|
MRI Abdomen w/ + w/o Contrast
|
Professional
|
Both
|
$5,795.00
|
|
|
Service Code
|
CPT 74183
|
| Hospital Charge Code |
625604
|
| Min. Negotiated Rate |
$1,302.22 |
| Max. Negotiated Rate |
$5,505.25 |
| Rate for Payer: Aetna Commercial |
$5,505.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,983.70
|
| Rate for Payer: Cash Price |
$1,738.50
|
| Rate for Payer: Cash Price |
$1,738.50
|
| Rate for Payer: Cash Price |
$1,738.50
|
| Rate for Payer: Cigna Commercial |
$5,505.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,897.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,477.00
|
| Rate for Payer: Health EOS Commercial |
$5,273.45
|
| Rate for Payer: HFN Commercial |
$5,505.25
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,302.22
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,302.22
|
| Rate for Payer: Multiplan Commercial |
$4,636.00
|
| Rate for Payer: Preferred Network Access Commercial |
$5,505.25
|
| Rate for Payer: Quartz Beloit One Network |
$2,549.80
|
| Rate for Payer: Quartz Commercial |
$3,303.15
|
| Rate for Payer: The Alliance Commercial |
$2,897.50
|
| Rate for Payer: WEA Trust Commercial |
$3,187.25
|
| Rate for Payer: WPS Commercial |
$4,292.36
|
|
|
MRI Abdomen w/ + w/o Contrast
|
Professional
|
Both
|
$6,365.00
|
|
|
Service Code
|
CPT 74183 TC
|
| Hospital Charge Code |
1610902
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$935.94 |
| Max. Negotiated Rate |
$6,046.75 |
| Rate for Payer: Aetna Commercial |
$6,046.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,473.90
|
| Rate for Payer: Cash Price |
$1,909.50
|
| Rate for Payer: Cash Price |
$1,909.50
|
| Rate for Payer: Cash Price |
$1,909.50
|
| Rate for Payer: Cigna Commercial |
$6,046.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$3,182.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,819.00
|
| Rate for Payer: Health EOS Commercial |
$5,792.15
|
| Rate for Payer: HFN Commercial |
$6,046.75
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$935.94
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$935.94
|
| Rate for Payer: Multiplan Commercial |
$5,092.00
|
| Rate for Payer: Preferred Network Access Commercial |
$6,046.75
|
| Rate for Payer: Quartz Beloit One Network |
$2,800.60
|
| Rate for Payer: Quartz Commercial |
$3,628.05
|
| Rate for Payer: The Alliance Commercial |
$3,182.50
|
| Rate for Payer: WEA Trust Commercial |
$3,500.75
|
| Rate for Payer: WPS Commercial |
$4,714.56
|
|
|
MRI Abdomen w/ + w/o Contrast
|
Facility
|
OP
|
$5,795.00
|
|
|
Service Code
|
CPT 74183
|
| Hospital Charge Code |
625604
|
| Min. Negotiated Rate |
$380.12 |
| Max. Negotiated Rate |
$5,331.40 |
| Rate for Payer: Aetna Commercial |
$5,215.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,983.70
|
| Rate for Payer: Aetna Managed Medicare |
$380.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,766.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,897.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,781.60
|
| Rate for Payer: Anthem Medicare Advantage |
$380.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,071.35
|
| 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 |
$1,738.50
|
| Rate for Payer: Cash Price |
$1,738.50
|
| Rate for Payer: Cigna Commercial |
$5,331.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$380.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,242.88
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$380.12
|
| Rate for Payer: Health EOS Commercial |
$5,157.55
|
| Rate for Payer: HFN Commercial |
$5,331.40
|
| 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 |
$4,636.00
|
| Rate for Payer: NAPHCARE Commercial |
$570.18
|
| Rate for Payer: Preferred Network Access Commercial |
$5,331.40
|
| Rate for Payer: Quartz Beloit One Network |
$2,839.55
|
| Rate for Payer: Quartz Commercial |
$3,766.75
|
| 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 |
$3,187.25
|
| Rate for Payer: Wellcare Medicare |
$380.12
|
| Rate for Payer: WPS Commercial |
$4,292.36
|
|
|
MRI Abdomen w/ + w/o Contrast
|
Facility
|
IP
|
$5,795.00
|
|
|
Service Code
|
CPT 74183
|
| Hospital Charge Code |
625604
|
| Min. Negotiated Rate |
$2,839.55 |
| Max. Negotiated Rate |
$5,331.40 |
| Rate for Payer: Aetna Commercial |
$5,215.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,983.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,071.35
