|
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 |
$1,862.81 |
| Max. Negotiated Rate |
$6,120.65 |
| Rate for Payer: Aetna Commercial |
$5,987.59
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,721.48
|
| Rate for Payer: Aetna Managed Medicare |
$1,862.81
|
| 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 |
$3,526.03
|
| 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 |
$6,120.65
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,723.05
|
| Rate for Payer: Health EOS Commercial |
$5,921.06
|
| Rate for Payer: HFN Commercial |
$6,120.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,989.66
|
| Rate for Payer: Multiplan Commercial |
$5,322.30
|
| Rate for Payer: NAPHCARE Commercial |
$3,991.73
|
| Rate for Payer: Preferred Network Access Commercial |
$6,120.65
|
| Rate for Payer: Quartz Beloit One Network |
$3,259.91
|
| Rate for Payer: Quartz Commercial |
$4,324.37
|
| Rate for Payer: Quartz Medicare Advantage |
$3,991.73
|
| Rate for Payer: The Alliance Commercial |
$3,326.44
|
| Rate for Payer: United Healthcare PPO |
$3,142.88
|
| Rate for Payer: WEA Trust Commercial |
$3,659.08
|
| Rate for Payer: WPS Commercial |
$4,927.61
|
|
|
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 |
$2,411.43 |
| Max. Negotiated Rate |
$4,527.58 |
| Rate for Payer: Aetna Commercial |
$4,429.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,232.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,608.28
|
| Rate for Payer: Cash Price |
$1,419.60
|
| Rate for Payer: Cigna Commercial |
$4,527.58
|
| Rate for Payer: Health EOS Commercial |
$4,379.94
|
| Rate for Payer: HFN Commercial |
$4,527.58
|
| Rate for Payer: Multiplan Commercial |
$3,937.02
|
| Rate for Payer: Preferred Network Access Commercial |
$4,527.58
|
| Rate for Payer: Quartz Beloit One Network |
$2,411.43
|
| Rate for Payer: Quartz Commercial |
$2,952.77
|
| Rate for Payer: WEA Trust Commercial |
$2,706.70
|
| Rate for Payer: WPS Commercial |
$3,645.06
|
|
|
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 |
$1,377.96 |
| Max. Negotiated Rate |
$4,527.58 |
| Rate for Payer: Aetna Commercial |
$4,429.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,232.30
|
| Rate for Payer: Aetna Managed Medicare |
$1,377.96
|
| 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 |
$2,608.28
|
| 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 |
$4,527.58
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,754.02
|
| Rate for Payer: Health EOS Commercial |
$4,379.94
|
| Rate for Payer: HFN Commercial |
$4,527.58
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,690.96
|
| Rate for Payer: Multiplan Commercial |
$3,937.02
|
| Rate for Payer: NAPHCARE Commercial |
$2,952.77
|
| Rate for Payer: Preferred Network Access Commercial |
$4,527.58
|
| Rate for Payer: Quartz Beloit One Network |
$2,411.43
|
| Rate for Payer: Quartz Commercial |
$3,198.83
|
| Rate for Payer: Quartz Medicare Advantage |
$2,952.77
|
| Rate for Payer: The Alliance Commercial |
$2,460.64
|
| Rate for Payer: United Healthcare PPO |
$3,142.88
|
| Rate for Payer: WEA Trust Commercial |
$2,706.70
|
| Rate for Payer: WPS Commercial |
$3,645.06
|
|
|
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 |
$792.57 |
| Max. Negotiated Rate |
$4,675.22 |
| Rate for Payer: Aetna Commercial |
$4,675.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,232.30
|
| 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 |
$4,675.22
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,460.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,952.77
|
| Rate for Payer: Health EOS Commercial |
$4,478.36
|
| Rate for Payer: HFN Commercial |
$4,675.22
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$792.57
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$792.57
|
| Rate for Payer: Multiplan Commercial |
$3,937.02
|
| Rate for Payer: Preferred Network Access Commercial |
