|
MRI Abdomen w/ Contrast
|
Facility
|
IP
|
$6,850.00
|
|
|
Service Code
|
CPT 74182 TC
|
| Hospital Charge Code |
1610904
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$3,490.76 |
| Max. Negotiated Rate |
$6,554.08 |
| Rate for Payer: Aetna Commercial |
$6,411.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,126.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,775.72
|
| Rate for Payer: Cash Price |
$2,055.00
|
| Rate for Payer: Cigna Commercial |
$6,554.08
|
| Rate for Payer: Health EOS Commercial |
$6,340.36
|
| Rate for Payer: HFN Commercial |
$6,554.08
|
| Rate for Payer: Multiplan Commercial |
$5,699.20
|
| Rate for Payer: Preferred Network Access Commercial |
$6,554.08
|
| Rate for Payer: Quartz Beloit One Network |
$3,490.76
|
| Rate for Payer: Quartz Commercial |
$4,274.40
|
| Rate for Payer: WEA Trust Commercial |
$3,918.20
|
| Rate for Payer: WPS Commercial |
$5,276.56
|
|
|
MRI Abdomen w/ Contrast
|
Professional
|
Both
|
$4,890.00
|
|
|
Service Code
|
CPT 74182
|
| Hospital Charge Code |
625606
|
| Min. Negotiated Rate |
$298.93 |
| Max. Negotiated Rate |
$4,831.32 |
| Rate for Payer: Aetna Commercial |
$4,831.32
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,373.62
|
| Rate for Payer: Aetna Managed Medicare |
$298.93
|
| Rate for Payer: Anthem Medicare Advantage |
$298.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$298.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$298.93
|
| Rate for Payer: Cash Price |
$1,467.00
|
| Rate for Payer: Cash Price |
$1,467.00
|
| Rate for Payer: Cash Price |
$1,467.00
|
| Rate for Payer: Cigna Commercial |
$4,831.32
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,542.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$298.93
|
| Rate for Payer: Health EOS Commercial |
$4,627.90
|
| Rate for Payer: HFN Commercial |
$4,831.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,214.06
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,214.06
|
| Rate for Payer: Independent Care Health Plan Medicare |
$298.93
|
| Rate for Payer: Multiplan Commercial |
$4,068.48
|
| Rate for Payer: NAPHCARE Commercial |
$448.39
|
| Rate for Payer: Preferred Network Access Commercial |
$4,831.32
|
| Rate for Payer: Quartz Beloit One Network |
$2,237.66
|
| Rate for Payer: Quartz Commercial |
$2,898.79
|
| Rate for Payer: Quartz Medicare Advantage |
$298.93
|
| Rate for Payer: The Alliance Commercial |
$1,135.92
|
| Rate for Payer: United Healthcare Medicare Advantage |
$298.93
|
| Rate for Payer: WEA Trust Commercial |
$2,797.08
|
| Rate for Payer: WPS Commercial |
$1,494.64
|
|
|
MRI Abdomen w/ Contrast
|
Facility
|
OP
|
$4,890.00
|
|
|
Service Code
|
CPT 74182
|
| Hospital Charge Code |
625606
|
| Min. Negotiated Rate |
$367.15 |
| Max. Negotiated Rate |
$4,678.75 |
| Rate for Payer: Aetna Commercial |
$4,577.04
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,373.62
|
| Rate for Payer: Aetna Managed Medicare |
$367.15
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,305.64
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,542.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,441.09
|
| Rate for Payer: Anthem Medicare Advantage |
$367.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,695.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$367.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$367.15
|
| Rate for Payer: Cash Price |
$1,467.00
|
| Rate for Payer: Cash Price |
$1,467.00
|
| Rate for Payer: Cigna Commercial |
$4,678.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$367.15
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,845.98
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$367.15
|
| Rate for Payer: Health EOS Commercial |
$4,526.18
|
| Rate for Payer: HFN Commercial |
$4,678.75
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,365.80
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$367.15
|
| Rate for Payer: Independent Care Health Plan Medicare |
$367.15
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$367.15
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$367.15
|
| Rate for Payer: Multiplan Commercial |
$4,068.48
|
| Rate for Payer: NAPHCARE Commercial |
$550.73
|
| Rate for Payer: Preferred Network Access Commercial |
$4,678.75
|
| Rate for Payer: Quartz Beloit One Network |
$2,491.94
|
| Rate for Payer: Quartz Commercial |
