|
MRI Face Neck Orbit w/o Contrast
|
Professional
|
Both
|
$6,194.00
|
|
|
Service Code
|
CPT 70540 TC
|
| Hospital Charge Code |
1611059
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$643.52 |
| Max. Negotiated Rate |
$5,884.30 |
| Rate for Payer: Aetna Commercial |
$5,884.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,326.84
|
| 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 |
$5,884.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$3,097.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,716.40
|
| Rate for Payer: Health EOS Commercial |
$5,636.54
|
| Rate for Payer: HFN Commercial |
$5,884.30
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$643.52
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$643.52
|
| Rate for Payer: Multiplan Commercial |
$4,955.20
|
| Rate for Payer: Preferred Network Access Commercial |
$5,884.30
|
| Rate for Payer: Quartz Beloit One Network |
$2,725.36
|
| Rate for Payer: Quartz Commercial |
$3,530.58
|
| Rate for Payer: The Alliance Commercial |
$3,097.00
|
| Rate for Payer: WEA Trust Commercial |
$3,406.70
|
| Rate for Payer: WPS Commercial |
$4,587.90
|
|
|
MRI Face Neck Orbit w/o Contrast
|
Facility
|
OP
|
$6,080.00
|
|
|
Service Code
|
CPT 70540
|
| Hospital Charge Code |
630859
|
| Min. Negotiated Rate |
$242.20 |
| Max. Negotiated Rate |
$5,593.60 |
| Rate for Payer: Aetna Commercial |
$5,472.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,228.80
|
| Rate for Payer: Aetna Managed Medicare |
$242.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,952.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,040.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,918.40
|
| Rate for Payer: Anthem Medicare Advantage |
$242.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,222.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$242.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$242.20
|
| Rate for Payer: Cash Price |
$1,824.00
|
| Rate for Payer: Cash Price |
$1,824.00
|
| Rate for Payer: Cigna Commercial |
$5,593.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$242.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,402.37
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$242.20
|
| Rate for Payer: Health EOS Commercial |
$5,411.20
|
| Rate for Payer: HFN Commercial |
$5,593.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$900.98
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$242.20
|
| Rate for Payer: Independent Care Health Plan Medicare |
$242.20
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$242.20
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$242.20
|
| Rate for Payer: Multiplan Commercial |
$4,864.00
|
| Rate for Payer: NAPHCARE Commercial |
$363.30
|
| Rate for Payer: Preferred Network Access Commercial |
$5,593.60
|
| Rate for Payer: Quartz Beloit One Network |
$2,979.20
|
| Rate for Payer: Quartz Commercial |
$3,952.00
|
| Rate for Payer: Quartz Medicare Advantage |
$242.20
|
| Rate for Payer: The Alliance Commercial |
$968.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$242.20
|
| Rate for Payer: WEA Trust Commercial |
$3,344.00
|
| Rate for Payer: Wellcare Medicare |
$242.20
|
| Rate for Payer: WPS Commercial |
$4,503.46
|
|
|
MRI Face Neck Orbit w/o Contrast
|
Facility
|
OP
|
$6,194.00
|
|
|
Service Code
|
CPT 70540 TC
|
| Hospital Charge Code |
1611059
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$242.20 |
| Max. Negotiated Rate |
$5,698.48 |
| Rate for Payer: Aetna Commercial |
$5,574.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,326.84
|
| Rate for Payer: Aetna Managed Medicare |
$242.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,496.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,871.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,726.00
|
| Rate for Payer: Anthem Medicare Advantage |
$242.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,282.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$242.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$242.20
|
| Rate for Payer: Cash Price |
$1,858.20
|
| 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 |
$5,698.48
