer: Preferred Network Access Commercial |
$4,839.49
|
| Rate for Payer: Quartz Beloit One Network |
$2,577.56
|
| Rate for Payer: Quartz Commercial |
$3,419.21
|
| Rate for Payer: Quartz Medicare Advantage |
$3,156.19
|
| Rate for Payer: The Alliance Commercial |
$486.72
|
| Rate for Payer: United Healthcare PPO |
$3,142.88
|
| Rate for Payer: WEA Trust Commercial |
$2,893.18
|
| Rate for Payer: WPS Commercial |
$851.76
|
|
|
MRI Spine Cervical w/o Contrast
|
Professional
|
Both
|
$5,058.00
|
|
|
Service Code
|
CPT 72141 TC
|
| Hospital Charge Code |
3072640
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$4,997.30 |
| Rate for Payer: Aetna Commercial |
$4,997.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,523.88
|
| Rate for Payer: Aetna Managed Medicare |
$121.68
|
| Rate for Payer: Anthem Medicare Advantage |
$121.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$121.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$121.68
|
| Rate for Payer: Cash Price |
$1,517.40
|
| Rate for Payer: Cash Price |
$1,517.40
|
| Rate for Payer: Cash Price |
$1,517.40
|
| Rate for Payer: Cigna Commercial |
$4,997.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,630.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$121.68
|
| Rate for Payer: Health EOS Commercial |
$4,786.89
|
| Rate for Payer: HFN Commercial |
$4,997.30
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$493.93
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$493.93
|
| Rate for Payer: Independent Care Health Plan Medicare |
$121.68
|
| Rate for Payer: Multiplan Commercial |
$4,208.26
|
| Rate for Payer: NAPHCARE Commercial |
$182.52
|
| Rate for Payer: Preferred Network Access Commercial |
$4,997.30
|
| Rate for Payer: Quartz Beloit One Network |
$2,314.54
|
| Rate for Payer: Quartz Commercial |
$2,998.38
|
| Rate for Payer: Quartz Medicare Advantage |
$121.68
|
| Rate for Payer: The Alliance Commercial |
$462.38
|
| Rate for Payer: United Healthcare Medicare Advantage |
$121.68
|
| Rate for Payer: WEA Trust Commercial |
$2,893.18
|
| Rate for Payer: WPS Commercial |
$608.40
|
|
|
MRI Spine Cervical w/ + w/o Contrast
|
Facility
|
OP
|
$6,351.00
|
|
|
Service Code
|
CPT 72156 TC
|
| Hospital Charge Code |
1611263
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$843.90 |
| Max. Negotiated Rate |
$6,076.64 |
| Rate for Payer: Aetna Commercial |
$5,944.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,680.33
|
| Rate for Payer: Aetna Managed Medicare |
$1,849.41
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,635.84
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,985.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,835.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,500.67
|
| Rate for Payer: Cash Price |
$1,905.30
|
| Rate for Payer: Cash Price |
$1,905.30
|
| Rate for Payer: Cash Price |
$1,905.30
|
| Rate for Payer: Cash Price |
$1,905.30
|
| Rate for Payer: Cigna Commercial |
$6,076.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,696.28
|
| Rate for Payer: Health EOS Commercial |
$5,878.49
|
| Rate for Payer: HFN Commercial |
$6,076.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,953.78
|
| Rate for Payer: Multiplan Commercial |
$5,284.03
|
| Rate for Payer: NAPHCARE Commercial |
$3,963.02
|
| Rate for Payer: Preferred Network Access Commercial |
$6,076.64
|
| Rate for Payer: Quartz Beloit One Network |
$3,236.47
|
| Rate for Payer: Quartz Commercial |
$4,293.28
|
| Rate for Payer: Quartz Medicare Advantage |
$3,963.02
|
| Rate for Payer: The Alliance Commercial |
$843.90
|
| Rate for Payer: United Healthcare PPO |
$3,142.88
|
| Rate for Payer: WEA Trust Commercial |
$3,632.77
|
| Rate for Payer: WPS Commercial |
$1,476.82
|
|
|
MRI Spine Cervical w/ + w/o Contrast
|
Professional
|
Both
|
$6,235.00
|
|
|
Service Code
|
CPT 72156
|
| Hospital Charge Code |
629594
|
| Min. Negotiated Rate |
$316.45 |
| Max. Negotiated Rate |
$6,160.18 |
| Rate for Payer: Aetna Commercial |
$6,160.18
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,576.58
|
| Rate for Payer: Aetna Managed Medicare |