$3,305.64
|
| Rate for Payer: Quartz Medicare Advantage |
$367.15
|
| Rate for Payer: The Alliance Commercial |
$1,468.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$367.15
|
| Rate for Payer: WEA Trust Commercial |
$2,797.08
|
| Rate for Payer: Wellcare Medicare |
$367.15
|
| Rate for Payer: WPS Commercial |
$3,766.77
|
|
|
MRI Abdomen w/o Contrast
|
Facility
|
OP
|
$4,014.00
|
|
|
Service Code
|
CPT 74181
|
| Hospital Charge Code |
625612
|
| Min. Negotiated Rate |
$251.10 |
| Max. Negotiated Rate |
$3,840.60 |
| Rate for Payer: Aetna Commercial |
$3,757.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,590.12
|
| Rate for Payer: Aetna Managed Medicare |
$251.10
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,713.46
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,087.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,003.79
|
| Rate for Payer: Anthem Medicare Advantage |
$251.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,212.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$251.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$251.10
|
| Rate for Payer: Cash Price |
$1,204.20
|
| Rate for Payer: Cash Price |
$1,204.20
|
| Rate for Payer: Cigna Commercial |
$3,840.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$251.10
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,336.15
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$251.10
|
| Rate for Payer: Health EOS Commercial |
$3,715.36
|
| Rate for Payer: HFN Commercial |
$3,840.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$934.08
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$251.10
|
| Rate for Payer: Independent Care Health Plan Medicare |
$251.10
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$251.10
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$251.10
|
| Rate for Payer: Multiplan Commercial |
$3,339.65
|
| Rate for Payer: NAPHCARE Commercial |
$376.65
|
| Rate for Payer: Preferred Network Access Commercial |
$3,840.60
|
| Rate for Payer: Quartz Beloit One Network |
$2,045.53
|
| Rate for Payer: Quartz Commercial |
$2,713.46
|
| Rate for Payer: Quartz Medicare Advantage |
$251.10
|
| Rate for Payer: The Alliance Commercial |
$1,004.39
|
| Rate for Payer: United Healthcare Medicare Advantage |
$251.10
|
| Rate for Payer: WEA Trust Commercial |
$2,296.01
|
| Rate for Payer: Wellcare Medicare |
$251.10
|
| Rate for Payer: WPS Commercial |
$3,091.98
|
|
|
MRI Abdomen w/o Contrast
|
Professional
|
Both
|
$4,014.00
|
|
|
Service Code
|
CPT 74181
|
| Hospital Charge Code |
625612
|
| Min. Negotiated Rate |
$193.06 |
| Max. Negotiated Rate |
$3,965.83 |
| Rate for Payer: Aetna Commercial |
$3,965.83
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,590.12
|
| Rate for Payer: Aetna Managed Medicare |
$193.06
|
| Rate for Payer: Anthem Medicare Advantage |
$193.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$193.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$193.06
|
| Rate for Payer: Cash Price |
$1,204.20
|
| Rate for Payer: Cash Price |
$1,204.20
|
| Rate for Payer: Cash Price |
$1,204.20
|
| Rate for Payer: Cigna Commercial |
$3,965.83
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,087.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$193.06
|
| Rate for Payer: Health EOS Commercial |
$3,798.85
|
| Rate for Payer: HFN Commercial |
$3,965.83
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$776.13
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$776.13
|
| Rate for Payer: Independent Care Health Plan Medicare |
$193.06
|
| Rate for Payer: Multiplan Commercial |
$3,339.65
|
| Rate for Payer: NAPHCARE Commercial |
$289.58
|
| Rate for Payer: Preferred Network Access Commercial |
$3,965.83
|
| Rate for Payer: Quartz Beloit One Network |
$1,836.81
|
| Rate for Payer: Quartz Commercial |
$2,379.50
|
| Rate for Payer: Quartz Medicare Advantage |
$193.06
|
| Rate for Payer: The Alliance Commercial |
$733.61
|
| Rate for Payer: United Healthcare Medicare Advantage |
$193.06
|
| Rate for Payer: WEA Trust Commercial |
$2,296.01
|
| Rate for Payer: WPS Commercial |
$965.28
|
|
|
MRI Abdomen w/o Contrast
|
Facility
|
IP
|
$4,014.00
|
|
|
Service Code
|
CPT 74181
|
| Hospital Charge Code |
625612
|
| Min. Negotiated Rate |
$2,045.53 |
| Max. Negotiated Rate |
$3,840.60 |
| Rate for Payer: Aetna Commercial |
