|
MRI Hand w/ + w/o Contrast Left
|
Facility
|
OP
|
$5,767.00
|
|
|
Service Code
|
CPT 73220
|
| Hospital Charge Code |
630953
|
| Min. Negotiated Rate |
$380.12 |
| Max. Negotiated Rate |
$5,305.64 |
| Rate for Payer: Aetna Commercial |
$5,190.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,959.62
|
| Rate for Payer: Aetna Managed Medicare |
$380.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,748.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,883.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,768.16
|
| Rate for Payer: Anthem Medicare Advantage |
$380.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,056.51
|
| 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 |
$1,730.10
|
| Rate for Payer: Cash Price |
$1,730.10
|
| Rate for Payer: Cigna Commercial |
$5,305.64
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$380.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,227.21
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$380.12
|
| Rate for Payer: Health EOS Commercial |
$5,132.63
|
| Rate for Payer: HFN Commercial |
$5,305.64
|
| 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 |
$4,613.60
|
| Rate for Payer: NAPHCARE Commercial |
$570.18
|
| Rate for Payer: Preferred Network Access Commercial |
$5,305.64
|
| Rate for Payer: Quartz Beloit One Network |
$2,825.83
|
| Rate for Payer: Quartz Commercial |
$3,748.55
|
| 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 |
$3,171.85
|
| Rate for Payer: Wellcare Medicare |
$380.12
|
| Rate for Payer: WPS Commercial |
$4,271.62
|
|
|
MRI Hand w/ + w/o Contrast Left
|
Professional
|
Both
|
$6,636.00
|
|
|
Service Code
|
CPT 73220 TC,LT
|
| Hospital Charge Code |
1611119
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,596.12 |
| Max. Negotiated Rate |
$6,304.20 |
| Rate for Payer: Aetna Commercial |
$6,304.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,706.96
|
| Rate for Payer: Cash Price |
$1,990.80
|
| Rate for Payer: Cash Price |
$1,990.80
|
| Rate for Payer: Cash Price |
$1,990.80
|
| Rate for Payer: Cigna Commercial |
$6,304.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$3,318.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,981.60
|
| Rate for Payer: Health EOS Commercial |
$6,038.76
|
| Rate for Payer: HFN Commercial |
$6,304.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,596.12
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,596.12
|
| Rate for Payer: Multiplan Commercial |
$5,308.80
|
| Rate for Payer: Preferred Network Access Commercial |
$6,304.20
|
| Rate for Payer: Quartz Beloit One Network |
$2,919.84
|
| Rate for Payer: Quartz Commercial |
$3,782.52
|
| Rate for Payer: The Alliance Commercial |
$3,318.00
|
| Rate for Payer: WEA Trust Commercial |
$3,649.80
|
| Rate for Payer: WPS Commercial |
$4,915.29
|
|
|
MRI Hand w/ + w/o Contrast Left
|
Facility
|
IP
|
$5,767.00
|
|
|
Service Code
|
CPT 73220
|
| Hospital Charge Code |
630953
|
| Min. Negotiated Rate |
$2,825.83 |
| Max. Negotiated Rate |
$5,305.64 |
| Rate for Payer: Aetna Commercial |
$5,190.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,959.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,056.51
|
| Rate for Payer: Cash Price |
$1,730.10
|
| Rate for Payer: Cigna Commercial |
$5,305.64
|
| Rate for Payer: Health EOS Commercial |
$5,132.63
|
| Rate for Payer: HFN Commercial |
$5,305.64
|
| Rate for Payer: Multiplan Commercial |
$4,613.60
|
| Rate for Payer: NAPHCARE Commercial |
$3,460.20
|
| Rate for Payer: Preferred Network Access Commercial |
$5,305.64
|
| Rate for Payer: Quartz Beloit One Network |
$2,825.83
|
| Rate for Payer: Quartz Commercial |
$3,460.20
|
| Rate for Payer: WEA Trust Commercial |
$3,171.85
|
| Rate for Payer: WPS Commercial |
$4,271.62
|
|
|
MRI Hand w/ + w/o Contrast Left
|
Facility
|
IP
|
$6,636.00
|
|
|
Service Code
|
CPT 73220 TC,LT
|