$4,675.22
|
| Rate for Payer: Quartz Beloit One Network |
$2,165.36
|
| Rate for Payer: Quartz Commercial |
$2,805.13
|
| Rate for Payer: The Alliance Commercial |
$2,460.64
|
| Rate for Payer: WEA Trust Commercial |
$2,706.70
|
| Rate for Payer: WPS Commercial |
$3,645.06
|
|
|
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 |
$2,411.43 |
| Max. Negotiated Rate |
$4,527.58 |
| Rate for Payer: Aetna Commercial |
$4,429.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,232.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,608.28
|
| Rate for Payer: Cash Price |
$1,419.60
|
| Rate for Payer: Cigna Commercial |
$4,527.58
|
| Rate for Payer: Health EOS Commercial |
$4,379.94
|
| Rate for Payer: HFN Commercial |
$4,527.58
|
| Rate for Payer: Multiplan Commercial |
$3,937.02
|
| Rate for Payer: Preferred Network Access Commercial |
$4,527.58
|
| Rate for Payer: Quartz Beloit One Network |
$2,411.43
|
| Rate for Payer: Quartz Commercial |
$2,952.77
|
| Rate for Payer: WEA Trust Commercial |
$2,706.70
|
| Rate for Payer: WPS Commercial |
$3,645.06
|
|
|
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 |
$1,377.96 |
| Max. Negotiated Rate |
$4,527.58 |
| Rate for Payer: Aetna Commercial |
$4,429.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,232.30
|
| Rate for Payer: Aetna Managed Medicare |
$1,377.96
|
| 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 |
$2,608.28
|
| 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 |
$4,527.58
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,754.02
|
| Rate for Payer: Health EOS Commercial |
$4,379.94
|
| Rate for Payer: HFN Commercial |
$4,527.58
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,690.96
|
| Rate for Payer: Multiplan Commercial |
$3,937.02
|
| Rate for Payer: NAPHCARE Commercial |
$2,952.77
|
| Rate for Payer: Preferred Network Access Commercial |
$4,527.58
|
| Rate for Payer: Quartz Beloit One Network |
$2,411.43
|
| Rate for Payer: Quartz Commercial |
$3,198.83
|
| Rate for Payer: Quartz Medicare Advantage |
$2,952.77
|
| Rate for Payer: The Alliance Commercial |
$2,460.64
|
| Rate for Payer: United Healthcare PPO |
$3,142.88
|
| Rate for Payer: WEA Trust Commercial |
$2,706.70
|
| Rate for Payer: WPS Commercial |
$3,645.06
|
|
|
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 |
$792.57 |
| Max. Negotiated Rate |
$4,675.22 |
| Rate for Payer: Aetna Commercial |
$4,675.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,232.30
|
| 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 |
$4,675.22
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,460.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,952.77
|
| Rate for Payer: Health EOS Commercial |
$4,478.36
|
| Rate for Payer: HFN Commercial |
$4,675.22
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$792.57
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$792.57
|
| Rate for Payer: Multiplan Commercial |
$3,937.02
|
| Rate for Payer: Preferred Network Access Commercial |
$4,675.22
|
| Rate for Payer: Quartz Beloit One Network |
$2,165.36
|
| Rate for Payer: Quartz Commercial |
$2,805.13
|
| Rate for Payer: The Alliance Commercial |
$2,460.64
|
| Rate for Payer: WEA Trust Commercial |
$2,706.70
|
| Rate for Payer: WPS Commercial |
$3,645.06
|
|
|
MRSA, PCR
|
Facility
|
OP
|
$168.00
|
|
|
Service Code
|
CPT 87641
|
| Hospital Charge Code |
4291332
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$36.49 |
| Max. Negotiated Rate |
$160.74 |
| Rate for Payer: Aetna Commercial |
$157.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$150.26
|
| Rate for Payer: Aetna Managed Medicare |
$36.49
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$136.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$63.86
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$60.58
|
| Rate for Payer: Anthem Medicare Advantage |