$3,757.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,590.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,212.52
|
| Rate for Payer: Cash Price |
$1,204.20
|
| Rate for Payer: Cigna Commercial |
$3,840.60
|
| Rate for Payer: Health EOS Commercial |
$3,715.36
|
| Rate for Payer: HFN Commercial |
$3,840.60
|
| Rate for Payer: Multiplan Commercial |
$3,339.65
|
| Rate for Payer: Preferred Network Access Commercial |
$3,840.60
|
| Rate for Payer: Quartz Beloit One Network |
$2,045.53
|
| Rate for Payer: Quartz Commercial |
$2,504.74
|
| Rate for Payer: WEA Trust Commercial |
$2,296.01
|
| Rate for Payer: WPS Commercial |
$3,091.98
|
|
|
MRI Abdomen w/o Contrast
|
Facility
|
OP
|
$4,014.00
|
|
|
Service Code
|
CPT 74181 TC
|
| Hospital Charge Code |
1610906
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$505.36 |
| Max. Negotiated Rate |
$3,840.60 |
| Rate for Payer: Aetna Commercial |
$3,757.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,590.12
|
| Rate for Payer: Aetna Managed Medicare |
$1,168.88
|
| 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 |
$2,212.52
|
| Rate for Payer: Cash Price |
$1,204.20
|
| Rate for Payer: Cash Price |
$1,204.20
|
| Rate for Payer: Cash Price |
$1,204.20
|
| Rate for Payer: Cash Price |
$1,204.20
|
| Rate for Payer: Cigna Commercial |
$3,840.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,336.15
|
| Rate for Payer: Health EOS Commercial |
$3,715.36
|
| Rate for Payer: HFN Commercial |
$3,840.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,130.92
|
| Rate for Payer: Multiplan Commercial |
$3,339.65
|
| Rate for Payer: NAPHCARE Commercial |
$2,504.74
|
| Rate for Payer: Preferred Network Access Commercial |
$3,840.60
|
| Rate for Payer: Quartz Beloit One Network |
$2,045.53
|
| Rate for Payer: Quartz Commercial |
$2,713.46
|
| Rate for Payer: Quartz Medicare Advantage |
$2,504.74
|
| Rate for Payer: The Alliance Commercial |
$505.36
|
| Rate for Payer: United Healthcare PPO |
$3,142.88
|
| Rate for Payer: WEA Trust Commercial |
$2,296.01
|
| Rate for Payer: WPS Commercial |
$884.37
|
|
|
MRI Abdomen w/o Contrast
|
Facility
|
IP
|
$4,014.00
|
|
|
Service Code
|
CPT 74181 TC
|
| Hospital Charge Code |
1610906
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$2,045.53 |
| Max. Negotiated Rate |
$3,840.60 |
| Rate for Payer: Aetna Commercial |
$3,757.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,590.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,212.52
|
| Rate for Payer: Cash Price |
$1,204.20
|
| Rate for Payer: Cigna Commercial |
$3,840.60
|
| Rate for Payer: Health EOS Commercial |
$3,715.36
|
| Rate for Payer: HFN Commercial |
$3,840.60
|
| Rate for Payer: Multiplan Commercial |
$3,339.65
|
| Rate for Payer: Preferred Network Access Commercial |
$3,840.60
|
| Rate for Payer: Quartz Beloit One Network |
$2,045.53
|
| Rate for Payer: Quartz Commercial |
$2,504.74
|
| Rate for Payer: WEA Trust Commercial |
$2,296.01
|
| Rate for Payer: WPS Commercial |
$3,091.98
|
|
|
MRI Abdomen w/o Contrast
|
Professional
|
Both
|
$4,014.00
|
|
|
Service Code
|
CPT 74181 TC
|
| Hospital Charge Code |
1610906
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$126.34 |
| Max. Negotiated Rate |
$3,965.83 |
| Rate for Payer: Aetna Commercial |
$3,965.83
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,590.12
|
| Rate for Payer: Aetna Managed Medicare |
$126.34
|
| Rate for Payer: Anthem Medicare Advantage |
$126.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$126.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$126.34
|
| Rate for Payer: Cash Price |
$1,204.20
|
| Rate for Payer: Cash Price |
$1,204.20
|
| Rate for Payer: Cash Price |
$1,204.20
|
| Rate for Payer: Cigna Commercial |
$3,965.83
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,087.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$126.34
|
| Rate for Payer: Health EOS Commercial |
$3,798.85
|
| Rate for Payer: HFN Commercial |
$3,965.83
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$524.07
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$524.07
|
| Rate for Payer: Independent Care Health Plan Medicare |
$126.34
|
| Rate for Payer: Multiplan Commercial |
$3,339.65
|
| Rate for Payer: NAPHCARE Commercial |
$189.51
|
| Rate for Payer: Preferred Network Access Commercial |
$3,965.83
|