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$242.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,466.16
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$242.20
|
| Rate for Payer: Health EOS Commercial |
$5,512.66
|
| Rate for Payer: HFN Commercial |
$5,698.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$900.98
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$242.20
|
| Rate for Payer: Independent Care Health Plan Medicare |
$242.20
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$242.20
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$242.20
|
| Rate for Payer: Multiplan Commercial |
$4,955.20
|
| Rate for Payer: NAPHCARE Commercial |
$363.30
|
| Rate for Payer: Preferred Network Access Commercial |
$5,698.48
|
| Rate for Payer: Quartz Beloit One Network |
$3,035.06
|
| Rate for Payer: Quartz Commercial |
$4,026.10
|
| Rate for Payer: Quartz Medicare Advantage |
$242.20
|
| Rate for Payer: The Alliance Commercial |
$968.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$242.20
|
| Rate for Payer: United Healthcare PPO |
$3,022.00
|
| Rate for Payer: WEA Trust Commercial |
$3,406.70
|
| Rate for Payer: Wellcare Medicare |
$242.20
|
| Rate for Payer: WPS Commercial |
$4,587.90
|
|
|
MRI Face Neck Orbit w/o Contrast
|
Facility
|
IP
|
$6,080.00
|
|
|
Service Code
|
CPT 70540
|
| Hospital Charge Code |
630859
|
| Min. Negotiated Rate |
$2,979.20 |
| Max. Negotiated Rate |
$5,593.60 |
| Rate for Payer: Aetna Commercial |
$5,472.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,228.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,222.40
|
| Rate for Payer: Cash Price |
$1,824.00
|
| Rate for Payer: Cigna Commercial |
$5,593.60
|
| Rate for Payer: Health EOS Commercial |
$5,411.20
|
| Rate for Payer: HFN Commercial |
$5,593.60
|
| Rate for Payer: Multiplan Commercial |
$4,864.00
|
| Rate for Payer: NAPHCARE Commercial |
$3,648.00
|
| Rate for Payer: Preferred Network Access Commercial |
$5,593.60
|
| Rate for Payer: Quartz Beloit One Network |
$2,979.20
|
| Rate for Payer: Quartz Commercial |
$3,648.00
|
| Rate for Payer: WEA Trust Commercial |
$3,344.00
|
| Rate for Payer: WPS Commercial |
$4,503.46
|
|
|
MRI Face Neck Orbit w/o Contrast
|
Professional
|
Both
|
$6,080.00
|
|
|
Service Code
|
CPT 70540
|
| Hospital Charge Code |
630859
|
| Min. Negotiated Rate |
$867.32 |
| Max. Negotiated Rate |
$5,776.00 |
| Rate for Payer: Aetna Commercial |
$5,776.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,228.80
|
| 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 |
$5,776.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$3,040.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,648.00
|
| Rate for Payer: Health EOS Commercial |
$5,532.80
|
| Rate for Payer: HFN Commercial |
$5,776.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$867.32
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$867.32
|
| Rate for Payer: Multiplan Commercial |
$4,864.00
|
| Rate for Payer: Preferred Network Access Commercial |
$5,776.00
|
| Rate for Payer: Quartz Beloit One Network |
$2,675.20
|
| Rate for Payer: Quartz Commercial |
$3,465.60
|
| Rate for Payer: The Alliance Commercial |
$3,040.00
|
| Rate for Payer: WEA Trust Commercial |
$3,344.00
|
| Rate for Payer: WPS Commercial |
$4,503.46
|
|
|
MRI Face Neck Orbit w/o Contrast
|
Facility
|
IP
|
$6,194.00
|
|
|
Service Code
|
CPT 70540 TC
|
| Hospital Charge Code |
1611059
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$3,035.06 |
| Max. Negotiated Rate |
$5,698.48 |
| Rate for Payer: Aetna Commercial |
$5,574.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,326.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,282.82
|
| Rate for Payer: Cash Price |
$1,858.20
|
| Rate for Payer: Cigna Commercial |
$5,698.48
|
| Rate for Payer: Health EOS Commercial |
$5,512.66
|
| Rate for Payer: HFN Commercial |
$5,698.48
|
| Rate for Payer: Multiplan Commercial |
$4,955.20
|
| Rate for Payer: NAPHCARE Commercial |
$3,716.40
|
| Rate for Payer: Preferred Network Access Commercial |
$5,698.48
|
| Rate for Payer: Quartz Beloit One Network |
$3,035.06
|
| Rate for Payer: Quartz Commercial |