$36.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$92.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$36.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$36.49
|
| Rate for Payer: Cash Price |
$50.40
|
| Rate for Payer: Cash Price |
$50.40
|
| Rate for Payer: Cigna Commercial |
$160.74
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$36.49
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$97.78
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$36.49
|
| Rate for Payer: Health EOS Commercial |
$155.50
|
| Rate for Payer: HFN Commercial |
$160.74
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$135.76
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$36.49
|
| Rate for Payer: Independent Care Health Plan Medicare |
$36.49
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$36.49
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$36.49
|
| Rate for Payer: Multiplan Commercial |
$139.78
|
| Rate for Payer: NAPHCARE Commercial |
$54.74
|
| Rate for Payer: Preferred Network Access Commercial |
$160.74
|
| Rate for Payer: Quartz Beloit One Network |
$85.61
|
| Rate for Payer: Quartz Commercial |
$113.57
|
| Rate for Payer: Quartz Medicare Advantage |
$36.49
|
| Rate for Payer: The Alliance Commercial |
$145.97
|
| Rate for Payer: United Healthcare Medicare Advantage |
$36.49
|
| Rate for Payer: United Healthcare PPO |
$131.04
|
| Rate for Payer: WEA Trust Commercial |
$96.10
|
| Rate for Payer: Wellcare Medicare |
$36.49
|
| Rate for Payer: WPS Commercial |
$129.41
|
|
|
MRSA, PCR
|
Professional
|
Both
|
$168.00
|
|
|
Service Code
|
CPT 87641
|
| Hospital Charge Code |
4291332
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$36.49 |
| Max. Negotiated Rate |
$165.98 |
| Rate for Payer: Aetna Commercial |
$165.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$150.26
|
| Rate for Payer: Aetna Managed Medicare |
$36.49
|
| Rate for Payer: Anthem Medicare Advantage |
$36.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$36.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$36.49
|
| Rate for Payer: Cash Price |
$50.40
|
| Rate for Payer: Cash Price |
$50.40
|
| Rate for Payer: Cigna Commercial |
$165.98
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$87.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$36.49
|
| Rate for Payer: Health EOS Commercial |
$159.00
|
| Rate for Payer: HFN Commercial |
$165.98
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$128.82
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$128.82
|
| Rate for Payer: Independent Care Health Plan Medicare |
$36.49
|
| Rate for Payer: Multiplan Commercial |
$139.78
|
| Rate for Payer: NAPHCARE Commercial |
$54.74
|
| Rate for Payer: Preferred Network Access Commercial |
$165.98
|
| Rate for Payer: Quartz Beloit One Network |
$76.88
|
| Rate for Payer: Quartz Commercial |
$99.59
|
| Rate for Payer: Quartz Medicare Advantage |
$36.49
|
| Rate for Payer: The Alliance Commercial |
$144.15
|
| Rate for Payer: United Healthcare Medicare Advantage |
$36.49
|
| Rate for Payer: WEA Trust Commercial |
$96.10
|
| Rate for Payer: WPS Commercial |
$160.57
|
|
|
MRSA, PCR
|
Facility
|
IP
|
$168.00
|
|
|
Service Code
|
CPT 87641
|
| Hospital Charge Code |
4291332
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$85.61 |
| Max. Negotiated Rate |
$160.74 |
| Rate for Payer: Aetna Commercial |
$157.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$150.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$92.60
|
| Rate for Payer: Cash Price |
$50.40
|
| Rate for Payer: Cigna Commercial |
$160.74
|
| Rate for Payer: Health EOS Commercial |
$155.50
|
| Rate for Payer: HFN Commercial |
$160.74
|
| Rate for Payer: Multiplan Commercial |
$139.78
|
| Rate for Payer: Preferred Network Access Commercial |
$160.74
|
| Rate for Payer: Quartz Beloit One Network |
$85.61
|
| Rate for Payer: Quartz Commercial |
$104.83
|