| Rate for Payer: Quartz Beloit One Network |
$1,836.81
|
| Rate for Payer: Quartz Commercial |
$2,379.50
|
| Rate for Payer: Quartz Medicare Advantage |
$126.34
|
| Rate for Payer: The Alliance Commercial |
$480.09
|
| Rate for Payer: United Healthcare Medicare Advantage |
$126.34
|
| Rate for Payer: WEA Trust Commercial |
$2,296.01
|
| Rate for Payer: WPS Commercial |
$631.70
|
|
|
MRI Abdomen w/ + w/o Contrast
|
Facility
|
OP
|
$6,365.00
|
|
|
Service Code
|
CPT 74183 TC
|
| Hospital Charge Code |
1610902
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$931.76 |
| Max. Negotiated Rate |
$6,090.03 |
| Rate for Payer: Aetna Commercial |
$5,957.64
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,692.86
|
| Rate for Payer: Aetna Managed Medicare |
$1,853.49
|
| 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 |
$3,508.39
|
| 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: Cash Price |
$1,909.50
|
| Rate for Payer: Cigna Commercial |
$6,090.03
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,704.43
|
| Rate for Payer: Health EOS Commercial |
$5,891.44
|
| Rate for Payer: HFN Commercial |
$6,090.03
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,964.70
|
| Rate for Payer: Multiplan Commercial |
$5,295.68
|
| Rate for Payer: NAPHCARE Commercial |
$3,971.76
|
| Rate for Payer: Preferred Network Access Commercial |
$6,090.03
|
| Rate for Payer: Quartz Beloit One Network |
$3,243.60
|
| Rate for Payer: Quartz Commercial |
$4,302.74
|
| Rate for Payer: Quartz Medicare Advantage |
$3,971.76
|
| Rate for Payer: The Alliance Commercial |
$931.76
|
| Rate for Payer: United Healthcare PPO |
$3,142.88
|
| Rate for Payer: WEA Trust Commercial |
$3,640.78
|
| Rate for Payer: WPS Commercial |
$1,630.57
|
|
|
MRI Abdomen w/ + w/o Contrast
|
Facility
|
IP
|
$5,795.00
|
|
|
Service Code
|
CPT 74183
|
| Hospital Charge Code |
625604
|
| Min. Negotiated Rate |
$2,953.13 |
| Max. Negotiated Rate |
$5,544.66 |
| Rate for Payer: Aetna Commercial |
$5,424.12
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,183.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,194.20
|
| Rate for Payer: Cash Price |
$1,738.50
|
| Rate for Payer: Cigna Commercial |
$5,544.66
|
| Rate for Payer: Health EOS Commercial |
$5,363.85
|
| Rate for Payer: HFN Commercial |
$5,544.66
|
| Rate for Payer: Multiplan Commercial |
$4,821.44
|
| Rate for Payer: Preferred Network Access Commercial |
$5,544.66
|
| Rate for Payer: Quartz Beloit One Network |
$2,953.13
|
| Rate for Payer: Quartz Commercial |
$3,616.08
|
| Rate for Payer: WEA Trust Commercial |
$3,314.74
|
| Rate for Payer: WPS Commercial |
$4,463.89
|
|
|
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 |
$3,243.60 |
| Max. Negotiated Rate |
$6,090.03 |
| Rate for Payer: Aetna Commercial |
$5,957.64
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,692.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,508.39
|
| Rate for Payer: Cash Price |
$1,909.50
|
| Rate for Payer: Cigna Commercial |
$6,090.03
|
| Rate for Payer: Health EOS Commercial |
$5,891.44
|
| Rate for Payer: HFN Commercial |
$6,090.03
|
| Rate for Payer: Multiplan Commercial |
$5,295.68
|
| Rate for Payer: Preferred Network Access Commercial |
$6,090.03
|
| Rate for Payer: Quartz Beloit One Network |
$3,243.60
|
| Rate for Payer: Quartz Commercial |
$3,971.76
|
| Rate for Payer: WEA Trust Commercial |
$3,640.78
|
| Rate for Payer: WPS Commercial |
$4,902.96
|
|
|
MRI Abdomen w/ + w/o Contrast
|
Professional
|
Both
|
$5,795.00
|
|
|
Service Code
|
CPT 74183
|
| Hospital Charge Code |
625604
|
| Min. Negotiated Rate |
$334.30 |
| Max. Negotiated Rate |
$5,725.46 |
| Rate for Payer: Aetna Commercial |
$5,725.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,183.05
|
| Rate for Payer: Aetna Managed Medicare |
$334.30
|
| Rate for Payer: Anthem Medicare Advantage |
$334.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$334.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$334.30
|
| 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 |
$5,725.46
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$3,013.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$334.30
|
| Rate for Payer: Health EOS Commercial |
$5,484.39
|
| Rate for Payer: HFN Commercial |
$5,725.46
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,354.31