$3,716.40
|
| Rate for Payer: WEA Trust Commercial |
$3,406.70
|
| Rate for Payer: WPS Commercial |
$4,587.90
|
|
|
MRI Face Neck Orbit w/ + w/o Contrast
|
Facility
|
OP
|
$7,100.00
|
|
|
Service Code
|
CPT 70543 TC
|
| Hospital Charge Code |
1611055
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$380.12 |
| Max. Negotiated Rate |
$6,532.00 |
| Rate for Payer: Aetna Commercial |
$6,390.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,106.00
|
| Rate for Payer: Aetna Managed Medicare |
$380.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,496.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,871.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,726.00
|
| Rate for Payer: Anthem Medicare Advantage |
$380.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,763.00
|
| 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 |
$2,130.00
|
| Rate for Payer: Cash Price |
$2,130.00
|
| Rate for Payer: Cash Price |
$2,130.00
|
| Rate for Payer: Cash Price |
$2,130.00
|
| Rate for Payer: Cigna Commercial |
$6,532.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$380.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,973.16
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$380.12
|
| Rate for Payer: Health EOS Commercial |
$6,319.00
|
| Rate for Payer: HFN Commercial |
$6,532.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,414.05
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$380.12
|
| Rate for Payer: Independent Care Health Plan Medicare |
$380.12
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$380.12
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$380.12
|
| Rate for Payer: Multiplan Commercial |
$5,680.00
|
| Rate for Payer: NAPHCARE Commercial |
$570.18
|
| Rate for Payer: Preferred Network Access Commercial |
$6,532.00
|
| Rate for Payer: Quartz Beloit One Network |
$3,479.00
|
| Rate for Payer: Quartz Commercial |
$4,615.00
|
| Rate for Payer: Quartz Medicare Advantage |
$380.12
|
| Rate for Payer: The Alliance Commercial |
$1,520.48
|
| Rate for Payer: United Healthcare Medicare Advantage |
$380.12
|
| Rate for Payer: United Healthcare PPO |
$3,022.00
|
| Rate for Payer: WEA Trust Commercial |
$3,905.00
|
| Rate for Payer: Wellcare Medicare |
$380.12
|
| Rate for Payer: WPS Commercial |
$5,258.97
|
|
|
MRI Face Neck Orbit w/ + w/o Contrast
|
Facility
|
IP
|
$6,129.00
|
|
|
Service Code
|
CPT 70543
|
| Hospital Charge Code |
630853
|
| Min. Negotiated Rate |
$3,003.21 |
| Max. Negotiated Rate |
$5,638.68 |
| Rate for Payer: Aetna Commercial |
$5,516.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,270.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,248.37
|
| Rate for Payer: Cash Price |
$1,838.70
|
| Rate for Payer: Cigna Commercial |
$5,638.68
|
| Rate for Payer: Health EOS Commercial |
$5,454.81
|
| Rate for Payer: HFN Commercial |
$5,638.68
|
| Rate for Payer: Multiplan Commercial |
$4,903.20
|
| Rate for Payer: NAPHCARE Commercial |
$3,677.40
|
| Rate for Payer: Preferred Network Access Commercial |
$5,638.68
|
| Rate for Payer: Quartz Beloit One Network |
$3,003.21
|
| Rate for Payer: Quartz Commercial |
$3,677.40
|
| Rate for Payer: WEA Trust Commercial |
$3,370.95
|
| Rate for Payer: WPS Commercial |
$4,539.75
|
|
|
MRI Face Neck Orbit w/ + w/o Contrast
|
Facility
|
IP
|
$7,100.00
|
|
|
Service Code
|
CPT 70543 TC
|
| Hospital Charge Code |
1611055
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$3,479.00 |
| Max. Negotiated Rate |
$6,532.00 |
| Rate for Payer: Aetna Commercial |
$6,390.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,106.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,763.00
|
| Rate for Payer: Cash Price |
$2,130.00
|
| Rate for Payer: Cigna Commercial |
$6,532.00
|
| Rate for Payer: Health EOS Commercial |
$6,319.00
|
| Rate for Payer: HFN Commercial |
$6,532.00
|
| Rate for Payer: Multiplan Commercial |
$5,680.00
|
| Rate for Payer: NAPHCARE Commercial |
$4,260.00
|
| Rate for Payer: Preferred Network Access Commercial |
$6,532.00
|
| Rate for Payer: Quartz Beloit One Network |
$3,479.00
|
| Rate for Payer: Quartz Commercial |
$4,260.00
|