| Rate for Payer: WEA Trust Commercial |
$96.10
|
| Rate for Payer: WPS Commercial |
$129.41
|
|
|
MRSA, PCR - Nares
|
Facility
|
IP
|
$136.00
|
|
|
Service Code
|
CPT 87641
|
| Hospital Charge Code |
4109348
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$69.31 |
| Max. Negotiated Rate |
$130.12 |
| Rate for Payer: Aetna Commercial |
$127.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$121.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$74.96
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cigna Commercial |
$130.12
|
| Rate for Payer: Health EOS Commercial |
$125.88
|
| Rate for Payer: HFN Commercial |
$130.12
|
| Rate for Payer: Multiplan Commercial |
$113.15
|
| Rate for Payer: Preferred Network Access Commercial |
$130.12
|
| Rate for Payer: Quartz Beloit One Network |
$69.31
|
| Rate for Payer: Quartz Commercial |
$84.86
|
| Rate for Payer: WEA Trust Commercial |
$77.79
|
| Rate for Payer: WPS Commercial |
$104.76
|
|
|
MRSA, PCR - Nares
|
Professional
|
Both
|
$136.00
|
|
|
Service Code
|
CPT 87641
|
| Hospital Charge Code |
4109348
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$36.49 |
| Max. Negotiated Rate |
$160.57 |
| Rate for Payer: Aetna Commercial |
$134.37
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$121.64
|
| Rate for Payer: Aetna Managed Medicare |
$36.49
|
| Rate for Payer: Anthem Medicare Advantage |
$36.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$36.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$36.49
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cigna Commercial |
$134.37
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$70.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$36.49
|
| Rate for Payer: Health EOS Commercial |
$128.71
|
| Rate for Payer: HFN Commercial |
$134.37
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$128.82
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$128.82
|
| Rate for Payer: Independent Care Health Plan Medicare |
$36.49
|
| Rate for Payer: Multiplan Commercial |
$113.15
|
| Rate for Payer: NAPHCARE Commercial |
$54.74
|
| Rate for Payer: Preferred Network Access Commercial |
$134.37
|
| Rate for Payer: Quartz Beloit One Network |
$62.23
|
| Rate for Payer: Quartz Commercial |
$80.62
|
| Rate for Payer: Quartz Medicare Advantage |
$36.49
|
| Rate for Payer: The Alliance Commercial |
$144.15
|
| Rate for Payer: United Healthcare Medicare Advantage |
$36.49
|
| Rate for Payer: WEA Trust Commercial |
$77.79
|
| Rate for Payer: WPS Commercial |
$160.57
|
|
|
MRSA, PCR - Nares
|
Facility
|
OP
|
$136.00
|
|
|
Service Code
|
CPT 87641
|
| Hospital Charge Code |
4109348
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$36.49 |
| Max. Negotiated Rate |
$145.97 |
| Rate for Payer: Aetna Commercial |
$127.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$121.64
|
| Rate for Payer: Aetna Managed Medicare |
$36.49
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$136.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$63.86
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$60.58
|
| Rate for Payer: Anthem Medicare Advantage |
$36.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$74.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$36.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$36.49
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cigna Commercial |
$130.12
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$36.49
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$79.15
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$36.49
|
| Rate for Payer: Health EOS Commercial |
$125.88
|
| Rate for Payer: HFN Commercial |
$130.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$135.76
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$36.49
|
| Rate for Payer: Independent Care Health Plan Medicare |
$36.49
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$36.49