| Hospital Charge Code |
1611119
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$3,251.64 |
| Max. Negotiated Rate |
$6,105.12 |
| Rate for Payer: Aetna Commercial |
$5,972.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,706.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,517.08
|
| Rate for Payer: Cash Price |
$1,990.80
|
| Rate for Payer: Cigna Commercial |
$6,105.12
|
| Rate for Payer: Health EOS Commercial |
$5,906.04
|
| Rate for Payer: HFN Commercial |
$6,105.12
|
| Rate for Payer: Multiplan Commercial |
$5,308.80
|
| Rate for Payer: NAPHCARE Commercial |
$3,981.60
|
| Rate for Payer: Preferred Network Access Commercial |
$6,105.12
|
| Rate for Payer: Quartz Beloit One Network |
$3,251.64
|
| Rate for Payer: Quartz Commercial |
$3,981.60
|
| Rate for Payer: WEA Trust Commercial |
$3,649.80
|
| Rate for Payer: WPS Commercial |
$4,915.29
|
|
|
MRI Hand w/ + w/o Contrast Left
|
Facility
|
OP
|
$6,636.00
|
|
|
Service Code
|
CPT 73220 TC,LT
|
| Hospital Charge Code |
1611119
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$380.12 |
| Max. Negotiated Rate |
$6,105.12 |
| Rate for Payer: Aetna Commercial |
$5,972.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,706.96
|
| 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 |
$3,517.08
|
| 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 |
$1,990.80
|
| Rate for Payer: Cash Price |
$1,990.80
|
| Rate for Payer: Cash Price |
$1,990.80
|
| Rate for Payer: Cash Price |
$1,990.80
|
| Rate for Payer: Cigna Commercial |
$6,105.12
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$380.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,713.51
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$380.12
|
| Rate for Payer: Health EOS Commercial |
$5,906.04
|
| Rate for Payer: HFN Commercial |
$6,105.12
|
| 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 |
$5,308.80
|
| Rate for Payer: NAPHCARE Commercial |
$570.18
|
| Rate for Payer: Preferred Network Access Commercial |
$6,105.12
|
| Rate for Payer: Quartz Beloit One Network |
$3,251.64
|
| Rate for Payer: Quartz Commercial |
$4,313.40
|
| 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 |
$3,649.80
|
| Rate for Payer: Wellcare Medicare |
$380.12
|
| Rate for Payer: WPS Commercial |
$4,915.29
|
|
|
MRI Hand w/ + w/o Contrast Right
|
Facility
|
OP
|
$6,636.00
|
|
|
Service Code
|
CPT 73220 TC,RT
|
| Hospital Charge Code |
1611121
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$380.12 |
| Max. Negotiated Rate |
$6,105.12 |
| Rate for Payer: Aetna Commercial |
$5,972.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,706.96
|
| 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 |
$3,517.08
|
| 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 |
$1,990.80
|
| Rate for Payer: Cash Price |
$1,990.80
|
| Rate for Payer: Cash Price |
$1,990.80
|
| Rate for Payer: Cash Price |
$1,990.80
|
| Rate for Payer: Cigna Commercial |
$6,105.12
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$380.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,713.51
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$380.12
|
| Rate for Payer: Health EOS Commercial |
$5,906.04
|
| Rate for Payer: HFN Commercial |
$6,105.12
|
| 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 |
$5,308.80
|
| Rate for Payer: NAPHCARE Commercial |
$570.18
|
| Rate for Payer: Preferred Network Access Commercial |
$6,105.12
|
| Rate for Payer: Quartz Beloit One Network |
$3,251.64
|
| Rate for Payer: Quartz Commercial |
$4,313.40
|
| 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 |
$3,649.80
|
| Rate for Payer: Wellcare Medicare |
$380.12
|
| Rate for Payer: WPS Commercial |
$4,915.29
|
|
|
MRI Hand w/ + w/o Contrast Right
|
Professional
|
Both
|
$6,636.00
|
|
|
Service Code
|
CPT 73220 TC,RT
|
| Hospital Charge Code |
1611121
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,596.12 |
