|
MRI Hip w/o Contrast Right
|
Professional
|
Both
|
$4,732.00
|
|
|
Service Code
|
CPT 73721 TC,RT
|
| Hospital Charge Code |
1611151
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$762.09 |
| Max. Negotiated Rate |
$4,495.40 |
| Rate for Payer: Aetna Commercial |
$4,495.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,069.52
|
| Rate for Payer: Cash Price |
$1,419.60
|
| Rate for Payer: Cash Price |
$1,419.60
|
| Rate for Payer: Cash Price |
$1,419.60
|
| Rate for Payer: Cigna Commercial |
$4,495.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,366.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,839.20
|
| Rate for Payer: Health EOS Commercial |
$4,306.12
|
| Rate for Payer: HFN Commercial |
$4,495.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$762.09
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$762.09
|
| Rate for Payer: Multiplan Commercial |
$3,785.60
|
| Rate for Payer: Preferred Network Access Commercial |
$4,495.40
|
| Rate for Payer: Quartz Beloit One Network |
$2,082.08
|
| Rate for Payer: Quartz Commercial |
$2,697.24
|
| Rate for Payer: The Alliance Commercial |
$2,366.00
|
| Rate for Payer: WEA Trust Commercial |
$2,602.60
|
| Rate for Payer: WPS Commercial |
$3,504.99
|
|
|
MRI Hip w/o Contrast Right
|
Professional
|
Both
|
$4,557.00
|
|
|
Service Code
|
CPT 73721 TC,RT
|
| Hospital Charge Code |
2980104
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$762.09 |
| Max. Negotiated Rate |
$4,329.15 |
| Rate for Payer: Aetna Commercial |
$4,329.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,919.02
|
| Rate for Payer: Cash Price |
$1,367.10
|
| Rate for Payer: Cash Price |
$1,367.10
|
| Rate for Payer: Cash Price |
$1,367.10
|
| Rate for Payer: Cigna Commercial |
$4,329.15
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,278.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,734.20
|
| Rate for Payer: Health EOS Commercial |
$4,146.87
|
| Rate for Payer: HFN Commercial |
$4,329.15
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$762.09
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$762.09
|
| Rate for Payer: Multiplan Commercial |
$3,645.60
|
| Rate for Payer: Preferred Network Access Commercial |
$4,329.15
|
| Rate for Payer: Quartz Beloit One Network |
$2,005.08
|
| Rate for Payer: Quartz Commercial |
$2,597.49
|
| Rate for Payer: The Alliance Commercial |
$2,278.50
|
| Rate for Payer: WEA Trust Commercial |
$2,506.35
|
| Rate for Payer: WPS Commercial |
$3,375.37
|
|
|
MRI Hip w/o Contrast Right
|
Facility
|
IP
|
$4,732.00
|
|
|
Service Code
|
CPT 73721 TC,RT
|
| Hospital Charge Code |
1611151
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$2,318.68 |
| Max. Negotiated Rate |
$4,353.44 |
| Rate for Payer: Aetna Commercial |
$4,258.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,069.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,507.96
|
| Rate for Payer: Cash Price |
$1,419.60
|
| Rate for Payer: Cigna Commercial |
$4,353.44
|
| Rate for Payer: Health EOS Commercial |
$4,211.48
|
| Rate for Payer: HFN Commercial |
$4,353.44
|
| Rate for Payer: Multiplan Commercial |
$3,785.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,839.20
|
| Rate for Payer: Preferred Network Access Commercial |
$4,353.44
|
| Rate for Payer: Quartz Beloit One Network |
$2,318.68
|
| Rate for Payer: Quartz Commercial |
$2,839.20
|
| Rate for Payer: WEA Trust Commercial |
$2,602.60
|
| Rate for Payer: WPS Commercial |
$3,504.99
|
|
|
MRI Hip w/o Contrast Right
|
Facility
|
IP
|
$4,557.00
|
|
|
Service Code
|
CPT 73721 TC,RT
|
| Hospital Charge Code |
2980104
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$2,232.93 |
| Max. Negotiated Rate |
$4,192.44 |
| Rate for Payer: Aetna Commercial |
$4,101.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,919.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,415.21
|
| Rate for Payer: Cash Price |
$1,367.10
|
| Rate for Payer: Cigna Commercial |
$4,192.44