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$36.49
|
| Rate for Payer: Multiplan Commercial |
$113.15
|
| Rate for Payer: NAPHCARE Commercial |
$54.74
|
| Rate for Payer: Preferred Network Access Commercial |
$130.12
|
| Rate for Payer: Quartz Beloit One Network |
$69.31
|
| Rate for Payer: Quartz Commercial |
$91.94
|
| Rate for Payer: Quartz Medicare Advantage |
$36.49
|
| Rate for Payer: The Alliance Commercial |
$145.97
|
| Rate for Payer: United Healthcare Medicare Advantage |
$36.49
|
| Rate for Payer: United Healthcare PPO |
$106.08
|
| Rate for Payer: WEA Trust Commercial |
$77.79
|
| Rate for Payer: Wellcare Medicare |
$36.49
|
| Rate for Payer: WPS Commercial |
$104.76
|
|
|
MRSA-SA, PCR - SSTI
|
Professional
|
Both
|
$304.00
|
|
|
Service Code
|
CPT 87640
|
| Hospital Charge Code |
4109349
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$36.49 |
| Max. Negotiated Rate |
$300.35 |
| Rate for Payer: Aetna Commercial |
$300.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$271.90
|
| Rate for Payer: Aetna Managed Medicare |
$36.49
|
| Rate for Payer: Anthem Medicare Advantage |
$36.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$36.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$36.49
|
| Rate for Payer: Cash Price |
$91.20
|
| Rate for Payer: Cash Price |
$91.20
|
| Rate for Payer: Cigna Commercial |
$300.35
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$158.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$36.49
|
| Rate for Payer: Health EOS Commercial |
$287.71
|
| Rate for Payer: HFN Commercial |
$300.35
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$128.82
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$128.82
|
| Rate for Payer: Independent Care Health Plan Medicare |
$36.49
|
| Rate for Payer: Multiplan Commercial |
$252.93
|
| Rate for Payer: NAPHCARE Commercial |
$54.74
|
| Rate for Payer: Preferred Network Access Commercial |
$300.35
|
| Rate for Payer: Quartz Beloit One Network |
$139.11
|
| Rate for Payer: Quartz Commercial |
$180.21
|
| Rate for Payer: Quartz Medicare Advantage |
$36.49
|
| Rate for Payer: The Alliance Commercial |
$144.15
|
| Rate for Payer: United Healthcare Medicare Advantage |
$36.49
|
| Rate for Payer: WEA Trust Commercial |
$173.89
|
| Rate for Payer: WPS Commercial |
$160.57
|
|
|
MRSA-SA, PCR - SSTI
|
Facility
|
OP
|
$304.00
|
|
|
Service Code
|
CPT 87640
|
| Hospital Charge Code |
4109349
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$36.49 |
| Max. Negotiated Rate |
$290.87 |
| Rate for Payer: Aetna Commercial |
$284.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$271.90
|
| Rate for Payer: Aetna Managed Medicare |
$36.49
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$136.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$63.86
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$60.58
|
| Rate for Payer: Anthem Medicare Advantage |
$36.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$167.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$36.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$36.49
|
| Rate for Payer: Cash Price |
$91.20
|
| Rate for Payer: Cash Price |
$91.20
|
| Rate for Payer: Cigna Commercial |
$290.87
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$36.49
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$176.93
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$36.49
|
| Rate for Payer: Health EOS Commercial |
$281.38
|
| Rate for Payer: HFN Commercial |
$290.87
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$135.76
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$36.49
|
| Rate for Payer: Independent Care Health Plan Medicare |
$36.49
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$36.49
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$36.49
|
| Rate for Payer: Multiplan Commercial |
$252.93
|
| Rate for Payer: NAPHCARE Commercial |