$316.45
|
| Rate for Payer: Anthem Medicare Advantage |
$316.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$316.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$316.45
|
| Rate for Payer: Cash Price |
$1,870.50
|
| Rate for Payer: Cash Price |
$1,870.50
|
| Rate for Payer: Cash Price |
$1,870.50
|
| Rate for Payer: Cigna Commercial |
$6,160.18
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$3,242.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$316.45
|
| Rate for Payer: Health EOS Commercial |
$5,900.80
|
| Rate for Payer: HFN Commercial |
$6,160.18
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,272.08
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,272.08
|
| Rate for Payer: Independent Care Health Plan Medicare |
$316.45
|
| Rate for Payer: Multiplan Commercial |
$5,187.52
|
| Rate for Payer: NAPHCARE Commercial |
$474.68
|
| Rate for Payer: Preferred Network Access Commercial |
$6,160.18
|
| Rate for Payer: Quartz Beloit One Network |
$2,853.14
|
| Rate for Payer: Quartz Commercial |
$3,696.11
|
| Rate for Payer: Quartz Medicare Advantage |
$316.45
|
| Rate for Payer: The Alliance Commercial |
$1,202.51
|
| Rate for Payer: United Healthcare Medicare Advantage |
$316.45
|
| Rate for Payer: WEA Trust Commercial |
$3,566.42
|
| Rate for Payer: WPS Commercial |
$1,582.26
|
|
|
MRI Spine Cervical w/ + w/o Contrast
|
Facility
|
OP
|
$6,235.00
|
|
|
Service Code
|
CPT 72156
|
| Hospital Charge Code |
629594
|
| Min. Negotiated Rate |
$367.15 |
| Max. Negotiated Rate |
$5,965.65 |
| Rate for Payer: Aetna Commercial |
$5,835.96
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,576.58
|
| Rate for Payer: Aetna Managed Medicare |
$367.15
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,214.86
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,242.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,112.51
|
| Rate for Payer: Anthem Medicare Advantage |
$367.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,436.73
|
| 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 |
$1,870.50
|
| Rate for Payer: Cash Price |
$1,870.50
|
| Rate for Payer: Cigna Commercial |
$5,965.65
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$367.15
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,628.77
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$367.15
|
| Rate for Payer: Health EOS Commercial |
$5,771.12
|
| Rate for Payer: HFN Commercial |
$5,965.65
|
| 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 |
$5,187.52
|
| Rate for Payer: NAPHCARE Commercial |
$550.73
|
| Rate for Payer: Preferred Network Access Commercial |
$5,965.65
|
| Rate for Payer: Quartz Beloit One Network |
$3,177.36
|
| Rate for Payer: Quartz Commercial |
$4,214.86
|
| 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 |
$3,566.42
|
| Rate for Payer: Wellcare Medicare |
$367.15
|
| Rate for Payer: WPS Commercial |
$4,802.82
|
|
|
MRI Spine Cervical w/ + w/o Contrast
|
Facility
|
IP
|
$6,235.00
|
|
|
Service Code
|
CPT 72156
|
| Hospital Charge Code |
629594
|
| Min. Negotiated Rate |
$3,177.36 |
| Max. Negotiated Rate |
$5,965.65 |
| Rate for Payer: Aetna Commercial |
$5,835.96
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,576.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,436.73
|
| Rate for Payer: Cash Price |
$1,870.50
|
| Rate for Payer: Cigna Commercial |
$5,965.65
|
| Rate for Payer: Health EOS Commercial |
$5,771.12
|
| Rate for Payer: HFN Commercial |
$5,965.65
|
| Rate for Payer: Multiplan Commercial |
$5,187.52
|
| Rate for Payer: Preferred Network Access Commercial |
$5,965.65
|
| Rate for Payer: Quartz Beloit One Network |
$3,177.36
|
| Rate for Payer: Quartz Commercial |
$3,890.64
|
| Rate for Payer: WEA Trust Commercial |
$3,566.42
|
| Rate for Payer: WPS Commercial |
$4,802.82
|
|
|
MRI Spine Cervical w/ + w/o Contrast
|
Facility
|
IP
|
$6,351.00
|
|
|
Service Code
|
CPT 72156 TC
|
| Hospital Charge Code |
1611263
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$3,236.47 |
| Max. Negotiated Rate |
$6,076.64 |
| Rate for Payer: Aetna Commercial |