|
| Rate for Payer: Cash Price |
$1,738.50
|
| Rate for Payer: Cigna Commercial |
$5,331.40
|
| Rate for Payer: Health EOS Commercial |
$5,157.55
|
| Rate for Payer: HFN Commercial |
$5,331.40
|
| Rate for Payer: Multiplan Commercial |
$4,636.00
|
| Rate for Payer: NAPHCARE Commercial |
$3,477.00
|
| Rate for Payer: Preferred Network Access Commercial |
$5,331.40
|
| Rate for Payer: Quartz Beloit One Network |
$2,839.55
|
| Rate for Payer: Quartz Commercial |
$3,477.00
|
| Rate for Payer: WEA Trust Commercial |
$3,187.25
|
| Rate for Payer: WPS Commercial |
$4,292.36
|
|
|
MRI Abdomen w/ + w/o Contrast
|
Facility
|
IP
|
$6,365.00
|
|
|
Service Code
|
CPT 74183 TC
|
| Hospital Charge Code |
1610902
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$3,118.85 |
| Max. Negotiated Rate |
$5,855.80 |
| Rate for Payer: Aetna Commercial |
$5,728.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,473.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,373.45
|
| Rate for Payer: Cash Price |
$1,909.50
|
| Rate for Payer: Cigna Commercial |
$5,855.80
|
| Rate for Payer: Health EOS Commercial |
$5,664.85
|
| Rate for Payer: HFN Commercial |
$5,855.80
|
| Rate for Payer: Multiplan Commercial |
$5,092.00
|
| Rate for Payer: NAPHCARE Commercial |
$3,819.00
|
| Rate for Payer: Preferred Network Access Commercial |
$5,855.80
|
| Rate for Payer: Quartz Beloit One Network |
$3,118.85
|
| Rate for Payer: Quartz Commercial |
$3,819.00
|
| Rate for Payer: WEA Trust Commercial |
$3,500.75
|
| Rate for Payer: WPS Commercial |
$4,714.56
|
|
|
MRI Ankle w/ Contrast Bilateral
|
Facility
|
OP
|
$10,169.00
|
|
|
Service Code
|
CPT 73722
|
| Hospital Charge Code |
625704
|
| Min. Negotiated Rate |
$791.40 |
| Max. Negotiated Rate |
$9,355.48 |
| Rate for Payer: Aetna Commercial |
$9,152.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,745.34
|
| Rate for Payer: Aetna Managed Medicare |
$791.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,609.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,084.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,881.12
|
| Rate for Payer: Anthem Medicare Advantage |
$791.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,389.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$791.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$791.40
|
| Rate for Payer: Cash Price |
$3,050.70
|
| Rate for Payer: Cash Price |
$3,050.70
|
| Rate for Payer: Cigna Commercial |
$9,355.48
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$791.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,690.57
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$791.40
|
| Rate for Payer: Health EOS Commercial |
$9,050.41
|
| Rate for Payer: HFN Commercial |
$9,355.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,944.01
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$791.40
|
| Rate for Payer: Independent Care Health Plan Medicare |
$791.40
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$791.40
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$791.40
|
| Rate for Payer: Multiplan Commercial |
$8,135.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,187.10
|
| Rate for Payer: Preferred Network Access Commercial |
$9,355.48
|
| Rate for Payer: Quartz Beloit One Network |
$4,982.81
|
| Rate for Payer: Quartz Commercial |
$6,609.85
|
| Rate for Payer: Quartz Medicare Advantage |
$791.40
|
| Rate for Payer: The Alliance Commercial |
$3,165.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$791.40
|
| Rate for Payer: WEA Trust Commercial |
$5,592.95
|
| Rate for Payer: Wellcare Medicare |
$791.40
|
| Rate for Payer: WPS Commercial |
$7,532.18
|
|
|
MRI Ankle w/ Contrast Bilateral
|
Facility
|
IP
|
$10,169.00
|
|
|
Service Code
|
CPT 73722
|
| Hospital Charge Code |
625704
|
| Min. Negotiated Rate |
$4,982.81 |
| Max. Negotiated Rate |
$9,355.48 |
| Rate for Payer: Aetna Commercial |
$9,152.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,745.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,389.57
|
| Rate for Payer: Cash Price |
$3,050.70
|
| Rate for Payer: Cigna Commercial |
$9,355.48
|
| Rate for Payer: Health EOS Commercial |
$9,050.41
|
| Rate for Payer: HFN Commercial |
$9,355.48
|
| Rate for Payer: Multiplan Commercial |
$8,135.20
|
| Rate for Payer: NAPHCARE Commercial |
$6,101.40
|
| Rate for Payer: Preferred Network Access Commercial |
$9,355.48