| Max. Negotiated Rate |
$6,304.20 |
| Rate for Payer: Aetna Commercial |
$6,304.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,706.96
|
| Rate for Payer: Cash Price |
$1,990.80
|
| Rate for Payer: Cash Price |
$1,990.80
|
| Rate for Payer: Cash Price |
$1,990.80
|
| Rate for Payer: Cigna Commercial |
$6,304.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$3,318.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,981.60
|
| Rate for Payer: Health EOS Commercial |
$6,038.76
|
| Rate for Payer: HFN Commercial |
$6,304.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,596.12
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,596.12
|
| Rate for Payer: Multiplan Commercial |
$5,308.80
|
| Rate for Payer: Preferred Network Access Commercial |
$6,304.20
|
| Rate for Payer: Quartz Beloit One Network |
$2,919.84
|
| Rate for Payer: Quartz Commercial |
$3,782.52
|
| Rate for Payer: The Alliance Commercial |
$3,318.00
|
| Rate for Payer: WEA Trust Commercial |
$3,649.80
|
| Rate for Payer: WPS Commercial |
$4,915.29
|
|
|
MRI Hand w/ + w/o Contrast Right
|
Professional
|
Both
|
$5,767.00
|
|
|
Service Code
|
CPT 73220
|
| Hospital Charge Code |
630955
|
| Min. Negotiated Rate |
$1,596.12 |
| Max. Negotiated Rate |
$5,478.65 |
| Rate for Payer: Aetna Commercial |
$5,478.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,959.62
|
| Rate for Payer: Cash Price |
$1,730.10
|
| Rate for Payer: Cash Price |
$1,730.10
|
| Rate for Payer: Cash Price |
$1,730.10
|
| Rate for Payer: Cigna Commercial |
$5,478.65
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,883.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,460.20
|
| Rate for Payer: Health EOS Commercial |
$5,247.97
|
| Rate for Payer: HFN Commercial |
$5,478.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,596.12
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,596.12
|
| Rate for Payer: Multiplan Commercial |
$4,613.60
|
| Rate for Payer: Preferred Network Access Commercial |
$5,478.65
|
| Rate for Payer: Quartz Beloit One Network |
$2,537.48
|
| Rate for Payer: Quartz Commercial |
$3,287.19
|
| Rate for Payer: The Alliance Commercial |
$2,883.50
|
| Rate for Payer: WEA Trust Commercial |
$3,171.85
|
| Rate for Payer: WPS Commercial |
$4,271.62
|
|
|
MRI Hand w/ + w/o Contrast Right
|
Facility
|
IP
|
$6,397.00
|
|
|
Service Code
|
CPT 73220 TC,RT
|
| Hospital Charge Code |
2980036
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$3,134.53 |
| Max. Negotiated Rate |
$5,885.24 |
| Rate for Payer: Aetna Commercial |
$5,757.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,501.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,390.41
|
| Rate for Payer: Cash Price |
$1,919.10
|
| Rate for Payer: Cigna Commercial |
$5,885.24
|
| Rate for Payer: Health EOS Commercial |
$5,693.33
|
| Rate for Payer: HFN Commercial |
$5,885.24
|
| Rate for Payer: Multiplan Commercial |
$5,117.60
|
| Rate for Payer: NAPHCARE Commercial |
$3,838.20
|
| Rate for Payer: Preferred Network Access Commercial |
$5,885.24
|
| Rate for Payer: Quartz Beloit One Network |
$3,134.53
|
| Rate for Payer: Quartz Commercial |
$3,838.20
|
| Rate for Payer: WEA Trust Commercial |
$3,518.35
|
| Rate for Payer: WPS Commercial |
$4,738.26
|
|
|
MRI Hand w/ + w/o Contrast Right
|
Professional
|
Both
|
$6,397.00
|
|
|
Service Code
|
CPT 73220 TC,RT
|
| Hospital Charge Code |
2980036
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,596.12 |
| Max. Negotiated Rate |
$6,077.15 |
| Rate for Payer: Aetna Commercial |
$6,077.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,501.42
|
| Rate for Payer: Cash Price |
$1,919.10
|
| Rate for Payer: Cash Price |
$1,919.10
|
| Rate for Payer: Cash Price |
$1,919.10
|
| Rate for Payer: Cigna Commercial |
$6,077.15