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,354.31
|
| Rate for Payer: Independent Care Health Plan Medicare |
$334.30
|
| Rate for Payer: Multiplan Commercial |
$4,821.44
|
| Rate for Payer: NAPHCARE Commercial |
$501.45
|
| Rate for Payer: Preferred Network Access Commercial |
$5,725.46
|
| Rate for Payer: Quartz Beloit One Network |
$2,651.79
|
| Rate for Payer: Quartz Commercial |
$3,435.28
|
| Rate for Payer: Quartz Medicare Advantage |
$334.30
|
| Rate for Payer: The Alliance Commercial |
$1,270.33
|
| Rate for Payer: United Healthcare Medicare Advantage |
$334.30
|
| Rate for Payer: WEA Trust Commercial |
$3,314.74
|
| Rate for Payer: WPS Commercial |
$1,671.49
|
|
|
MRI Abdomen w/ + w/o Contrast
|
Facility
|
OP
|
$5,795.00
|
|
|
Service Code
|
CPT 74183
|
| Hospital Charge Code |
625604
|
| Min. Negotiated Rate |
$367.15 |
| Max. Negotiated Rate |
$5,544.66 |
| Rate for Payer: Aetna Commercial |
$5,424.12
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,183.05
|
| Rate for Payer: Aetna Managed Medicare |
$367.15
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,917.42
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,013.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,892.86
|
| Rate for Payer: Anthem Medicare Advantage |
$367.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,194.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$367.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$367.15
|
| Rate for Payer: Cash Price |
$1,738.50
|
| Rate for Payer: Cash Price |
$1,738.50
|
| Rate for Payer: Cigna Commercial |
$5,544.66
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$367.15
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,372.69
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$367.15
|
| Rate for Payer: Health EOS Commercial |
$5,363.85
|
| Rate for Payer: HFN Commercial |
$5,544.66
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,365.80
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$367.15
|
| Rate for Payer: Independent Care Health Plan Medicare |
$367.15
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$367.15
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$367.15
|
| Rate for Payer: Multiplan Commercial |
$4,821.44
|
| Rate for Payer: NAPHCARE Commercial |
$550.73
|
| Rate for Payer: Preferred Network Access Commercial |
$5,544.66
|
| Rate for Payer: Quartz Beloit One Network |
$2,953.13
|
| Rate for Payer: Quartz Commercial |
$3,917.42
|
| Rate for Payer: Quartz Medicare Advantage |
$367.15
|
| Rate for Payer: The Alliance Commercial |
$1,468.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$367.15
|
| Rate for Payer: WEA Trust Commercial |
$3,314.74
|
| Rate for Payer: Wellcare Medicare |
$367.15
|
| Rate for Payer: WPS Commercial |
$4,463.89
|
|
|
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 |
$232.94 |
| Max. Negotiated Rate |
$6,288.62 |
| Rate for Payer: Aetna Commercial |
$6,288.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,692.86
|
| Rate for Payer: Aetna Managed Medicare |
$232.94
|
| Rate for Payer: Anthem Medicare Advantage |
$232.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$232.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$232.94
|
| 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 |
$6,288.62
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$3,309.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$232.94
|
| Rate for Payer: Health EOS Commercial |
$6,023.84
|
| Rate for Payer: HFN Commercial |
$6,288.62
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$973.38
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$973.38
|
| Rate for Payer: Independent Care Health Plan Medicare |
$232.94
|
| Rate for Payer: Multiplan Commercial |
$5,295.68
|
| Rate for Payer: NAPHCARE Commercial |
$349.41
|
| Rate for Payer: Preferred Network Access Commercial |
$6,288.62
|
| Rate for Payer: Quartz Beloit One Network |
$2,912.62
|
| Rate for Payer: Quartz Commercial |
$3,773.17
|
| Rate for Payer: Quartz Medicare Advantage |
$232.94
|
| Rate for Payer: The Alliance Commercial |
$885.17
|
| Rate for Payer: United Healthcare Medicare Advantage |
$232.94
|
| Rate for Payer: WEA Trust Commercial |
$3,640.78
|
| Rate for Payer: WPS Commercial |
$1,164.70
|
|
|
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 |
$1,452.51 |
| Max. Negotiated Rate |