|
| Rate for Payer: Quartz Beloit One Network |
$4,982.81
|
| Rate for Payer: Quartz Commercial |
$6,101.40
|
| Rate for Payer: WEA Trust Commercial |
$5,592.95
|
| Rate for Payer: WPS Commercial |
$7,532.18
|
|
|
MRI Ankle w/ Contrast Bilateral
|
Professional
|
Both
|
$10,169.00
|
|
|
Service Code
|
CPT 73722
|
| Hospital Charge Code |
625704
|
| Min. Negotiated Rate |
$1,222.30 |
| Max. Negotiated Rate |
$9,660.55 |
| Rate for Payer: Aetna Commercial |
$9,660.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,745.34
|
| Rate for Payer: Cash Price |
$3,050.70
|
| Rate for Payer: Cash Price |
$3,050.70
|
| Rate for Payer: Cash Price |
$3,050.70
|
| Rate for Payer: Cigna Commercial |
$9,660.55
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$5,084.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,101.40
|
| Rate for Payer: Health EOS Commercial |
$9,253.79
|
| Rate for Payer: HFN Commercial |
$9,660.55
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,222.30
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,222.30
|
| Rate for Payer: Multiplan Commercial |
$8,135.20
|
| Rate for Payer: Preferred Network Access Commercial |
$9,660.55
|
| Rate for Payer: Quartz Beloit One Network |
$4,474.36
|
| Rate for Payer: Quartz Commercial |
$5,796.33
|
| Rate for Payer: The Alliance Commercial |
$5,084.50
|
| Rate for Payer: WEA Trust Commercial |
$5,592.95
|
| Rate for Payer: WPS Commercial |
$7,532.18
|
|
|
MRI Ankle w/ Contrast Bilateral
|
Facility
|
IP
|
$4,988.00
|
|
|
Service Code
|
CPT 73722 LT,TC
|
| Hospital Charge Code |
1610914
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$2,444.12 |
| Max. Negotiated Rate |
$4,588.96 |
| Rate for Payer: Aetna Commercial |
$4,489.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,289.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,643.64
|
| Rate for Payer: Cash Price |
$1,496.40
|
| Rate for Payer: Cigna Commercial |
$4,588.96
|
| Rate for Payer: Health EOS Commercial |
$4,439.32
|
| Rate for Payer: HFN Commercial |
$4,588.96
|
| Rate for Payer: Multiplan Commercial |
$3,990.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,992.80
|
| Rate for Payer: Preferred Network Access Commercial |
$4,588.96
|
| Rate for Payer: Quartz Beloit One Network |
$2,444.12
|
| Rate for Payer: Quartz Commercial |
$2,992.80
|
| Rate for Payer: WEA Trust Commercial |
$2,743.40
|
| Rate for Payer: WPS Commercial |
$3,694.61
|
|
|
MRI Ankle w/ Contrast Bilateral
|
Professional
|
Both
|
$4,988.00
|
|
|
Service Code
|
CPT 73722 LT,TC
|
| Hospital Charge Code |
1610914
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,222.30 |
| Max. Negotiated Rate |
$4,738.60 |
| Rate for Payer: Aetna Commercial |
$4,738.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,289.68
|
| Rate for Payer: Cash Price |
$1,496.40
|
| Rate for Payer: Cash Price |
$1,496.40
|
| Rate for Payer: Cash Price |
$1,496.40
|
| Rate for Payer: Cigna Commercial |
$4,738.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,494.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,992.80
|
| Rate for Payer: Health EOS Commercial |
$4,539.08
|
| Rate for Payer: HFN Commercial |
$4,738.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,222.30
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,222.30
|
| Rate for Payer: Multiplan Commercial |
$3,990.40
|
| Rate for Payer: Preferred Network Access Commercial |
$4,738.60
|
| Rate for Payer: Quartz Beloit One Network |
$2,194.72
|
| Rate for Payer: Quartz Commercial |
$2,843.16
|
| Rate for Payer: The Alliance Commercial |
$2,494.00
|
| Rate for Payer: WEA Trust Commercial |
$2,743.40
|
| Rate for Payer: WPS Commercial |
$3,694.61
|
|
|
MRI Ankle w/ Contrast Bilateral
|
Facility
|
OP
|
$4,988.00
|
|
|
Service Code
|
CPT 73722 LT,TC
|
| Hospital Charge Code |
1610914
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$791.40 |
| Max. Negotiated Rate |
$4,588.96 |
| Rate for Payer: Aetna Commercial |
$4,489.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,289.68
|
| Rate for Payer: Aetna Managed Medicare |
$791.40
|
| 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 |
$791.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,643.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$791.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$791.40
|
| Rate for Payer: Cash Price |
$1,496.40
|
| Rate for Payer: Cash Price |