$5,944.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,680.33
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,500.67
|
| Rate for Payer: Cash Price |
$1,905.30
|
| Rate for Payer: Cigna Commercial |
$6,076.64
|
| Rate for Payer: Health EOS Commercial |
$5,878.49
|
| Rate for Payer: HFN Commercial |
$6,076.64
|
| Rate for Payer: Multiplan Commercial |
$5,284.03
|
| Rate for Payer: Preferred Network Access Commercial |
$6,076.64
|
| Rate for Payer: Quartz Beloit One Network |
$3,236.47
|
| Rate for Payer: Quartz Commercial |
$3,963.02
|
| Rate for Payer: WEA Trust Commercial |
$3,632.77
|
| Rate for Payer: WPS Commercial |
$4,892.18
|
|
|
MRI Spine Cervical w/ + w/o Contrast
|
Professional
|
Both
|
$6,351.00
|
|
|
Service Code
|
CPT 72156 TC
|
| Hospital Charge Code |
1611263
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$210.97 |
| Max. Negotiated Rate |
$6,274.79 |
| Rate for Payer: Aetna Commercial |
$6,274.79
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,680.33
|
| Rate for Payer: Aetna Managed Medicare |
$210.97
|
| Rate for Payer: Anthem Medicare Advantage |
$210.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$210.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$210.97
|
| Rate for Payer: Cash Price |
$1,905.30
|
| Rate for Payer: Cash Price |
$1,905.30
|
| Rate for Payer: Cash Price |
$1,905.30
|
| Rate for Payer: Cigna Commercial |
$6,274.79
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$3,302.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$210.97
|
| Rate for Payer: Health EOS Commercial |
$6,010.59
|
| Rate for Payer: HFN Commercial |
$6,274.79
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$874.41
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$874.41
|
| Rate for Payer: Independent Care Health Plan Medicare |
$210.97
|
| Rate for Payer: Multiplan Commercial |
$5,284.03
|
| Rate for Payer: NAPHCARE Commercial |
$316.46
|
| Rate for Payer: Preferred Network Access Commercial |
$6,274.79
|
| Rate for Payer: Quartz Beloit One Network |
$2,906.22
|
| Rate for Payer: Quartz Commercial |
$3,764.87
|
| Rate for Payer: Quartz Medicare Advantage |
$210.97
|
| Rate for Payer: The Alliance Commercial |
$801.70
|
| Rate for Payer: United Healthcare Medicare Advantage |
$210.97
|
| Rate for Payer: WEA Trust Commercial |
$3,632.77
|
| Rate for Payer: WPS Commercial |
$1,054.87
|
|
|
MRI Spine Lumbar, Plexis w/o Contrast
|
Facility
|
OP
|
$5,965.00
|
|
|
Service Code
|
CPT 72148 TC
|
| Hospital Charge Code |
1611308
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$489.38 |
| 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 |
$489.38
|
| Rate for Payer: United Healthcare PPO |
$3,142.88
|
| Rate for Payer: WEA Trust Commercial |
$3,411.98
|
| Rate for Payer: WPS Commercial |
$856.42
|
|
|
MRI Spine Lumbar, Plexis w/o Contrast
|
Facility
|
IP
|
$5,965.00
|
|
|
Service Code
|
CPT 72148 TC
|
| Hospital Charge Code |
1611308
|
|
Hospital Revenue Code
|
612
|
| 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 Spine Lumbar, Plexis w/o Contrast
|
Professional
|
Both
|
$5,965.00
|
|
|
Service Code
|
CPT 72148 TC
|
| Hospital Charge Code |
1611308
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$122.35 |
| 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 |
$122.35
|
| Rate for Payer: Anthem Medicare Advantage |
$122.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$122.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$122.35
|
| Rate for Payer: Cash Price |
$1,789.50
|
| 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 |
$122.35
|
| 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 |
$495.13
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$495.13
|
| Rate for Payer: Independent Care Health Plan Medicare |
$122.35
|
| Rate for Payer: Multiplan Commercial |
$4,962.88
|
| Rate for Payer: NAPHCARE Commercial |
$183.52
|
| 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 |
$122.35
|
| Rate for Payer: The Alliance Commercial |
$464.91
|
| Rate for Payer: United Healthcare Medicare Advantage |