| Rate for Payer: WEA Trust Commercial |
$3,905.00
|
| Rate for Payer: WPS Commercial |
$5,258.97
|
|
|
MRI Face Neck Orbit w/ + w/o Contrast
|
Facility
|
OP
|
$6,129.00
|
|
|
Service Code
|
CPT 70543
|
| Hospital Charge Code |
630853
|
| Min. Negotiated Rate |
$380.12 |
| Max. Negotiated Rate |
$5,638.68 |
| Rate for Payer: Aetna Commercial |
$5,516.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,270.94
|
| Rate for Payer: Aetna Managed Medicare |
$380.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,983.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,064.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,941.92
|
| Rate for Payer: Anthem Medicare Advantage |
$380.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,248.37
|
| 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 |
$1,838.70
|
| Rate for Payer: Cash Price |
$1,838.70
|
| Rate for Payer: Cigna Commercial |
$5,638.68
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$380.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,429.79
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$380.12
|
| Rate for Payer: Health EOS Commercial |
$5,454.81
|
| Rate for Payer: HFN Commercial |
$5,638.68
|
| 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 |
$4,903.20
|
| Rate for Payer: NAPHCARE Commercial |
$570.18
|
| Rate for Payer: Preferred Network Access Commercial |
$5,638.68
|
| Rate for Payer: Quartz Beloit One Network |
$3,003.21
|
| Rate for Payer: Quartz Commercial |
$3,983.85
|
| 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 |
$3,370.95
|
| Rate for Payer: Wellcare Medicare |
$380.12
|
| Rate for Payer: WPS Commercial |
$4,539.75
|
|
|
MRI Face Neck Orbit w/ + w/o Contrast
|
Professional
|
Both
|
$7,100.00
|
|
|
Service Code
|
CPT 70543 TC
|
| Hospital Charge Code |
1611055
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$941.73 |
| Max. Negotiated Rate |
$6,745.00 |
| Rate for Payer: Aetna Commercial |
$6,745.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,106.00
|
| Rate for Payer: Cash Price |
$2,130.00
|
| Rate for Payer: Cash Price |
$2,130.00
|
| Rate for Payer: Cash Price |
$2,130.00
|
| Rate for Payer: Cigna Commercial |
$6,745.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$3,550.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,260.00
|
| Rate for Payer: Health EOS Commercial |
$6,461.00
|
| Rate for Payer: HFN Commercial |
$6,745.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$941.73
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$941.73
|
| Rate for Payer: Multiplan Commercial |
$5,680.00
|
| Rate for Payer: Preferred Network Access Commercial |
$6,745.00
|
| Rate for Payer: Quartz Beloit One Network |
$3,124.00
|
| Rate for Payer: Quartz Commercial |
$4,047.00
|
| Rate for Payer: The Alliance Commercial |
$3,550.00
|
| Rate for Payer: WEA Trust Commercial |
$3,905.00
|
| Rate for Payer: WPS Commercial |
$5,258.97
|
|
|
MRI Face Neck Orbit w/ + w/o Contrast
|
Professional
|
Both
|
$6,129.00
|
|
|
Service Code
|
CPT 70543
|
| Hospital Charge Code |
630853
|
| Min. Negotiated Rate |
$1,299.53 |
| Max. Negotiated Rate |
$5,822.55 |
| Rate for Payer: Aetna Commercial |
$5,822.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,270.94
|
| Rate for Payer: Cash Price |
$1,838.70
|
| Rate for Payer: Cash Price |
$1,838.70
|
| Rate for Payer: Cash Price |
$1,838.70
|
| Rate for Payer: Cigna Commercial |
$5,822.55
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$3,064.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,677.40
|
| Rate for Payer: Health EOS Commercial |
$5,577.39
|
| Rate for Payer: HFN Commercial |
$5,822.55
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,299.53
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,299.53
|
| Rate for Payer: Multiplan Commercial |
$4,903.20
|
| Rate for Payer: Preferred Network Access Commercial |
$5,822.55
|
| Rate for Payer: Quartz Beloit One Network |
$2,696.76
|
| Rate for Payer: Quartz Commercial |
$3,493.53
|
| Rate for Payer: The Alliance Commercial |
$3,064.50
|
| Rate for Payer: WEA Trust Commercial |
$3,370.95
|
| Rate for Payer: WPS Commercial |
$4,539.75
|