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$3,198.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,838.20
|
| Rate for Payer: Health EOS Commercial |
$5,821.27
|
| Rate for Payer: HFN Commercial |
$6,077.15
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,596.12
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,596.12
|
| Rate for Payer: Multiplan Commercial |
$5,117.60
|
| Rate for Payer: Preferred Network Access Commercial |
$6,077.15
|
| Rate for Payer: Quartz Beloit One Network |
$2,814.68
|
| Rate for Payer: Quartz Commercial |
$3,646.29
|
| Rate for Payer: The Alliance Commercial |
$3,198.50
|
| Rate for Payer: WEA Trust Commercial |
$3,518.35
|
| Rate for Payer: WPS Commercial |
$4,738.26
|
|
|
MRI Hand w/ + w/o Contrast Right
|
Facility
|
IP
|
$6,636.00
|
|
|
Service Code
|
CPT 73220 TC,RT
|
| Hospital Charge Code |
1611121
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$3,251.64 |
| Max. Negotiated Rate |
$6,105.12 |
| Rate for Payer: Aetna Commercial |
$5,972.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,706.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,517.08
|
| Rate for Payer: Cash Price |
$1,990.80
|
| Rate for Payer: Cigna Commercial |
$6,105.12
|
| Rate for Payer: Health EOS Commercial |
$5,906.04
|
| Rate for Payer: HFN Commercial |
$6,105.12
|
| Rate for Payer: Multiplan Commercial |
$5,308.80
|
| Rate for Payer: NAPHCARE Commercial |
$3,981.60
|
| Rate for Payer: Preferred Network Access Commercial |
$6,105.12
|
| Rate for Payer: Quartz Beloit One Network |
$3,251.64
|
| Rate for Payer: Quartz Commercial |
$3,981.60
|
| Rate for Payer: WEA Trust Commercial |
$3,649.80
|
| Rate for Payer: WPS Commercial |
$4,915.29
|
|
|
MRI Hand w/ + w/o Contrast Right
|
Facility
|
OP
|
$6,397.00
|
|
|
Service Code
|
CPT 73220 TC,RT
|
| Hospital Charge Code |
2980036
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$380.12 |
| Max. Negotiated Rate |
$5,885.24 |
| Rate for Payer: Aetna Commercial |
$5,757.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,501.42
|
| 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 |
$3,390.41
|
| 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 |
$1,919.10
|
| Rate for Payer: Cash Price |
$1,919.10
|
| Rate for Payer: Cash Price |
$1,919.10
|
| Rate for Payer: Cash Price |
$1,919.10
|
| Rate for Payer: Cigna Commercial |
$5,885.24
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$380.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,579.76
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$380.12
|
| Rate for Payer: Health EOS Commercial |
$5,693.33
|
| Rate for Payer: HFN Commercial |
$5,885.24
|
| 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 |
$5,117.60
|
| Rate for Payer: NAPHCARE Commercial |
$570.18
|
| Rate for Payer: Preferred Network Access Commercial |
$5,885.24
|
| Rate for Payer: Quartz Beloit One Network |
$3,134.53
|
| Rate for Payer: Quartz Commercial |
$4,158.05
|
| 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 |
$3,518.35
|
| Rate for Payer: Wellcare Medicare |
$380.12
|
| Rate for Payer: WPS Commercial |
$4,738.26
|
|
|
MRI Hand w/ + w/o Contrast Right
|
Facility
|
OP
|
$5,767.00
|
|
|
Service Code
|
CPT 73220
|
| Hospital Charge Code |
630955
|
| Min. Negotiated Rate |
$380.12 |
| Max. Negotiated Rate |
$5,305.64 |
| Rate for Payer: Aetna Commercial |
$5,190.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,959.62
|
| Rate for Payer: Aetna Managed Medicare |
$380.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,748.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,883.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,768.16
|
| Rate for Payer: Anthem Medicare Advantage |
$380.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,056.51
|
| 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 |
$1,730.10
|
| Rate for Payer: Cash Price |
$1,730.10
|
| Rate for Payer: Cigna Commercial |