$1,496.40
|
| Rate for Payer: Cash Price |
$1,496.40
|
| Rate for Payer: Cash Price |
$1,496.40
|
| Rate for Payer: Cigna Commercial |
$4,588.96
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$791.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,791.28
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$791.40
|
| Rate for Payer: Health EOS Commercial |
$4,439.32
|
| Rate for Payer: HFN Commercial |
$4,588.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,944.01
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$791.40
|
| Rate for Payer: Independent Care Health Plan Medicare |
$791.40
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$791.40
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$791.40
|
| Rate for Payer: Multiplan Commercial |
$3,990.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,187.10
|
| Rate for Payer: Preferred Network Access Commercial |
$4,588.96
|
| Rate for Payer: Quartz Beloit One Network |
$2,444.12
|
| Rate for Payer: Quartz Commercial |
$3,242.20
|
| Rate for Payer: Quartz Medicare Advantage |
$791.40
|
| Rate for Payer: The Alliance Commercial |
$3,165.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$791.40
|
| Rate for Payer: United Healthcare PPO |
$3,022.00
|
| Rate for Payer: WEA Trust Commercial |
$2,743.40
|
| Rate for Payer: Wellcare Medicare |
$791.40
|
| Rate for Payer: WPS Commercial |
$3,694.61
|
|
|
MRI Ankle w/ Contrast Left
|
Professional
|
Both
|
$4,988.00
|
|
|
Service Code
|
CPT 73722 LT,TC
|
| Hospital Charge Code |
1610916
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,222.30 |
| Max. Negotiated Rate |
$4,738.60 |
| Rate for Payer: Aetna Commercial |
$4,738.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,289.68
|
| Rate for Payer: Cash Price |
$1,496.40
|
| Rate for Payer: Cash Price |
$1,496.40
|
| Rate for Payer: Cash Price |
$1,496.40
|
| Rate for Payer: Cigna Commercial |
$4,738.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,494.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,992.80
|
| Rate for Payer: Health EOS Commercial |
$4,539.08
|
| Rate for Payer: HFN Commercial |
$4,738.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,222.30
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,222.30
|
| Rate for Payer: Multiplan Commercial |
$3,990.40
|
| Rate for Payer: Preferred Network Access Commercial |
$4,738.60
|
| Rate for Payer: Quartz Beloit One Network |
$2,194.72
|
| Rate for Payer: Quartz Commercial |
$2,843.16
|
| Rate for Payer: The Alliance Commercial |
$2,494.00
|
| Rate for Payer: WEA Trust Commercial |
$2,743.40
|
| Rate for Payer: WPS Commercial |
$3,694.61
|
|
|
MRI Ankle w/ Contrast Left
|
Professional
|
Both
|
$5,085.00
|
|
|
Service Code
|
CPT 73722
|
| Hospital Charge Code |
625706
|
| Min. Negotiated Rate |
$1,222.30 |
| Max. Negotiated Rate |
$4,830.75 |
| Rate for Payer: Aetna Commercial |
$4,830.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,373.10
|
| Rate for Payer: Cash Price |
$1,525.50
|
| Rate for Payer: Cash Price |
$1,525.50
|
| Rate for Payer: Cash Price |
$1,525.50
|
| Rate for Payer: Cigna Commercial |
$4,830.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,542.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,051.00
|
| Rate for Payer: Health EOS Commercial |
$4,627.35
|
| Rate for Payer: HFN Commercial |
$4,830.75
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,222.30
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,222.30
|
| Rate for Payer: Multiplan Commercial |
$4,068.00
|
| Rate for Payer: Preferred Network Access Commercial |
$4,830.75
|
| Rate for Payer: Quartz Beloit One Network |
$2,237.40
|
| Rate for Payer: Quartz Commercial |
$2,898.45
|
| Rate for Payer: The Alliance Commercial |
$2,542.50
|
| Rate for Payer: WEA Trust Commercial |
$2,796.75
|
| Rate for Payer: WPS Commercial |
$3,766.46
|
|
|
MRI Ankle w/ Contrast Left
|
Facility
|
IP
|
$4,988.00
|
|
|
Service Code
|
CPT 73722 LT,TC
|
| Hospital Charge Code |
1610916
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$2,444.12 |
| Max. Negotiated Rate |
$4,588.96 |
| Rate for Payer: Aetna Commercial |
$4,489.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,289.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,643.64
|
| Rate for Payer: Cash Price |
$1,496.40
|
| Rate for Payer: Cigna Commercial |
$4,588.96
|
| Rate for Payer: Health EOS Commercial |