$122.35
|
| Rate for Payer: WEA Trust Commercial |
$3,411.98
|
| Rate for Payer: WPS Commercial |
$611.73
|
|
|
MRI Spine Lumbar w/ Contrast
|
Facility
|
OP
|
$6,194.00
|
|
|
Service Code
|
CPT 72149 TC
|
| Hospital Charge Code |
1611295
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$744.06 |
| Max. Negotiated Rate |
$5,926.42 |
| Rate for Payer: Aetna Commercial |
$5,797.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,539.91
|
| Rate for Payer: Aetna Managed Medicare |
$1,803.69
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,635.84
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,985.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,835.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,414.13
|
| Rate for Payer: Cash Price |
$1,858.20
|
| Rate for Payer: Cash Price |
$1,858.20
|
| Rate for Payer: Cash Price |
$1,858.20
|
| Rate for Payer: Cash Price |
$1,858.20
|
| Rate for Payer: Cigna Commercial |
$5,926.42
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,604.91
|
| Rate for Payer: Health EOS Commercial |
$5,733.17
|
| Rate for Payer: HFN Commercial |
$5,926.42
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,831.32
|
| Rate for Payer: Multiplan Commercial |
$5,153.41
|
| Rate for Payer: NAPHCARE Commercial |
$3,865.06
|
| Rate for Payer: Preferred Network Access Commercial |
$5,926.42
|
| Rate for Payer: Quartz Beloit One Network |
$3,156.46
|
| Rate for Payer: Quartz Commercial |
$4,187.14
|
| Rate for Payer: Quartz Medicare Advantage |
$3,865.06
|
| Rate for Payer: The Alliance Commercial |
$744.06
|
| Rate for Payer: United Healthcare PPO |
$3,142.88
|
| Rate for Payer: WEA Trust Commercial |
$3,542.97
|
| Rate for Payer: WPS Commercial |
$1,302.10
|
|
|
MRI Spine Lumbar w/ Contrast
|
Facility
|
IP
|
$6,194.00
|
|
|
Service Code
|
CPT 72149 TC
|
| Hospital Charge Code |
1611295
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$3,156.46 |
| Max. Negotiated Rate |
$5,926.42 |
| Rate for Payer: Aetna Commercial |
$5,797.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,539.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,414.13
|
| Rate for Payer: Cash Price |
$1,858.20
|
| Rate for Payer: Cigna Commercial |
$5,926.42
|
| Rate for Payer: Health EOS Commercial |
$5,733.17
|
| Rate for Payer: HFN Commercial |
$5,926.42
|
| Rate for Payer: Multiplan Commercial |
$5,153.41
|
| Rate for Payer: Preferred Network Access Commercial |
$5,926.42
|
| Rate for Payer: Quartz Beloit One Network |
$3,156.46
|
| Rate for Payer: Quartz Commercial |
$3,865.06
|
| Rate for Payer: WEA Trust Commercial |
$3,542.97
|
| Rate for Payer: WPS Commercial |
$4,771.24
|
|
|
MRI Spine Lumbar w/ Contrast
|
Professional
|
Both
|
$6,194.00
|
|
|
Service Code
|
CPT 72149 TC
|
| Hospital Charge Code |
1611295
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$186.01 |
| Max. Negotiated Rate |
$6,119.67 |
| Rate for Payer: Aetna Commercial |
$6,119.67
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,539.91
|
| Rate for Payer: Aetna Managed Medicare |
$186.01
|
| Rate for Payer: Anthem Medicare Advantage |
$186.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$186.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$186.01
|
| Rate for Payer: Cash Price |
$1,858.20
|
| Rate for Payer: Cash Price |
$1,858.20
|
| Rate for Payer: Cash Price |
$1,858.20
|
| Rate for Payer: Cigna Commercial |
$6,119.67
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$3,220.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$186.01
|
| Rate for Payer: Health EOS Commercial |
$5,862.00
|
| Rate for Payer: HFN Commercial |
$6,119.67
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$764.60
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$764.60
|
| Rate for Payer: Independent Care Health Plan Medicare |
$186.01
|
| Rate for Payer: Multiplan Commercial |
$5,153.41
|
| Rate for Payer: NAPHCARE Commercial |
$279.02
|
| Rate for Payer: Preferred Network Access Commercial |
$6,119.67
|
| Rate for Payer: Quartz Beloit One Network |
$2,834.37
|
| Rate for Payer: Quartz Commercial |
$3,671.80