$4,772.52 |
| Rate for Payer: Aetna Commercial |
$4,668.77
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,461.27
|
| Rate for Payer: Aetna Managed Medicare |
$1,452.51
|
| 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 |
$2,749.39
|
| 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 |
$4,772.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,903.02
|
| Rate for Payer: Health EOS Commercial |
$4,616.89
|
| Rate for Payer: HFN Commercial |
$4,772.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,890.64
|
| Rate for Payer: Multiplan Commercial |
$4,150.02
|
| Rate for Payer: NAPHCARE Commercial |
$3,112.51
|
| Rate for Payer: Preferred Network Access Commercial |
$4,772.52
|
| Rate for Payer: Quartz Beloit One Network |
$2,541.88
|
| Rate for Payer: Quartz Commercial |
$3,371.89
|
| Rate for Payer: Quartz Medicare Advantage |
$3,112.51
|
| Rate for Payer: The Alliance Commercial |
$2,593.76
|
| Rate for Payer: United Healthcare PPO |
$3,142.88
|
| Rate for Payer: WEA Trust Commercial |
$2,853.14
|
| Rate for Payer: WPS Commercial |
$3,842.26
|
|
|
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 |
$1,271.19 |
| Max. Negotiated Rate |
$4,928.14 |
| Rate for Payer: Aetna Commercial |
$4,928.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,461.27
|
| 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 |
$4,928.14
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,593.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,112.51
|
| Rate for Payer: Health EOS Commercial |
$4,720.64
|
| Rate for Payer: HFN Commercial |
$4,928.14
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,271.19
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,271.19
|
| Rate for Payer: Multiplan Commercial |
$4,150.02
|
| Rate for Payer: Preferred Network Access Commercial |
$4,928.14
|
| Rate for Payer: Quartz Beloit One Network |
$2,282.51
|
| Rate for Payer: Quartz Commercial |
$2,956.89
|
| Rate for Payer: The Alliance Commercial |
$2,593.76
|
| Rate for Payer: WEA Trust Commercial |
$2,853.14
|
| Rate for Payer: WPS Commercial |
$3,842.26
|
|
|
MRI Ankle w/ Contrast Bilateral
|
Professional
|
Both
|
$10,169.00
|
|
|
Service Code
|
CPT 73722
|
| Hospital Charge Code |
625704
|
| Min. Negotiated Rate |
$313.63 |
| Max. Negotiated Rate |
$10,046.97 |
| Rate for Payer: Aetna Commercial |
$10,046.97
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,095.15
|
| Rate for Payer: Aetna Managed Medicare |
$313.63
|
| Rate for Payer: Anthem Medicare Advantage |
$313.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$313.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$313.63
|
| 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 |
$10,046.97
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$5,287.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$313.63
|
| Rate for Payer: Health EOS Commercial |
$9,623.94
|
| Rate for Payer: HFN Commercial |
$10,046.97
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,271.19
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,271.19
|
| Rate for Payer: Independent Care Health Plan Medicare |
$313.63
|
| Rate for Payer: Multiplan Commercial |
$8,460.61
|
| Rate for Payer: NAPHCARE Commercial |
$470.45
|
| Rate for Payer: Preferred Network Access Commercial |
$10,046.97
|
| Rate for Payer: Quartz Beloit One Network |
$4,653.33
|
| Rate for Payer: Quartz Commercial |
$6,028.18
|
| Rate for Payer: Quartz Medicare Advantage |
$313.63
|
| Rate for Payer: The Alliance Commercial |
$1,191.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$313.63
|
| Rate for Payer: WEA Trust Commercial |
$5,816.67
|
| Rate for Payer: WPS Commercial |
$1,568.16
|
|
|
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 |
$2,541.88 |
| Max. Negotiated Rate |
$4,772.52 |
| Rate for Payer: Aetna Commercial |
$4,668.77
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,461.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,749.39
|
| Rate for Payer: Cash Price |
$1,496.40
|
| Rate for Payer: Cigna Commercial |
$4,772.52
|
| Rate for Payer: Health EOS Commercial |
$4,616.89
|
| Rate for Payer: HFN Commercial |
$4,772.52
|
| Rate for Payer: Multiplan Commercial |
$4,150.02
|
| Rate for Payer: Preferred Network Access Commercial |
$4,772.52
|
| Rate for Payer: Quartz Beloit One Network |
$2,541.88
|
| Rate for Payer: Quartz Commercial |