$4,439.32
|
| Rate for Payer: HFN Commercial |
$4,588.96
|
| Rate for Payer: Multiplan Commercial |
$3,990.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,992.80
|
| Rate for Payer: Preferred Network Access Commercial |
$4,588.96
|
| Rate for Payer: Quartz Beloit One Network |
$2,444.12
|
| Rate for Payer: Quartz Commercial |
$2,992.80
|
| Rate for Payer: WEA Trust Commercial |
$2,743.40
|
| Rate for Payer: WPS Commercial |
$3,694.61
|
|
|
MRI Ankle w/ Contrast Left
|
Facility
|
OP
|
$5,085.00
|
|
|
Service Code
|
CPT 73722
|
| Hospital Charge Code |
625706
|
| Min. Negotiated Rate |
$791.40 |
| Max. Negotiated Rate |
$4,678.20 |
| Rate for Payer: Aetna Commercial |
$4,576.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,373.10
|
| Rate for Payer: Aetna Managed Medicare |
$791.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,305.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,542.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,440.80
|
| Rate for Payer: Anthem Medicare Advantage |
$791.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,695.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$791.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$791.40
|
| Rate for Payer: Cash Price |
$1,525.50
|
| Rate for Payer: Cash Price |
$1,525.50
|
| Rate for Payer: Cigna Commercial |
$4,678.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$791.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,845.57
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$791.40
|
| Rate for Payer: Health EOS Commercial |
$4,525.65
|
| Rate for Payer: HFN Commercial |
$4,678.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,944.01
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$791.40
|
| Rate for Payer: Independent Care Health Plan Medicare |
$791.40
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$791.40
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$791.40
|
| Rate for Payer: Multiplan Commercial |
$4,068.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,187.10
|
| Rate for Payer: Preferred Network Access Commercial |
$4,678.20
|
| Rate for Payer: Quartz Beloit One Network |
$2,491.65
|
| Rate for Payer: Quartz Commercial |
$3,305.25
|
| Rate for Payer: Quartz Medicare Advantage |
$791.40
|
| Rate for Payer: The Alliance Commercial |
$3,165.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$791.40
|
| Rate for Payer: WEA Trust Commercial |
$2,796.75
|
| Rate for Payer: Wellcare Medicare |
$791.40
|
| Rate for Payer: WPS Commercial |
$3,766.46
|
|
|
MRI Ankle w/ Contrast Left
|
Facility
|
IP
|
$5,085.00
|
|
|
Service Code
|
CPT 73722
|
| Hospital Charge Code |
625706
|
| Min. Negotiated Rate |
$2,491.65 |
| Max. Negotiated Rate |
$4,678.20 |
| Rate for Payer: Aetna Commercial |
$4,576.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,373.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,695.05
|
| Rate for Payer: Cash Price |
$1,525.50
|
| Rate for Payer: Cigna Commercial |
$4,678.20
|
| Rate for Payer: Health EOS Commercial |
$4,525.65
|
| Rate for Payer: HFN Commercial |
$4,678.20
|
| Rate for Payer: Multiplan Commercial |
$4,068.00
|
| Rate for Payer: NAPHCARE Commercial |
$3,051.00
|
| Rate for Payer: Preferred Network Access Commercial |
$4,678.20
|
| Rate for Payer: Quartz Beloit One Network |
$2,491.65
|
| Rate for Payer: Quartz Commercial |
$3,051.00
|
| Rate for Payer: WEA Trust Commercial |
$2,796.75
|
| Rate for Payer: WPS Commercial |
$3,766.46
|
|
|
MRI Ankle w/ Contrast Left
|
Facility
|
OP
|
$4,988.00
|
|
|
Service Code
|
CPT 73722 LT,TC
|
| Hospital Charge Code |
1610916
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$791.40 |
| Max. Negotiated Rate |
$4,588.96 |
| Rate for Payer: Aetna Commercial |
$4,489.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,289.68
|
| Rate for Payer: Aetna Managed Medicare |
$791.40
|
| 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 |
$791.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,643.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$791.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$791.40
|
| Rate for Payer: Cash Price |
$1,496.40
|
| Rate for Payer: Cash Price |
$1,496.40
|
| Rate for Payer: Cash Price |
$1,496.40
|
| Rate for Payer: Cash Price |
$1,496.40
|
| Rate for Payer: Cigna Commercial |
$4,588.96