$54.74
|
| Rate for Payer: Preferred Network Access Commercial |
$290.87
|
| Rate for Payer: Quartz Beloit One Network |
$154.92
|
| Rate for Payer: Quartz Commercial |
$205.50
|
| Rate for Payer: Quartz Medicare Advantage |
$36.49
|
| Rate for Payer: The Alliance Commercial |
$145.97
|
| Rate for Payer: United Healthcare Medicare Advantage |
$36.49
|
| Rate for Payer: United Healthcare PPO |
$237.12
|
| Rate for Payer: WEA Trust Commercial |
$173.89
|
| Rate for Payer: Wellcare Medicare |
$36.49
|
| Rate for Payer: WPS Commercial |
$234.17
|
|
|
MRSA-SA, PCR - SSTI
|
Facility
|
IP
|
$304.00
|
|
|
Service Code
|
CPT 87640
|
| Hospital Charge Code |
4109349
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$154.92 |
| Max. Negotiated Rate |
$290.87 |
| Rate for Payer: Aetna Commercial |
$284.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$271.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$167.56
|
| Rate for Payer: Cash Price |
$91.20
|
| Rate for Payer: Cigna Commercial |
$290.87
|
| Rate for Payer: Health EOS Commercial |
$281.38
|
| Rate for Payer: HFN Commercial |
$290.87
|
| Rate for Payer: Multiplan Commercial |
$252.93
|
| Rate for Payer: Preferred Network Access Commercial |
$290.87
|
| Rate for Payer: Quartz Beloit One Network |
$154.92
|
| Rate for Payer: Quartz Commercial |
$189.70
|
| Rate for Payer: WEA Trust Commercial |
$173.89
|
| Rate for Payer: WPS Commercial |
$234.17
|
|
|
MRV Head Venous Angiogram w/o
|
Facility
|
OP
|
$5,965.00
|
|
|
Service Code
|
CPT 70544 TC
|
| Hospital Charge Code |
1611408
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$633.57 |
| 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 |
$633.57
|
| Rate for Payer: United Healthcare PPO |
$3,142.88
|
| Rate for Payer: WEA Trust Commercial |
$3,411.98
|
| Rate for Payer: WPS Commercial |
$1,108.74
|
|
|
MRV Head Venous Angiogram w/o
|
Facility
|
IP
|
$5,965.00
|
|
|
Service Code
|
CPT 70544 TC
|
| Hospital Charge Code |
1611408
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$3,039.76 |
| Max. Negotiated Rate |
$5,707.31 |
| Rate for Payer: Aetna Commercial |
$5,583.24
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,335.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,287.91
|
| Rate for Payer: Cash Price |
$1,789.50
|
| Rate for Payer: Cigna Commercial |
$5,707.31
|
| Rate for Payer: Health EOS Commercial |
$5,521.20
|
| Rate for Payer: HFN Commercial |
$5,707.31
|
| Rate for Payer: Multiplan Commercial |
$4,962.88
|
| Rate for Payer: Preferred Network Access Commercial |
$5,707.31
|
| Rate for Payer: Quartz Beloit One Network |
$3,039.76
|
| Rate for Payer: Quartz Commercial |
$3,722.16
|
| Rate for Payer: WEA Trust Commercial |
$3,411.98
|
| Rate for Payer: WPS Commercial |
$4,594.84
|
|
|
MRV Head Venous Angiogram w/o Contrast
|
Professional
|
Both
|
$4,293.00
|
|
|
Service Code
|
CPT 70544 TC
|
| Hospital Charge Code |
5288678
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$158.39 |
| Max. Negotiated Rate |
$4,241.48 |
| Rate for Payer: Aetna Commercial |
$4,241.48
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,839.66
|
| Rate for Payer: Aetna Managed Medicare |
$158.39
|
| Rate for Payer: Anthem Medicare Advantage |
$158.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$158.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$158.39
|
| Rate for Payer: Cash Price |
$1,287.90
|
| Rate for Payer: Cash Price |
$1,287.90
|
| Rate for Payer: Cash Price |
$1,287.90
|
| Rate for Payer: Cigna Commercial |
$4,241.48
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,232.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$158.39
|
| Rate for Payer: Health EOS Commercial |
$4,062.90
|
| Rate for Payer: HFN Commercial |
$4,241.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$637.90
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$637.90
|