|
| Rate for Payer: Health EOS Commercial |
$4,055.73
|
| Rate for Payer: HFN Commercial |
$4,192.44
|
| Rate for Payer: Multiplan Commercial |
$3,645.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,734.20
|
| Rate for Payer: Preferred Network Access Commercial |
$4,192.44
|
| Rate for Payer: Quartz Beloit One Network |
$2,232.93
|
| Rate for Payer: Quartz Commercial |
$2,734.20
|
| Rate for Payer: WEA Trust Commercial |
$2,506.35
|
| Rate for Payer: WPS Commercial |
$3,375.37
|
|
|
MRI Hip w/o Contrast Right
|
Facility
|
IP
|
$4,524.00
|
|
|
Service Code
|
CPT 73721
|
| Hospital Charge Code |
631011
|
| Min. Negotiated Rate |
$2,216.76 |
| Max. Negotiated Rate |
$4,162.08 |
| Rate for Payer: Aetna Commercial |
$4,071.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,890.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,397.72
|
| Rate for Payer: Cash Price |
$1,357.20
|
| Rate for Payer: Cigna Commercial |
$4,162.08
|
| Rate for Payer: Health EOS Commercial |
$4,026.36
|
| Rate for Payer: HFN Commercial |
$4,162.08
|
| Rate for Payer: Multiplan Commercial |
$3,619.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,714.40
|
| Rate for Payer: Preferred Network Access Commercial |
$4,162.08
|
| Rate for Payer: Quartz Beloit One Network |
$2,216.76
|
| Rate for Payer: Quartz Commercial |
$2,714.40
|
| Rate for Payer: WEA Trust Commercial |
$2,488.20
|
| Rate for Payer: WPS Commercial |
$3,350.93
|
|
|
MRI Hip w/o Contrast Right
|
Facility
|
OP
|
$4,524.00
|
|
|
Service Code
|
CPT 73721
|
| Hospital Charge Code |
631011
|
| Min. Negotiated Rate |
$242.20 |
| Max. Negotiated Rate |
$4,162.08 |
| Rate for Payer: Aetna Commercial |
$4,071.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,890.64
|
| Rate for Payer: Aetna Managed Medicare |
$242.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,940.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,262.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,171.52
|
| Rate for Payer: Anthem Medicare Advantage |
$242.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,397.72
|
| 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 |
$1,357.20
|
| Rate for Payer: Cash Price |
$1,357.20
|
| Rate for Payer: Cigna Commercial |
$4,162.08
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$242.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,531.63
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$242.20
|
| Rate for Payer: Health EOS Commercial |
$4,026.36
|
| Rate for Payer: HFN Commercial |
$4,162.08
|
| 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 |
$3,619.20
|
| Rate for Payer: NAPHCARE Commercial |
$363.30
|
| Rate for Payer: Preferred Network Access Commercial |
$4,162.08
|
| Rate for Payer: Quartz Beloit One Network |
$2,216.76
|
| Rate for Payer: Quartz Commercial |
$2,940.60
|
| 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 |
$2,488.20
|
| Rate for Payer: Wellcare Medicare |
$242.20
|
| Rate for Payer: WPS Commercial |
$3,350.93
|
|
|
MRI Hip w/o Contrast Right
|
Facility
|
OP
|
$4,732.00
|
|
|
Service Code
|
CPT 73721 TC,RT
|
| Hospital Charge Code |
1611151
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$242.20 |
| Max. Negotiated Rate |
$4,353.44 |
| Rate for Payer: Aetna Commercial |
$4,258.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,069.52
|
| 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 |
$2,507.96
|
| 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 |
$1,419.60
|
| Rate for Payer: Cash Price |
$1,419.60
|
| Rate for Payer: Cash Price |
$1,419.60
|
| Rate for Payer: Cash Price |
$1,419.60
|
| Rate for Payer: Cigna Commercial |
$4,353.44
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$242.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,648.03
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$242.20
|
| Rate for Payer: Health EOS Commercial |
$4,211.48
|
| Rate for Payer: HFN Commercial |
$4,353.44
|
| 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 |