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$791.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,791.28
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$791.40
|
| Rate for Payer: Health EOS Commercial |
$4,439.32
|
| Rate for Payer: HFN Commercial |
$4,588.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,944.01
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$791.40
|
| Rate for Payer: Independent Care Health Plan Medicare |
$791.40
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$791.40
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$791.40
|
| Rate for Payer: Multiplan Commercial |
$3,990.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,187.10
|
| Rate for Payer: Preferred Network Access Commercial |
$4,588.96
|
| Rate for Payer: Quartz Beloit One Network |
$2,444.12
|
| Rate for Payer: Quartz Commercial |
$3,242.20
|
| Rate for Payer: Quartz Medicare Advantage |
$791.40
|
| Rate for Payer: The Alliance Commercial |
$3,165.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$791.40
|
| Rate for Payer: United Healthcare PPO |
$3,022.00
|
| Rate for Payer: WEA Trust Commercial |
$2,743.40
|
| Rate for Payer: Wellcare Medicare |
$791.40
|
| Rate for Payer: WPS Commercial |
$3,694.61
|
|
|
MRI Ankle w/ Contrast Right
|
Facility
|
OP
|
$4,988.00
|
|
|
Service Code
|
CPT 73722 TC,RT
|
| Hospital Charge Code |
2980107
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$791.40 |
| Max. Negotiated Rate |
$4,588.96 |
| Rate for Payer: Aetna Commercial |
$4,489.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,289.68
|
| Rate for Payer: Aetna Managed Medicare |
$791.40
|
| 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 |
$791.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,643.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$791.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$791.40
|
| Rate for Payer: Cash Price |
$1,496.40
|
| Rate for Payer: Cash Price |
$1,496.40
|
| Rate for Payer: Cash Price |
$1,496.40
|
| Rate for Payer: Cash Price |
$1,496.40
|
| Rate for Payer: Cigna Commercial |
$4,588.96
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$791.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,791.28
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$791.40
|
| Rate for Payer: Health EOS Commercial |
$4,439.32
|
| Rate for Payer: HFN Commercial |
$4,588.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,944.01
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$791.40
|
| Rate for Payer: Independent Care Health Plan Medicare |
$791.40
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$791.40
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$791.40
|
| Rate for Payer: Multiplan Commercial |
$3,990.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,187.10
|
| Rate for Payer: Preferred Network Access Commercial |
$4,588.96
|
| Rate for Payer: Quartz Beloit One Network |
$2,444.12
|
| Rate for Payer: Quartz Commercial |
$3,242.20
|
| Rate for Payer: Quartz Medicare Advantage |
$791.40
|
| Rate for Payer: The Alliance Commercial |
$3,165.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$791.40
|
| Rate for Payer: United Healthcare PPO |
$3,022.00
|
| Rate for Payer: WEA Trust Commercial |
$2,743.40
|
| Rate for Payer: Wellcare Medicare |
$791.40
|
| Rate for Payer: WPS Commercial |
$3,694.61
|
|
|
MRI Ankle w/ Contrast Right
|
Facility
|
OP
|
$5,085.00
|
|
|
Service Code
|
CPT 73722
|
| Hospital Charge Code |
625708
|
| Min. Negotiated Rate |
$791.40 |
| Max. Negotiated Rate |
$4,678.20 |
| Rate for Payer: Aetna Commercial |
$4,576.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,373.10
|
| Rate for Payer: Aetna Managed Medicare |
$791.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,305.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,542.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,440.80
|
| Rate for Payer: Anthem Medicare Advantage |
$791.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,695.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$791.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$791.40
|
| Rate for Payer: Cash Price |
$1,525.50
|
| Rate for Payer: Cash Price |
$1,525.50
|
| Rate for Payer: Cigna Commercial |
$4,678.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$791.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,845.57
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$791.40