| Rate for Payer: Independent Care Health Plan Medicare |
$158.39
|
| Rate for Payer: Multiplan Commercial |
$3,571.78
|
| Rate for Payer: NAPHCARE Commercial |
$237.59
|
| Rate for Payer: Preferred Network Access Commercial |
$4,241.48
|
| Rate for Payer: Quartz Beloit One Network |
$1,964.48
|
| Rate for Payer: Quartz Commercial |
$2,544.89
|
| Rate for Payer: Quartz Medicare Advantage |
$158.39
|
| Rate for Payer: The Alliance Commercial |
$601.89
|
| Rate for Payer: United Healthcare Medicare Advantage |
$158.39
|
| Rate for Payer: WEA Trust Commercial |
$2,455.60
|
| Rate for Payer: WPS Commercial |
$791.96
|
|
|
MRV Head Venous Angiogram w/o Contrast
|
Facility
|
IP
|
$4,293.00
|
|
|
Service Code
|
CPT 70544 TC
|
| Hospital Charge Code |
5288678
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$2,187.71 |
| Max. Negotiated Rate |
$4,107.54 |
| Rate for Payer: Aetna Commercial |
$4,018.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,839.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,366.30
|
| Rate for Payer: Cash Price |
$1,287.90
|
| Rate for Payer: Cigna Commercial |
$4,107.54
|
| Rate for Payer: Health EOS Commercial |
$3,973.60
|
| Rate for Payer: HFN Commercial |
$4,107.54
|
| Rate for Payer: Multiplan Commercial |
$3,571.78
|
| Rate for Payer: Preferred Network Access Commercial |
$4,107.54
|
| Rate for Payer: Quartz Beloit One Network |
$2,187.71
|
| Rate for Payer: Quartz Commercial |
$2,678.83
|
| Rate for Payer: WEA Trust Commercial |
$2,455.60
|
| Rate for Payer: WPS Commercial |
$3,306.90
|
|
|
MRV Head Venous Angiogram w/o Contrast
|
Facility
|
OP
|
$4,293.00
|
|
|
Service Code
|
CPT 70544 TC
|
| Hospital Charge Code |
5288678
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$633.57 |
| Max. Negotiated Rate |
$4,107.54 |
| Rate for Payer: Aetna Commercial |
$4,018.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,839.66
|
| Rate for Payer: Aetna Managed Medicare |
$1,250.12
|
| 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 |
$2,366.30
|
| Rate for Payer: Cash Price |
$1,287.90
|
| Rate for Payer: Cash Price |
$1,287.90
|
| Rate for Payer: Cash Price |
$1,287.90
|
| Rate for Payer: Cash Price |
$1,287.90
|
| Rate for Payer: Cigna Commercial |
$4,107.54
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,498.53
|
| Rate for Payer: Health EOS Commercial |
$3,973.60
|
| Rate for Payer: HFN Commercial |
$4,107.54
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,348.54
|
| Rate for Payer: Multiplan Commercial |
$3,571.78
|
| Rate for Payer: NAPHCARE Commercial |
$2,678.83
|
| Rate for Payer: Preferred Network Access Commercial |
$4,107.54
|
| Rate for Payer: Quartz Beloit One Network |
$2,187.71
|
| Rate for Payer: Quartz Commercial |
$2,902.07
|
| Rate for Payer: Quartz Medicare Advantage |
$2,678.83
|
| Rate for Payer: The Alliance Commercial |
$633.57
|
| Rate for Payer: United Healthcare PPO |
$3,142.88
|
| Rate for Payer: WEA Trust Commercial |
$2,455.60
|
| Rate for Payer: WPS Commercial |
$1,108.74
|
|
|
MRV Head Venous Angiogram w+ w/o
|
Facility
|
OP
|
$6,121.00
|
|
|
Service Code
|
CPT 70546 TC
|
| Hospital Charge Code |
1611405
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,032.01 |
| Max. Negotiated Rate |
$5,856.57 |
| Rate for Payer: Aetna Commercial |
$5,729.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,474.62
|
| Rate for Payer: Aetna Managed Medicare |
$1,782.44
|
| 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 |
$3,373.90
|
| Rate for Payer: Cash Price |
$1,836.30
|
| Rate for Payer: Cash Price |
$1,836.30
|
| Rate for Payer: Cash Price |
$1,836.30
|
| Rate for Payer: Cash Price |
$1,836.30
|
| Rate for Payer: Cigna Commercial |
$5,856.57
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,562.42
|
| Rate for Payer: Health EOS Commercial |
$5,665.60
|
| Rate for Payer: HFN Commercial |
$5,856.57
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,774.38