$3,112.51
|
| Rate for Payer: WEA Trust Commercial |
$2,853.14
|
| Rate for Payer: WPS Commercial |
$3,842.26
|
|
|
MRI Ankle w/ Contrast Bilateral
|
Facility
|
IP
|
$10,169.00
|
|
|
Service Code
|
CPT 73722
|
| Hospital Charge Code |
625704
|
| Min. Negotiated Rate |
$5,182.12 |
| Max. Negotiated Rate |
$9,729.70 |
| Rate for Payer: Aetna Commercial |
$9,518.18
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,095.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,605.15
|
| Rate for Payer: Cash Price |
$3,050.70
|
| Rate for Payer: Cigna Commercial |
$9,729.70
|
| Rate for Payer: Health EOS Commercial |
$9,412.43
|
| Rate for Payer: HFN Commercial |
$9,729.70
|
| Rate for Payer: Multiplan Commercial |
$8,460.61
|
| Rate for Payer: Preferred Network Access Commercial |
$9,729.70
|
| Rate for Payer: Quartz Beloit One Network |
$5,182.12
|
| Rate for Payer: Quartz Commercial |
$6,345.46
|
| Rate for Payer: WEA Trust Commercial |
$5,816.67
|
| Rate for Payer: WPS Commercial |
$7,833.18
|
|
|
MRI Ankle w/ Contrast Bilateral
|
Facility
|
OP
|
$10,169.00
|
|
|
Service Code
|
CPT 73722
|
| Hospital Charge Code |
625704
|
| Min. Negotiated Rate |
$824.99 |
| Max. Negotiated Rate |
$9,729.70 |
| Rate for Payer: Aetna Commercial |
$9,518.18
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,095.15
|
| Rate for Payer: Aetna Managed Medicare |
$824.99
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,874.24
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,287.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,076.36
|
| Rate for Payer: Anthem Medicare Advantage |
$824.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,605.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$824.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$824.99
|
| Rate for Payer: Cash Price |
$3,050.70
|
| Rate for Payer: Cash Price |
$3,050.70
|
| Rate for Payer: Cigna Commercial |
$9,729.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$824.99
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,918.36
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$824.99
|
| Rate for Payer: Health EOS Commercial |
$9,412.43
|
| Rate for Payer: HFN Commercial |
$9,729.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,068.96
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$824.99
|
| Rate for Payer: Independent Care Health Plan Medicare |
$824.99
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$824.99
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$824.99
|
| Rate for Payer: Multiplan Commercial |
$8,460.61
|
| Rate for Payer: NAPHCARE Commercial |
$1,237.49
|
| Rate for Payer: Preferred Network Access Commercial |
$9,729.70
|
| Rate for Payer: Quartz Beloit One Network |
$5,182.12
|
| Rate for Payer: Quartz Commercial |
$6,874.24
|
| Rate for Payer: Quartz Medicare Advantage |
$824.99
|
| Rate for Payer: The Alliance Commercial |
$3,299.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$824.99
|
| Rate for Payer: WEA Trust Commercial |
$5,816.67
|
| Rate for Payer: Wellcare Medicare |
$824.99
|
| Rate for Payer: WPS Commercial |
$7,833.18
|
|
|
MRI Ankle w/ Contrast Left
|
Facility
|
OP
|
$5,085.00
|
|
|
Service Code
|
CPT 73722
|
| Hospital Charge Code |
625706
|
| Min. Negotiated Rate |
$824.99 |
| Max. Negotiated Rate |
$4,865.33 |
| Rate for Payer: Aetna Commercial |
$4,759.56
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,548.02
|
| Rate for Payer: Aetna Managed Medicare |
$824.99
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,437.46
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,644.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,538.43
|
| Rate for Payer: Anthem Medicare Advantage |
$824.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,802.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$824.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$824.99
|
| Rate for Payer: Cash Price |
$1,525.50
|
| Rate for Payer: Cash Price |
$1,525.50
|
| Rate for Payer: Cigna Commercial |
$4,865.33
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$824.99
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,959.47
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$824.99
|
| Rate for Payer: Health EOS Commercial |
$4,706.68
|
| Rate for Payer: HFN Commercial |
$4,865.33
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,068.96