|
| Rate for Payer: Health EOS Commercial |
$4,525.65
|
| Rate for Payer: HFN Commercial |
$4,678.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,944.01
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$791.40
|
| Rate for Payer: Independent Care Health Plan Medicare |
$791.40
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$791.40
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$791.40
|
| Rate for Payer: Multiplan Commercial |
$4,068.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,187.10
|
| Rate for Payer: Preferred Network Access Commercial |
$4,678.20
|
| Rate for Payer: Quartz Beloit One Network |
$2,491.65
|
| Rate for Payer: Quartz Commercial |
$3,305.25
|
| Rate for Payer: Quartz Medicare Advantage |
$791.40
|
| Rate for Payer: The Alliance Commercial |
$3,165.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$791.40
|
| Rate for Payer: WEA Trust Commercial |
$2,796.75
|
| Rate for Payer: Wellcare Medicare |
$791.40
|
| Rate for Payer: WPS Commercial |
$3,766.46
|
|
|
MRI Ankle w/ Contrast Right
|
Professional
|
Both
|
$4,988.00
|
|
|
Service Code
|
CPT 73722 RT,TC
|
| Hospital Charge Code |
1610918
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,222.30 |
| Max. Negotiated Rate |
$4,738.60 |
| Rate for Payer: Aetna Commercial |
$4,738.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,289.68
|
| Rate for Payer: Cash Price |
$1,496.40
|
| Rate for Payer: Cash Price |
$1,496.40
|
| Rate for Payer: Cash Price |
$1,496.40
|
| Rate for Payer: Cigna Commercial |
$4,738.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,494.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,992.80
|
| Rate for Payer: Health EOS Commercial |
$4,539.08
|
| Rate for Payer: HFN Commercial |
$4,738.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,222.30
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,222.30
|
| Rate for Payer: Multiplan Commercial |
$3,990.40
|
| Rate for Payer: Preferred Network Access Commercial |
$4,738.60
|
| Rate for Payer: Quartz Beloit One Network |
$2,194.72
|
| Rate for Payer: Quartz Commercial |
$2,843.16
|
| Rate for Payer: The Alliance Commercial |
$2,494.00
|
| Rate for Payer: WEA Trust Commercial |
$2,743.40
|
| Rate for Payer: WPS Commercial |
$3,694.61
|
|
|
MRI Ankle w/ Contrast Right
|
Facility
|
IP
|
$4,988.00
|
|
|
Service Code
|
CPT 73722 TC,RT
|
| Hospital Charge Code |
2980107
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$2,444.12 |
| Max. Negotiated Rate |
$4,588.96 |
| Rate for Payer: Aetna Commercial |
$4,489.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,289.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,643.64
|
| Rate for Payer: Cash Price |
$1,496.40
|
| Rate for Payer: Cigna Commercial |
$4,588.96
|
| Rate for Payer: Health EOS Commercial |
$4,439.32
|
| Rate for Payer: HFN Commercial |
$4,588.96
|
| Rate for Payer: Multiplan Commercial |
$3,990.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,992.80
|
| Rate for Payer: Preferred Network Access Commercial |
$4,588.96
|
| Rate for Payer: Quartz Beloit One Network |
$2,444.12
|
| Rate for Payer: Quartz Commercial |
$2,992.80
|
| Rate for Payer: WEA Trust Commercial |
$2,743.40
|
| Rate for Payer: WPS Commercial |
$3,694.61
|
|
|
MRI Ankle w/ Contrast Right
|
Facility
|
IP
|
$5,085.00
|
|
|
Service Code
|
CPT 73722
|
| Hospital Charge Code |
625708
|
| Min. Negotiated Rate |
$2,491.65 |
| Max. Negotiated Rate |
$4,678.20 |
| Rate for Payer: Aetna Commercial |
$4,576.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,373.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,695.05
|
| Rate for Payer: Cash Price |
$1,525.50
|
| Rate for Payer: Cigna Commercial |
$4,678.20
|
| Rate for Payer: Health EOS Commercial |
$4,525.65
|
| Rate for Payer: HFN Commercial |
$4,678.20
|
| Rate for Payer: Multiplan Commercial |
$4,068.00
|
| Rate for Payer: NAPHCARE Commercial |
$3,051.00
|
| Rate for Payer: Preferred Network Access Commercial |
$4,678.20
|
| Rate for Payer: Quartz Beloit One Network |
$2,491.65
|
| Rate for Payer: Quartz Commercial |
$3,051.00
|
| Rate for Payer: WEA Trust Commercial |
$2,796.75
|
| Rate for Payer: WPS Commercial |
$3,766.46
|
|
|
MRI Ankle w/ Contrast Right
|
Professional
|
Both
|
$5,085.00
|
|
|
Service Code
|
CPT 73722
|
| Hospital Charge Code |
625708
|
| Min. Negotiated Rate |
$1,222.30 |
| Max. Negotiated Rate |