$3,785.60
|
| Rate for Payer: NAPHCARE Commercial |
$363.30
|
| Rate for Payer: Preferred Network Access Commercial |
$4,353.44
|
| Rate for Payer: Quartz Beloit One Network |
$2,318.68
|
| Rate for Payer: Quartz Commercial |
$3,075.80
|
| 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 |
$2,602.60
|
| Rate for Payer: Wellcare Medicare |
$242.20
|
| Rate for Payer: WPS Commercial |
$3,504.99
|
|
|
MRI Hip w/o Contrast Right
|
Facility
|
OP
|
$4,557.00
|
|
|
Service Code
|
CPT 73721 TC,RT
|
| Hospital Charge Code |
2980104
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$242.20 |
| Max. Negotiated Rate |
$4,192.44 |
| Rate for Payer: Aetna Commercial |
$4,101.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,919.02
|
| 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 |
$2,415.21
|
| 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 |
$1,367.10
|
| Rate for Payer: Cash Price |
$1,367.10
|
| Rate for Payer: Cash Price |
$1,367.10
|
| Rate for Payer: Cash Price |
$1,367.10
|
| Rate for Payer: Cigna Commercial |
$4,192.44
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$242.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,550.10
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$242.20
|
| Rate for Payer: Health EOS Commercial |
$4,055.73
|
| Rate for Payer: HFN Commercial |
$4,192.44
|
| 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 |
$3,645.60
|
| Rate for Payer: NAPHCARE Commercial |
$363.30
|
| Rate for Payer: Preferred Network Access Commercial |
$4,192.44
|
| Rate for Payer: Quartz Beloit One Network |
$2,232.93
|
| Rate for Payer: Quartz Commercial |
$2,962.05
|
| 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 |
$2,506.35
|
| Rate for Payer: Wellcare Medicare |
$242.20
|
| Rate for Payer: WPS Commercial |
$3,375.37
|
|
|
MRI Hip w/o Contrast Right
|
Professional
|
Both
|
$4,524.00
|
|
|
Service Code
|
CPT 73721
|
| Hospital Charge Code |
631011
|
| Min. Negotiated Rate |
$762.09 |
| Max. Negotiated Rate |
$4,297.80 |
| Rate for Payer: Aetna Commercial |
$4,297.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,890.64
|
| Rate for Payer: Cash Price |
$1,357.20
|
| Rate for Payer: Cash Price |
$1,357.20
|
| Rate for Payer: Cash Price |
$1,357.20
|
| Rate for Payer: Cigna Commercial |
$4,297.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,262.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,714.40
|
| Rate for Payer: Health EOS Commercial |
$4,116.84
|
| Rate for Payer: HFN Commercial |
$4,297.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$762.09
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$762.09
|
| Rate for Payer: Multiplan Commercial |
$3,619.20
|
| Rate for Payer: Preferred Network Access Commercial |
$4,297.80
|
| Rate for Payer: Quartz Beloit One Network |
$1,990.56
|
| Rate for Payer: Quartz Commercial |
$2,578.68
|
| Rate for Payer: The Alliance Commercial |
$2,262.00
|
| Rate for Payer: WEA Trust Commercial |
$2,488.20
|
| Rate for Payer: WPS Commercial |
$3,350.93
|
|
|
MRI Hip w/ + w/o Contrast Bilateral
|
Professional
|
Both
|
$5,965.00
|
|
|
Service Code
|
CPT 73723 TC,LT
|
| Hospital Charge Code |
1611135
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,502.58 |
| Max. Negotiated Rate |
$5,666.75 |
| Rate for Payer: Aetna Commercial |
$5,666.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,129.90
|
| Rate for Payer: Cash Price |
$1,789.50
|
| Rate for Payer: Cash Price |
$1,789.50
|
| Rate for Payer: Cash Price |
$1,789.50
|
| Rate for Payer: Cigna Commercial |
$5,666.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,982.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,579.00
|
| Rate for Payer: Health EOS Commercial |
$5,428.15
|
| Rate for Payer: HFN Commercial |
$5,666.75
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,502.58
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,502.58
|
| Rate for Payer: Multiplan Commercial |
$4,772.00