|
| Rate for Payer: Quartz Medicare Advantage |
$186.01
|
| Rate for Payer: The Alliance Commercial |
$706.85
|
| Rate for Payer: United Healthcare Medicare Advantage |
$186.01
|
| Rate for Payer: WEA Trust Commercial |
$3,542.97
|
| Rate for Payer: WPS Commercial |
$930.07
|
|
|
MRI Spine Lumbar w/ Contrast
|
Facility
|
IP
|
$6,080.00
|
|
|
Service Code
|
CPT 72149
|
| Hospital Charge Code |
631283
|
| 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 Spine Lumbar w/ Contrast
|
Facility
|
OP
|
$6,080.00
|
|
|
Service Code
|
CPT 72149
|
| Hospital Charge Code |
631283
|
| 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 Spine Lumbar w/ Contrast
|
Professional
|
Both
|
$6,080.00
|
|
|
Service Code
|
CPT 72149
|
| Hospital Charge Code |
631283
|
| Min. Negotiated Rate |
$268.38 |
| 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 |
$268.38
|
| Rate for Payer: Anthem Medicare Advantage |
$268.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$268.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$268.38
|
| 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 |
$268.38
|
| 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 |
$1,074.46
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,074.46
|
| Rate for Payer: Independent Care Health Plan Medicare |
$268.38
|
| Rate for Payer: Multiplan Commercial |
$5,058.56
|
| Rate for Payer: NAPHCARE Commercial |
$402.57
|
| 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 |
$268.38
|
| Rate for Payer: The Alliance Commercial |
$1,019.85
|
| Rate for Payer: United Healthcare Medicare Advantage |
$268.38
|
| Rate for Payer: WEA Trust Commercial |
$3,477.76
|
| Rate for Payer: WPS Commercial |
$1,341.91
|
|
|
MRI Spine Lumbar w/o Contrast
|
Facility
|
OP
|
$5,013.00
|
|
|
Service Code
|
CPT 72148 TC
|
| Hospital Charge Code |
1611297
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$489.38 |
| Max. Negotiated Rate |
$4,796.44 |
| Rate for Payer: Aetna Commercial |
$4,692.17
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,483.63
|
| Rate for Payer: Aetna Managed Medicare |
$1,459.79
|
| 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 |
$2,763.17
|
| Rate for Payer: Cash Price |
$1,503.90
|
| Rate for Payer: Cash Price |
$1,503.90
|
| Rate for Payer: Cash Price |
$1,503.90
|
| Rate for Payer: Cash Price |
$1,503.90
|
| Rate for Payer: Cigna Commercial |
$4,796.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,917.57
|
| Rate for Payer: Health EOS Commercial |
$4,640.03
|
| Rate for Payer: HFN Commercial |
$4,796.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,910.14
|
| Rate for Payer: Multiplan Commercial |
$4,170.82
|
| Rate for Payer: NAPHCARE Commercial |
$3,128.11
|
| Rate for Payer: Preferred Network Access Commercial |
$4,796.44
|
| Rate for Payer: Quartz Beloit One Network |
$2,554.62
|
| Rate for Payer: Quartz Commercial |
$3,388.79
|
| Rate for Payer: Quartz Medicare Advantage |
$3,128.11
|
| Rate for Payer: The Alliance Commercial |
$489.38
|
| Rate for Payer: United Healthcare PPO |
$3,142.88
|
| Rate for Payer: WEA Trust Commercial |
$2,867.44
|
| Rate for Payer: WPS Commercial |
$856.42
|
|
|
MRI Spine Lumbar w/o Contrast
|
Facility
|
IP
|
$5,013.00
|
|
|
Service Code
|
CPT 72148 TC
|
| Hospital Charge Code |
1611297
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$2,554.62 |
| Max. Negotiated Rate |
$4,796.44 |
| Rate for Payer: Aetna Commercial |
$4,692.17
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,483.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,763.17
|
| Rate for Payer: Cash Price |
$1,503.90
|
| Rate for Payer: Cigna Commercial |
$4,796.44
|
| Rate for Payer: Health EOS Commercial |
$4,640.03
|
| Rate for Payer: HFN Commercial |
$4,796.44
|
| Rate for Payer: Multiplan Commercial |
$4,170.82
|
| Rate for Payer: Preferred Network Access Commercial |
$4,796.44
|
| Rate for Payer: Quartz Beloit One Network |
$2,554.62
|
| Rate for Payer: Quartz Commercial |
$3,128.11
|
| Rate for Payer: WEA Trust Commercial |
$2,867.44
|
| Rate for Payer: WPS Commercial |
$3,861.51
|
|