$5,305.64
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$380.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,227.21
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$380.12
|
| Rate for Payer: Health EOS Commercial |
$5,132.63
|
| Rate for Payer: HFN Commercial |
$5,305.64
|
| 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 |
$4,613.60
|
| Rate for Payer: NAPHCARE Commercial |
$570.18
|
| Rate for Payer: Preferred Network Access Commercial |
$5,305.64
|
| Rate for Payer: Quartz Beloit One Network |
$2,825.83
|
| Rate for Payer: Quartz Commercial |
$3,748.55
|
| 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 |
$3,171.85
|
| Rate for Payer: Wellcare Medicare |
$380.12
|
| Rate for Payer: WPS Commercial |
$4,271.62
|
|
|
MRI Hand w/ + w/o Contrast Right
|
Facility
|
IP
|
$5,767.00
|
|
|
Service Code
|
CPT 73220
|
| Hospital Charge Code |
630955
|
| Min. Negotiated Rate |
$2,825.83 |
| Max. Negotiated Rate |
$5,305.64 |
| Rate for Payer: Aetna Commercial |
$5,190.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,959.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,056.51
|
| Rate for Payer: Cash Price |
$1,730.10
|
| Rate for Payer: Cigna Commercial |
$5,305.64
|
| Rate for Payer: Health EOS Commercial |
$5,132.63
|
| Rate for Payer: HFN Commercial |
$5,305.64
|
| Rate for Payer: Multiplan Commercial |
$4,613.60
|
| Rate for Payer: NAPHCARE Commercial |
$3,460.20
|
| Rate for Payer: Preferred Network Access Commercial |
$5,305.64
|
| Rate for Payer: Quartz Beloit One Network |
$2,825.83
|
| Rate for Payer: Quartz Commercial |
$3,460.20
|
| Rate for Payer: WEA Trust Commercial |
$3,171.85
|
| Rate for Payer: WPS Commercial |
$4,271.62
|
|
|
MRI Head w/ w/o Contrast
|
Facility
|
IP
|
$6,607.00
|
|
|
Service Code
|
CPT 70553 TC
|
| Hospital Charge Code |
3072656
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$3,237.43 |
| Max. Negotiated Rate |
$6,078.44 |
| Rate for Payer: Aetna Commercial |
$5,946.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,682.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,501.71
|
| Rate for Payer: Cash Price |
$1,982.10
|
| Rate for Payer: Cigna Commercial |
$6,078.44
|
| Rate for Payer: Health EOS Commercial |
$5,880.23
|
| Rate for Payer: HFN Commercial |
$6,078.44
|
| Rate for Payer: Multiplan Commercial |
$5,285.60
|
| Rate for Payer: NAPHCARE Commercial |
$3,964.20
|
| Rate for Payer: Preferred Network Access Commercial |
$6,078.44
|
| Rate for Payer: Quartz Beloit One Network |
$3,237.43
|
| Rate for Payer: Quartz Commercial |
$3,964.20
|
| Rate for Payer: WEA Trust Commercial |
$3,633.85
|
| Rate for Payer: WPS Commercial |
$4,893.80
|
|
|
MRI Head w/ w/o Contrast
|
Professional
|
Both
|
$6,607.00
|
|
|
Service Code
|
CPT 70553 TC
|
| Hospital Charge Code |
3072656
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$829.20 |
| Max. Negotiated Rate |
$6,276.65 |
| Rate for Payer: Aetna Commercial |
$6,276.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,682.02
|
| Rate for Payer: Cash Price |
$1,982.10
|
| Rate for Payer: Cash Price |
$1,982.10
|
| Rate for Payer: Cash Price |
$1,982.10
|
| Rate for Payer: Cigna Commercial |
$6,276.65
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$3,303.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,964.20
|
| Rate for Payer: Health EOS Commercial |
$6,012.37
|
| Rate for Payer: HFN Commercial |
$6,276.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$829.20
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$829.20
|
| Rate for Payer: Multiplan Commercial |
$5,285.60
|
| Rate for Payer: Preferred Network Access Commercial |
$6,276.65
|
| Rate for Payer: Quartz Beloit One Network |
$2,907.08
|
| Rate for Payer: Quartz Commercial |
$3,765.99
|
| Rate for Payer: The Alliance Commercial |
$3,303.50
|
| Rate for Payer: WEA Trust Commercial |
$3,633.85