|
| Rate for Payer: Multiplan Commercial |
$5,092.67
|
| Rate for Payer: NAPHCARE Commercial |
$3,819.50
|
| Rate for Payer: Preferred Network Access Commercial |
$5,856.57
|
| Rate for Payer: Quartz Beloit One Network |
$3,119.26
|
| Rate for Payer: Quartz Commercial |
$4,137.80
|
| Rate for Payer: Quartz Medicare Advantage |
$3,819.50
|
| Rate for Payer: The Alliance Commercial |
$1,032.01
|
| Rate for Payer: United Healthcare PPO |
$3,142.88
|
| Rate for Payer: WEA Trust Commercial |
$3,501.21
|
| Rate for Payer: WPS Commercial |
$1,806.02
|
|
|
MRV Head Venous Angiogram w+ w/o
|
Facility
|
IP
|
$6,121.00
|
|
|
Service Code
|
CPT 70546 TC
|
| Hospital Charge Code |
1611405
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$3,119.26 |
| Max. Negotiated Rate |
$5,856.57 |
| Rate for Payer: Aetna Commercial |
$5,729.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,474.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,373.90
|
| Rate for Payer: Cash Price |
$1,836.30
|
| Rate for Payer: Cigna Commercial |
$5,856.57
|
| Rate for Payer: Health EOS Commercial |
$5,665.60
|
| Rate for Payer: HFN Commercial |
$5,856.57
|
| Rate for Payer: Multiplan Commercial |
$5,092.67
|
| Rate for Payer: Preferred Network Access Commercial |
$5,856.57
|
| Rate for Payer: Quartz Beloit One Network |
$3,119.26
|
| Rate for Payer: Quartz Commercial |
$3,819.50
|
| Rate for Payer: WEA Trust Commercial |
$3,501.21
|
| Rate for Payer: WPS Commercial |
$4,715.01
|
|
|
MRV Head Venous Angiogram w + w/o Contrast
|
Facility
|
OP
|
$6,121.00
|
|
|
Service Code
|
CPT 70546 TC
|
| Hospital Charge Code |
5288676
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,032.01 |
| Max. Negotiated Rate |
$5,856.57 |
| Rate for Payer: Aetna Commercial |
$5,729.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,474.62
|
| Rate for Payer: Aetna Managed Medicare |
$1,782.44
|
| 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 |
$3,373.90
|
| Rate for Payer: Cash Price |
$1,836.30
|
| Rate for Payer: Cash Price |
$1,836.30
|
| Rate for Payer: Cash Price |
$1,836.30
|
| Rate for Payer: Cash Price |
$1,836.30
|
| Rate for Payer: Cigna Commercial |
$5,856.57
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,562.42
|
| Rate for Payer: Health EOS Commercial |
$5,665.60
|
| Rate for Payer: HFN Commercial |
$5,856.57
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,774.38
|
| Rate for Payer: Multiplan Commercial |
$5,092.67
|
| Rate for Payer: NAPHCARE Commercial |
$3,819.50
|
| Rate for Payer: Preferred Network Access Commercial |
$5,856.57
|
| Rate for Payer: Quartz Beloit One Network |
$3,119.26
|
| Rate for Payer: Quartz Commercial |
$4,137.80
|
| Rate for Payer: Quartz Medicare Advantage |
$3,819.50
|
| Rate for Payer: The Alliance Commercial |
$1,032.01
|
| Rate for Payer: United Healthcare PPO |
$3,142.88
|
| Rate for Payer: WEA Trust Commercial |
$3,501.21
|
| Rate for Payer: WPS Commercial |
$1,806.02
|
|
|
MRV Head Venous Angiogram w + w/o Contrast
|
Facility
|
IP
|
$6,121.00
|
|
|
Service Code
|
CPT 70546 TC
|
| Hospital Charge Code |
5288676
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$3,119.26 |
| Max. Negotiated Rate |
$5,856.57 |
| Rate for Payer: Aetna Commercial |
$5,729.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,474.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,373.90
|
| Rate for Payer: Cash Price |
$1,836.30
|
| Rate for Payer: Cigna Commercial |
$5,856.57
|
| Rate for Payer: Health EOS Commercial |
$5,665.60
|
| Rate for Payer: HFN Commercial |
$5,856.57
|
| Rate for Payer: Multiplan Commercial |
$5,092.67
|
| Rate for Payer: Preferred Network Access Commercial |
$5,856.57
|
| Rate for Payer: Quartz Beloit One Network |
$3,119.26
|
| Rate for Payer: Quartz Commercial |
$3,819.50
|
| Rate for Payer: WEA Trust Commercial |
$3,501.21
|
| Rate for Payer: WPS Commercial |
$4,715.01
|
|