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$824.99
|
| Rate for Payer: Independent Care Health Plan Medicare |
$824.99
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$824.99
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$824.99
|
| Rate for Payer: Multiplan Commercial |
$4,230.72
|
| Rate for Payer: NAPHCARE Commercial |
$1,237.49
|
| Rate for Payer: Preferred Network Access Commercial |
$4,865.33
|
| Rate for Payer: Quartz Beloit One Network |
$2,591.32
|
| Rate for Payer: Quartz Commercial |
$3,437.46
|
| Rate for Payer: Quartz Medicare Advantage |
$824.99
|
| Rate for Payer: The Alliance Commercial |
$3,299.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$824.99
|
| Rate for Payer: WEA Trust Commercial |
$2,908.62
|
| Rate for Payer: Wellcare Medicare |
$824.99
|
| Rate for Payer: WPS Commercial |
$3,916.98
|
|
|
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 |
$1,271.19 |
| Max. Negotiated Rate |
$4,928.14 |
| Rate for Payer: Aetna Commercial |
$4,928.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,461.27
|
| 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 |
$4,928.14
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,593.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,112.51
|
| Rate for Payer: Health EOS Commercial |
$4,720.64
|
| Rate for Payer: HFN Commercial |
$4,928.14
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,271.19
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,271.19
|
| Rate for Payer: Multiplan Commercial |
$4,150.02
|
| Rate for Payer: Preferred Network Access Commercial |
$4,928.14
|
| Rate for Payer: Quartz Beloit One Network |
$2,282.51
|
| Rate for Payer: Quartz Commercial |
$2,956.89
|
| Rate for Payer: The Alliance Commercial |
$2,593.76
|
| Rate for Payer: WEA Trust Commercial |
$2,853.14
|
| Rate for Payer: WPS Commercial |
$3,842.26
|
|
|
MRI Ankle w/ Contrast Left
|
Facility
|
IP
|
$5,085.00
|
|
|
Service Code
|
CPT 73722
|
| Hospital Charge Code |
625706
|
| Min. Negotiated Rate |
$2,591.32 |
| Max. Negotiated Rate |
$4,865.33 |
| Rate for Payer: Aetna Commercial |
$4,759.56
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,548.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,802.85
|
| Rate for Payer: Cash Price |
$1,525.50
|
| Rate for Payer: Cigna Commercial |
$4,865.33
|
| Rate for Payer: Health EOS Commercial |
$4,706.68
|
| Rate for Payer: HFN Commercial |
$4,865.33
|
| Rate for Payer: Multiplan Commercial |
$4,230.72
|
| Rate for Payer: Preferred Network Access Commercial |
$4,865.33
|
| Rate for Payer: Quartz Beloit One Network |
$2,591.32
|
| Rate for Payer: Quartz Commercial |
$3,173.04
|
| Rate for Payer: WEA Trust Commercial |
$2,908.62
|
| Rate for Payer: WPS Commercial |
$3,916.98
|
|
|
MRI Ankle w/ Contrast Left
|
Professional
|
Both
|
$5,085.00
|
|
|
Service Code
|
CPT 73722
|
| Hospital Charge Code |
625706
|
| Min. Negotiated Rate |
$313.63 |
| Max. Negotiated Rate |
$5,023.98 |
| Rate for Payer: Aetna Commercial |
$5,023.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,548.02
|
| Rate for Payer: Aetna Managed Medicare |
$313.63
|
| Rate for Payer: Anthem Medicare Advantage |
$313.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$313.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$313.63
|
| 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 |
$5,023.98
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,644.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$313.63
|
| Rate for Payer: Health EOS Commercial |
$4,812.44
|
| Rate for Payer: HFN Commercial |
$5,023.98
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,271.19
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,271.19
|
| Rate for Payer: Independent Care Health Plan Medicare |
$313.63
|
| Rate for Payer: Multiplan Commercial |
$4,230.72
|
| Rate for Payer: NAPHCARE Commercial |
$470.45
|
| Rate for Payer: Preferred Network Access Commercial |
$5,023.98
|
| Rate for Payer: Quartz Beloit One Network |
$2,326.90
|
| Rate for Payer: Quartz Commercial |
$3,014.39
|
| Rate for Payer: Quartz Medicare Advantage |
$313.63
|
| Rate for Payer: The Alliance Commercial |
$1,191.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$313.63
|
| Rate for Payer: WEA Trust Commercial |
$2,908.62
|
| Rate for Payer: WPS Commercial |
$1,568.16
|
|