|
|
MRI Femur w/ Contrast Bilat
|
Facility
|
IP
|
$4,714.00
|
|
|
Service Code
|
CPT 73719 TC,LT
|
| Hospital Charge Code |
1611067
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$2,309.86 |
| Max. Negotiated Rate |
$4,336.88 |
| Rate for Payer: Aetna Commercial |
$4,242.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,054.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,498.42
|
| Rate for Payer: Cash Price |
$1,414.20
|
| Rate for Payer: Cigna Commercial |
$4,336.88
|
| Rate for Payer: Health EOS Commercial |
$4,195.46
|
| Rate for Payer: HFN Commercial |
$4,336.88
|
| Rate for Payer: Multiplan Commercial |
$3,771.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,828.40
|
| Rate for Payer: Preferred Network Access Commercial |
$4,336.88
|
| Rate for Payer: Quartz Beloit One Network |
$2,309.86
|
| Rate for Payer: Quartz Commercial |
$2,828.40
|
| Rate for Payer: WEA Trust Commercial |
$2,592.70
|
| Rate for Payer: WPS Commercial |
$3,491.66
|
|
|
MRI Femur w/ Contrast Bilat
|
Facility
|
OP
|
$4,714.00
|
|
|
Service Code
|
CPT 73719 TC,LT
|
| Hospital Charge Code |
1611067
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$380.12 |
| Max. Negotiated Rate |
$4,336.88 |
| Rate for Payer: Aetna Commercial |
$4,242.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,054.04
|
| Rate for Payer: Aetna Managed Medicare |
$380.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,496.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,871.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,726.00
|
| Rate for Payer: Anthem Medicare Advantage |
$380.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,498.42
|
| 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 |
$1,414.20
|
| Rate for Payer: Cash Price |
$1,414.20
|
| Rate for Payer: Cash Price |
$1,414.20
|
| Rate for Payer: Cash Price |
$1,414.20
|
| Rate for Payer: Cigna Commercial |
$4,336.88
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$380.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,637.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$380.12
|
| Rate for Payer: Health EOS Commercial |
$4,195.46
|
| Rate for Payer: HFN Commercial |
$4,336.88
|
| 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 |
$3,771.20
|
| Rate for Payer: NAPHCARE Commercial |
$570.18
|
| Rate for Payer: Preferred Network Access Commercial |
$4,336.88
|
| Rate for Payer: Quartz Beloit One Network |
$2,309.86
|
| Rate for Payer: Quartz Commercial |
$3,064.10
|
| Rate for Payer: Quartz Medicare Advantage |
$380.12
|
| Rate for Payer: The Alliance Commercial |
$1,520.48
|
| Rate for Payer: United Healthcare Medicare Advantage |
$380.12
|
| Rate for Payer: United Healthcare PPO |
$3,022.00
|
| Rate for Payer: WEA Trust Commercial |
$2,592.70
|
| Rate for Payer: Wellcare Medicare |
$380.12
|
| Rate for Payer: WPS Commercial |
$3,491.66
|
|
|
MRI Femur w/ Contrast Bilat
|
Professional
|
Both
|
$4,714.00
|
|
|
Service Code
|
CPT 73719 TC,LT
|
| Hospital Charge Code |
1611067
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,008.80 |
| Max. Negotiated Rate |
$4,478.30 |
| Rate for Payer: Aetna Commercial |
$4,478.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,054.04
|
| Rate for Payer: Cash Price |
$1,414.20
|
| Rate for Payer: Cash Price |
$1,414.20
|
| Rate for Payer: Cash Price |
$1,414.20
|
| Rate for Payer: Cigna Commercial |
$4,478.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,357.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,828.40
|
| Rate for Payer: Health EOS Commercial |
$4,289.74
|
| Rate for Payer: HFN Commercial |
$4,478.30
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,008.80
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,008.80
|
| Rate for Payer: Multiplan Commercial |
$3,771.20
|
| Rate for Payer: Preferred Network Access Commercial |
$4,478.30
|
| Rate for Payer: Quartz Beloit One Network |
$2,074.16
|
| Rate for Payer: Quartz Commercial |
$2,686.98
|
| Rate for Payer: The Alliance Commercial |
$2,357.00
|
| Rate for Payer: WEA Trust Commercial |
$2,592.70
|
| Rate for Payer: WPS Commercial |
$3,491.66
|
|
|
MRI Femur w/ Contrast Bilat