|
| Rate for Payer: Preferred Network Access Commercial |
$5,666.75
|
| Rate for Payer: Quartz Beloit One Network |
$2,624.60
|
| Rate for Payer: Quartz Commercial |
$3,400.05
|
| Rate for Payer: The Alliance Commercial |
$2,982.50
|
| Rate for Payer: WEA Trust Commercial |
$3,280.75
|
| Rate for Payer: WPS Commercial |
$4,418.28
|
|
|
MRI Hip w/ + w/o Contrast Bilateral
|
Facility
|
OP
|
$5,965.00
|
|
|
Service Code
|
CPT 73723 TC,LT
|
| Hospital Charge Code |
1611135
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$380.12 |
| Max. Negotiated Rate |
$5,487.80 |
| Rate for Payer: Aetna Commercial |
$5,368.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,129.90
|
| 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 |
$3,161.45
|
| 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 |
$1,789.50
|
| Rate for Payer: Cash Price |
$1,789.50
|
| Rate for Payer: Cash Price |
$1,789.50
|
| Rate for Payer: Cash Price |
$1,789.50
|
| Rate for Payer: Cigna Commercial |
$5,487.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$380.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,338.01
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$380.12
|
| Rate for Payer: Health EOS Commercial |
$5,308.85
|
| Rate for Payer: HFN Commercial |
$5,487.80
|
| 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 |
$4,772.00
|
| Rate for Payer: NAPHCARE Commercial |
$570.18
|
| Rate for Payer: Preferred Network Access Commercial |
$5,487.80
|
| Rate for Payer: Quartz Beloit One Network |
$2,922.85
|
| Rate for Payer: Quartz Commercial |
$3,877.25
|
| 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 |
$3,280.75
|
| Rate for Payer: Wellcare Medicare |
$380.12
|
| Rate for Payer: WPS Commercial |
$4,418.28
|
|
|
MRI Hip w/ + w/o Contrast Bilateral
|
Facility
|
IP
|
$5,965.00
|
|
|
Service Code
|
CPT 73723 TC,LT
|
| Hospital Charge Code |
1611135
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$2,922.85 |
| Max. Negotiated Rate |
$5,487.80 |
| Rate for Payer: Aetna Commercial |
$5,368.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,129.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,161.45
|
| Rate for Payer: Cash Price |
$1,789.50
|
| Rate for Payer: Cigna Commercial |
$5,487.80
|
| Rate for Payer: Health EOS Commercial |
$5,308.85
|
| Rate for Payer: HFN Commercial |
$5,487.80
|
| Rate for Payer: Multiplan Commercial |
$4,772.00
|
| Rate for Payer: NAPHCARE Commercial |
$3,579.00
|
| Rate for Payer: Preferred Network Access Commercial |
$5,487.80
|
| Rate for Payer: Quartz Beloit One Network |
$2,922.85
|
| Rate for Payer: Quartz Commercial |
$3,579.00
|
| Rate for Payer: WEA Trust Commercial |
$3,280.75
|
| Rate for Payer: WPS Commercial |
$4,418.28
|
|
|
MRI Hip w/ + w/o Contrast Left
|
Facility
|
IP
|
$6,080.00
|
|
|
Service Code
|
CPT 73723
|
| Hospital Charge Code |
630981
|
| 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 Hip w/ + w/o Contrast Left
|
Professional
|
Both
|
$5,965.00
|
|
|
Service Code
|
CPT 73723 TC,LT
|
| Hospital Charge Code |
3072727
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,502.58 |
| Max. Negotiated Rate |
$5,666.75 |
| Rate for Payer: Aetna Commercial |
$5,666.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,129.90
|
| Rate for Payer: Cash Price |
$1,789.50
|
| Rate for Payer: Cash Price |
$1,789.50
|
| Rate for Payer: Cash Price |
$1,789.50
|
| Rate for Payer: Cigna Commercial |
$5,666.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,982.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,579.00
|
| Rate for Payer: Health EOS Commercial |
$5,428.15
|
| Rate for Payer: HFN Commercial |
$5,666.75
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,502.58
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,502.58
|
| Rate for Payer: Multiplan Commercial |
$4,772.00
|
| Rate for Payer: Preferred Network Access Commercial |
$5,666.75
|
| Rate for Payer: Quartz Beloit One Network |
$2,624.60
|