$4,830.75 |
| Rate for Payer: Aetna Commercial |
$4,830.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,373.10
|
| Rate for Payer: Cash Price |
$1,525.50
|
| Rate for Payer: Cash Price |
$1,525.50
|
| Rate for Payer: Cash Price |
$1,525.50
|
| Rate for Payer: Cigna Commercial |
$4,830.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,542.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,051.00
|
| Rate for Payer: Health EOS Commercial |
$4,627.35
|
| Rate for Payer: HFN Commercial |
$4,830.75
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,222.30
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,222.30
|
| Rate for Payer: Multiplan Commercial |
$4,068.00
|
| Rate for Payer: Preferred Network Access Commercial |
$4,830.75
|
| Rate for Payer: Quartz Beloit One Network |
$2,237.40
|
| Rate for Payer: Quartz Commercial |
$2,898.45
|
| Rate for Payer: The Alliance Commercial |
$2,542.50
|
| Rate for Payer: WEA Trust Commercial |
$2,796.75
|
| Rate for Payer: WPS Commercial |
$3,766.46
|
|
|
MRI Ankle w/ Contrast Right
|
Professional
|
Both
|
$4,988.00
|
|
|
Service Code
|
CPT 73722 TC,RT
|
| Hospital Charge Code |
2980107
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,222.30 |
| Max. Negotiated Rate |
$4,738.60 |
| Rate for Payer: Aetna Commercial |
$4,738.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,289.68
|
| Rate for Payer: Cash Price |
$1,496.40
|
| Rate for Payer: Cash Price |
$1,496.40
|
| Rate for Payer: Cash Price |
$1,496.40
|
| Rate for Payer: Cigna Commercial |
$4,738.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,494.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,992.80
|
| Rate for Payer: Health EOS Commercial |
$4,539.08
|
| Rate for Payer: HFN Commercial |
$4,738.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,222.30
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,222.30
|
| Rate for Payer: Multiplan Commercial |
$3,990.40
|
| Rate for Payer: Preferred Network Access Commercial |
$4,738.60
|
| Rate for Payer: Quartz Beloit One Network |
$2,194.72
|
| Rate for Payer: Quartz Commercial |
$2,843.16
|
| Rate for Payer: The Alliance Commercial |
$2,494.00
|
| Rate for Payer: WEA Trust Commercial |
$2,743.40
|
| Rate for Payer: WPS Commercial |
$3,694.61
|
|
|
MRI Ankle w/ Contrast Right
|
Facility
|
OP
|
$4,988.00
|
|
|
Service Code
|
CPT 73722 RT,TC
|
| Hospital Charge Code |
1610918
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$791.40 |
| Max. Negotiated Rate |
$4,588.96 |
| Rate for Payer: Aetna Commercial |
$4,489.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,289.68
|
| Rate for Payer: Aetna Managed Medicare |
$791.40
|
| 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 |
$791.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,643.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$791.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$791.40
|
| Rate for Payer: Cash Price |
$1,496.40
|
| Rate for Payer: Cash Price |
$1,496.40
|
| Rate for Payer: Cash Price |
$1,496.40
|
| Rate for Payer: Cash Price |
$1,496.40
|
| Rate for Payer: Cigna Commercial |
$4,588.96
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$791.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,791.28
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$791.40
|
| Rate for Payer: Health EOS Commercial |
$4,439.32
|
| Rate for Payer: HFN Commercial |
$4,588.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,944.01
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$791.40
|
| Rate for Payer: Independent Care Health Plan Medicare |
$791.40
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$791.40
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$791.40
|
| Rate for Payer: Multiplan Commercial |
$3,990.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,187.10
|
| Rate for Payer: Preferred Network Access Commercial |
$4,588.96
|
| Rate for Payer: Quartz Beloit One Network |
$2,444.12
|
| Rate for Payer: Quartz Commercial |
$3,242.20
|
| Rate for Payer: Quartz Medicare Advantage |
$791.40
|
| Rate for Payer: The Alliance Commercial |
$3,165.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$791.40
|
| Rate for Payer: United Healthcare PPO |
$3,022.00
|
| Rate for Payer: WEA Trust Commercial |
$2,743.40
|
| Rate for Payer: Wellcare Medicare |
$791.40
|
| Rate for Payer: WPS Commercial |
$3,694.61
|
|