|
Professional
|
Both
|
$9,612.00
|
|
|
Service Code
|
CPT 73719
|
| Hospital Charge Code |
630867
|
| Min. Negotiated Rate |
$1,008.80 |
| Max. Negotiated Rate |
$9,131.40 |
| Rate for Payer: Aetna Commercial |
$9,131.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,266.32
|
| Rate for Payer: Cash Price |
$2,883.60
|
| Rate for Payer: Cash Price |
$2,883.60
|
| Rate for Payer: Cash Price |
$2,883.60
|
| Rate for Payer: Cigna Commercial |
$9,131.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$4,806.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,767.20
|
| Rate for Payer: Health EOS Commercial |
$8,746.92
|
| Rate for Payer: HFN Commercial |
$9,131.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,008.80
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,008.80
|
| Rate for Payer: Multiplan Commercial |
$7,689.60
|
| Rate for Payer: Preferred Network Access Commercial |
$9,131.40
|
| Rate for Payer: Quartz Beloit One Network |
$4,229.28
|
| Rate for Payer: Quartz Commercial |
$5,478.84
|
| Rate for Payer: The Alliance Commercial |
$4,806.00
|
| Rate for Payer: WEA Trust Commercial |
$5,286.60
|
| Rate for Payer: WPS Commercial |
$7,119.61
|
|
|
MRI Femur w/ Contrast Bilat
|
Facility
|
IP
|
$9,612.00
|
|
|
Service Code
|
CPT 73719
|
| Hospital Charge Code |
630867
|
| Min. Negotiated Rate |
$4,709.88 |
| Max. Negotiated Rate |
$8,843.04 |
| Rate for Payer: Aetna Commercial |
$8,650.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,266.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,094.36
|
| Rate for Payer: Cash Price |
$2,883.60
|
| Rate for Payer: Cigna Commercial |
$8,843.04
|
| Rate for Payer: Health EOS Commercial |
$8,554.68
|
| Rate for Payer: HFN Commercial |
$8,843.04
|
| Rate for Payer: Multiplan Commercial |
$7,689.60
|
| Rate for Payer: NAPHCARE Commercial |
$5,767.20
|
| Rate for Payer: Preferred Network Access Commercial |
$8,843.04
|
| Rate for Payer: Quartz Beloit One Network |
$4,709.88
|
| Rate for Payer: Quartz Commercial |
$5,767.20
|
| Rate for Payer: WEA Trust Commercial |
$5,286.60
|
| Rate for Payer: WPS Commercial |
$7,119.61
|
|
|
MRI Femur w/ Contrast Bilat
|
Facility
|
OP
|
$9,612.00
|
|
|
Service Code
|
CPT 73719
|
| Hospital Charge Code |
630867
|
| Min. Negotiated Rate |
$380.12 |
| Max. Negotiated Rate |
$8,843.04 |
| Rate for Payer: Aetna Commercial |
$8,650.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,266.32
|
| Rate for Payer: Aetna Managed Medicare |
$380.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,247.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,806.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,613.76
|
| Rate for Payer: Anthem Medicare Advantage |
$380.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,094.36
|
| 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 |
$2,883.60
|
| Rate for Payer: Cash Price |
$2,883.60
|
| Rate for Payer: Cigna Commercial |
$8,843.04
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$380.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,378.88
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$380.12
|
| Rate for Payer: Health EOS Commercial |
$8,554.68
|
| Rate for Payer: HFN Commercial |
$8,843.04
|
| 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 |
$7,689.60
|
| Rate for Payer: NAPHCARE Commercial |
$570.18
|
| Rate for Payer: Preferred Network Access Commercial |
$8,843.04
|
| Rate for Payer: Quartz Beloit One Network |
$4,709.88
|
| Rate for Payer: Quartz Commercial |
$6,247.80
|
| 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 |
$5,286.60
|
| Rate for Payer: Wellcare Medicare |
$380.12
|
| Rate for Payer: WPS Commercial |
$7,119.61
|
|
|
MRI Femur w/ Contrast Left
|
Facility
|
IP
|
$4,714.00
|
|
|
Service Code
|
CPT 73719 TC,LT
|
| Hospital Charge Code |
1611069
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$2,309.86 |
| Max. Negotiated Rate |
$4,336.88 |
| Rate for Payer: Aetna Commercial |
$4,242.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,054.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,498.42
|
| Rate for Payer: Cash Price |
$1,414.20
|
| Rate for Payer: Cigna Commercial |