|
| Rate for Payer: WPS Commercial |
$4,893.80
|
|
|
MRI Head w/ w/o Contrast
|
Facility
|
OP
|
$6,607.00
|
|
|
Service Code
|
CPT 70553 TC
|
| Hospital Charge Code |
3072656
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$380.12 |
| Max. Negotiated Rate |
$6,078.44 |
| Rate for Payer: Aetna Commercial |
$5,946.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,682.02
|
| 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 |
$3,501.71
|
| 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 |
$1,982.10
|
| Rate for Payer: Cash Price |
$1,982.10
|
| Rate for Payer: Cash Price |
$1,982.10
|
| Rate for Payer: Cash Price |
$1,982.10
|
| Rate for Payer: Cigna Commercial |
$6,078.44
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$380.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,697.28
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$380.12
|
| Rate for Payer: Health EOS Commercial |
$5,880.23
|
| Rate for Payer: HFN Commercial |
$6,078.44
|
| 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 |
$5,285.60
|
| Rate for Payer: NAPHCARE Commercial |
$570.18
|
| Rate for Payer: Preferred Network Access Commercial |
$6,078.44
|
| Rate for Payer: Quartz Beloit One Network |
$3,237.43
|
| Rate for Payer: Quartz Commercial |
$4,294.55
|
| 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 |
$3,633.85
|
| Rate for Payer: Wellcare Medicare |
$380.12
|
| Rate for Payer: WPS Commercial |
$4,893.80
|
|
|
MRI Hip w/ Contrast Bilateral
|
Facility
|
IP
|
$10,169.00
|
|
|
Service Code
|
CPT 73722
|
| Hospital Charge Code |
630989
|
| 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 Hip w/ Contrast Bilateral
|
Professional
|
Both
|
$10,169.00
|
|
|
Service Code
|
CPT 73722
|
| Hospital Charge Code |
630989
|
| 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 Hip w/ Contrast Bilateral
|
Facility
|
IP
|
$4,988.00
|
|
|
Service Code
|
CPT 73722 TC,LT
|
| Hospital Charge Code |
1611141
|
|
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 Hip w/ Contrast Bilateral
|
Professional
|
Both
|
$4,988.00
|
|
|
Service Code
|
CPT 73722 TC,LT
|
| Hospital Charge Code |
1611141
|
|
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 Hip w/ Contrast Bilateral
|
Facility
|
OP
|
$10,169.00
|
|
|
Service Code
|
CPT 73722
|
| Hospital Charge Code |
630989
|
| 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 Hip w/ Contrast Bilateral
|
Facility
|
OP
|
$4,988.00
|
|
|
Service Code
|
CPT 73722 TC,LT
|
| Hospital Charge Code |
1611141
|
|
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 Hip w/ Contrast Left
|
Facility
|
OP
|
$5,085.00
|
|
|
Service Code
|
CPT 73722
|
| Hospital Charge Code |
630994
|
| 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 Hip w/ Contrast Left
|
Professional
|
Both
|
$5,180.00
|
|
|
Service Code
|
CPT 73722 TC,LT
|
| Hospital Charge Code |
1611143
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,222.30 |
| Max. Negotiated Rate |
$4,921.00 |
| Rate for Payer: Aetna Commercial |
$4,921.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,454.80
|
| Rate for Payer: Cash Price |
$1,554.00
|
| Rate for Payer: Cash Price |
$1,554.00
|
| Rate for Payer: Cash Price |
$1,554.00
|
| Rate for Payer: Cigna Commercial |
$4,921.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,590.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,108.00
|
| Rate for Payer: Health EOS Commercial |
$4,713.80
|
| Rate for Payer: HFN Commercial |
$4,921.00
|
| 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 |
$4,144.00
|
| Rate for Payer: Preferred Network Access Commercial |
$4,921.00
|
| Rate for Payer: Quartz Beloit One Network |
$2,279.20
|
| Rate for Payer: Quartz Commercial |
$2,952.60
|
| Rate for Payer: The Alliance Commercial |
$2,590.00
|
| Rate for Payer: WEA Trust Commercial |
$2,849.00
|
| Rate for Payer: WPS Commercial |
$3,836.83
|
|