$4,336.88
|
| Rate for Payer: Health EOS Commercial |
$4,195.46
|
| Rate for Payer: HFN Commercial |
$4,336.88
|
| Rate for Payer: Multiplan Commercial |
$3,771.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,828.40
|
| Rate for Payer: Preferred Network Access Commercial |
$4,336.88
|
| Rate for Payer: Quartz Beloit One Network |
$2,309.86
|
| Rate for Payer: Quartz Commercial |
$2,828.40
|
| Rate for Payer: WEA Trust Commercial |
$2,592.70
|
| Rate for Payer: WPS Commercial |
$3,491.66
|
|
|
MRI Femur w/ Contrast Left
|
Facility
|
IP
|
$4,806.00
|
|
|
Service Code
|
CPT 73719
|
| Hospital Charge Code |
630869
|
| Min. Negotiated Rate |
$2,354.94 |
| Max. Negotiated Rate |
$4,421.52 |
| Rate for Payer: Aetna Commercial |
$4,325.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,133.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,547.18
|
| Rate for Payer: Cash Price |
$1,441.80
|
| Rate for Payer: Cigna Commercial |
$4,421.52
|
| Rate for Payer: Health EOS Commercial |
$4,277.34
|
| Rate for Payer: HFN Commercial |
$4,421.52
|
| Rate for Payer: Multiplan Commercial |
$3,844.80
|
| Rate for Payer: NAPHCARE Commercial |
$2,883.60
|
| Rate for Payer: Preferred Network Access Commercial |
$4,421.52
|
| Rate for Payer: Quartz Beloit One Network |
$2,354.94
|
| Rate for Payer: Quartz Commercial |
$2,883.60
|
| Rate for Payer: WEA Trust Commercial |
$2,643.30
|
| Rate for Payer: WPS Commercial |
$3,559.80
|
|
|
MRI Femur w/ Contrast Left
|
Facility
|
OP
|
$4,806.00
|
|
|
Service Code
|
CPT 73719
|
| Hospital Charge Code |
630869
|
| Min. Negotiated Rate |
$380.12 |
| Max. Negotiated Rate |
$4,421.52 |
| Rate for Payer: Aetna Commercial |
$4,325.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,133.16
|
| Rate for Payer: Aetna Managed Medicare |
$380.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,123.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,403.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,306.88
|
| Rate for Payer: Anthem Medicare Advantage |
$380.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,547.18
|
| 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 |
$1,441.80
|
| Rate for Payer: Cash Price |
$1,441.80
|
| Rate for Payer: Cigna Commercial |
$4,421.52
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$380.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,689.44
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$380.12
|
| Rate for Payer: Health EOS Commercial |
$4,277.34
|
| Rate for Payer: HFN Commercial |
$4,421.52
|
| 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 |
$3,844.80
|
| Rate for Payer: NAPHCARE Commercial |
$570.18
|
| Rate for Payer: Preferred Network Access Commercial |
$4,421.52
|
| Rate for Payer: Quartz Beloit One Network |
$2,354.94
|
| Rate for Payer: Quartz Commercial |
$3,123.90
|
| 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 |
$2,643.30
|
| Rate for Payer: Wellcare Medicare |
$380.12
|
| Rate for Payer: WPS Commercial |
$3,559.80
|
|
|
MRI Femur w/ Contrast Left
|
Professional
|
Both
|
$4,714.00
|
|
|
Service Code
|
CPT 73719 TC,LT
|
| Hospital Charge Code |
1611069
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,008.80 |
| Max. Negotiated Rate |
$4,478.30 |
| Rate for Payer: Aetna Commercial |
$4,478.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,054.04
|
| Rate for Payer: Cash Price |
$1,414.20
|
| Rate for Payer: Cash Price |
$1,414.20
|
| Rate for Payer: Cash Price |
$1,414.20
|
| Rate for Payer: Cigna Commercial |
$4,478.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,357.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,828.40
|
| Rate for Payer: Health EOS Commercial |
$4,289.74
|
| Rate for Payer: HFN Commercial |
$4,478.30
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,008.80
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,008.80
|
| Rate for Payer: Multiplan Commercial |
$3,771.20
|
| Rate for Payer: Preferred Network Access Commercial |
$4,478.30
|
| Rate for Payer: Quartz Beloit One Network |
$2,074.16
|
| Rate for Payer: Quartz Commercial |
$2,686.98
|
| Rate for Payer: The Alliance Commercial |
$2,357.00
|
| Rate for Payer: WEA Trust Commercial |
$2,592.70
|
| Rate for Payer: WPS Commercial |
$3,491.66
|
|
|
MRI Femur w/ Contrast Left
|
Professional
|
Both
|
$4,806.00
|
|
|
Service Code
|
CPT 73719
|
| Hospital Charge Code |
630869
|
| Min. Negotiated Rate |
$1,008.80 |
| Max. Negotiated Rate |
$4,565.70 |
| Rate for Payer: Aetna Commercial |
$4,565.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,133.16
|
| Rate for Payer: Cash Price |
$1,441.80
|
| Rate for Payer: Cash Price |
$1,441.80
|
| Rate for Payer: Cash Price |
$1,441.80
|
| Rate for Payer: Cigna Commercial |
$4,565.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,403.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,883.60
|
| Rate for Payer: Health EOS Commercial |
$4,373.46
|
| Rate for Payer: HFN Commercial |
$4,565.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,008.80
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,008.80
|
| Rate for Payer: Multiplan Commercial |
$3,844.80
|
| Rate for Payer: Preferred Network Access Commercial |
$4,565.70
|
| Rate for Payer: Quartz Beloit One Network |
$2,114.64
|
| Rate for Payer: Quartz Commercial |
$2,739.42
|
| Rate for Payer: The Alliance Commercial |
$2,403.00
|
| Rate for Payer: WEA Trust Commercial |
$2,643.30
|
| Rate for Payer: WPS Commercial |
$3,559.80
|
|
|
MRI Femur w/ Contrast Left
|
Facility
|
OP
|
$4,714.00
|
|
|
Service Code
|
CPT 73719 TC,LT
|
| Hospital Charge Code |
1611069
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$380.12 |
| Max. Negotiated Rate |
$4,336.88 |
| Rate for Payer: Aetna Commercial |
$4,242.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,054.04
|
| Rate for Payer: Aetna Managed Medicare |
$380.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,496.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,871.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,726.00
|
| Rate for Payer: Anthem Medicare Advantage |
$380.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,498.42
|
| 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 |
$1,414.20
|
| Rate for Payer: Cash Price |
$1,414.20
|
| Rate for Payer: Cash Price |
$1,414.20
|
| Rate for Payer: Cash Price |
$1,414.20
|
| Rate for Payer: Cigna Commercial |
$4,336.88
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$380.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,637.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$380.12
|
| Rate for Payer: Health EOS Commercial |
$4,195.46
|
| Rate for Payer: HFN Commercial |
$4,336.88
|
| 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 |
$3,771.20
|
| Rate for Payer: NAPHCARE Commercial |
$570.18
|
| Rate for Payer: Preferred Network Access Commercial |
$4,336.88
|
| Rate for Payer: Quartz Beloit One Network |
$2,309.86
|
| Rate for Payer: Quartz Commercial |
$3,064.10
|
| Rate for Payer: Quartz Medicare Advantage |
$380.12
|
| Rate for Payer: The Alliance Commercial |
$1,520.48
|
| Rate for Payer: United Healthcare Medicare Advantage |
$380.12
|
| Rate for Payer: United Healthcare PPO |
$3,022.00
|
| Rate for Payer: WEA Trust Commercial |
$2,592.70
|
| Rate for Payer: Wellcare Medicare |
$380.12
|
| Rate for Payer: WPS Commercial |
$3,491.66
|
|
|
MRI Femur w/ Contrast Right
|
Facility
|
IP
|
$4,806.00
|
|
|
Service Code
|
CPT 73719
|
| Hospital Charge Code |
630871
|
| Min. Negotiated Rate |
$2,354.94 |
| Max. Negotiated Rate |
$4,421.52 |
| Rate for Payer: Aetna Commercial |
$4,325.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,133.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,547.18
|
| Rate for Payer: Cash Price |
$1,441.80
|
| Rate for Payer: Cigna Commercial |
$4,421.52
|
| Rate for Payer: Health EOS Commercial |
$4,277.34
|
| Rate for Payer: HFN Commercial |
$4,421.52
|
| Rate for Payer: Multiplan Commercial |
$3,844.80
|
| Rate for Payer: NAPHCARE Commercial |
$2,883.60
|
| Rate for Payer: Preferred Network Access Commercial |
$4,421.52
|
| Rate for Payer: Quartz Beloit One Network |
$2,354.94
|
| Rate for Payer: Quartz Commercial |
$2,883.60
|
| Rate for Payer: WEA Trust Commercial |
$2,643.30
|
| Rate for Payer: WPS Commercial |
$3,559.80
|
|