| Rate for Payer: Quartz Commercial |
$3,400.05
|
| Rate for Payer: The Alliance Commercial |
$2,982.50
|
| Rate for Payer: WEA Trust Commercial |
$3,280.75
|
| Rate for Payer: WPS Commercial |
$4,418.28
|
|
|
MRI Hip w/ + w/o Contrast Left
|
Facility
|
IP
|
$5,965.00
|
|
|
Service Code
|
CPT 73723 TC,LT
|
| Hospital Charge Code |
3072727
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$2,922.85 |
| Max. Negotiated Rate |
$5,487.80 |
| Rate for Payer: Aetna Commercial |
$5,368.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,129.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,161.45
|
| Rate for Payer: Cash Price |
$1,789.50
|
| Rate for Payer: Cigna Commercial |
$5,487.80
|
| Rate for Payer: Health EOS Commercial |
$5,308.85
|
| Rate for Payer: HFN Commercial |
$5,487.80
|
| Rate for Payer: Multiplan Commercial |
$4,772.00
|
| Rate for Payer: NAPHCARE Commercial |
$3,579.00
|
| Rate for Payer: Preferred Network Access Commercial |
$5,487.80
|
| Rate for Payer: Quartz Beloit One Network |
$2,922.85
|
| Rate for Payer: Quartz Commercial |
$3,579.00
|
| Rate for Payer: WEA Trust Commercial |
$3,280.75
|
| Rate for Payer: WPS Commercial |
$4,418.28
|
|
|
MRI Hip w/ + w/o Contrast Left
|
Facility
|
OP
|
$5,965.00
|
|
|
Service Code
|
CPT 73723 TC,LT
|
| Hospital Charge Code |
3072727
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$380.12 |
| Max. Negotiated Rate |
$5,487.80 |
| Rate for Payer: Aetna Commercial |
$5,368.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,129.90
|
| 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 |
$3,161.45
|
| 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 |
$1,789.50
|
| Rate for Payer: Cash Price |
$1,789.50
|
| Rate for Payer: Cash Price |
$1,789.50
|
| Rate for Payer: Cash Price |
$1,789.50
|
| Rate for Payer: Cigna Commercial |
$5,487.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$380.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,338.01
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$380.12
|
| Rate for Payer: Health EOS Commercial |
$5,308.85
|
| Rate for Payer: HFN Commercial |
$5,487.80
|
| 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 |
$4,772.00
|
| Rate for Payer: NAPHCARE Commercial |
$570.18
|
| Rate for Payer: Preferred Network Access Commercial |
$5,487.80
|
| Rate for Payer: Quartz Beloit One Network |
$2,922.85
|
| Rate for Payer: Quartz Commercial |
$3,877.25
|
| 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 |
$3,280.75
|
| Rate for Payer: Wellcare Medicare |
$380.12
|
| Rate for Payer: WPS Commercial |
$4,418.28
|
|
|
MRI Hip w/ + w/o Contrast Left
|
Facility
|
OP
|
$6,295.00
|
|
|
Service Code
|
CPT 73723 TC,LT
|
| Hospital Charge Code |
1611137
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$380.12 |
| Max. Negotiated Rate |
$5,791.40 |
| Rate for Payer: Aetna Commercial |
$5,665.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,413.70
|
| 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 |
$3,336.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$380.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$380.12
|
| Rate for Payer: Cash Price |
$1,888.50
|
| Rate for Payer: Cash Price |
$1,888.50
|
| Rate for Payer: Cash Price |
$1,888.50
|
| Rate for Payer: Cash Price |
$1,888.50
|
| Rate for Payer: Cigna Commercial |
$5,791.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$380.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,522.68
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$380.12
|
| Rate for Payer: Health EOS Commercial |
$5,602.55
|
| Rate for Payer: HFN Commercial |
$5,791.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,414.05
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$380.12
|
| Rate for Payer: Independent Care Health Plan Medicare |
$380.12
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$380.12
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$380.12
|
| Rate for Payer: Multiplan Commercial |
$5,036.00
|
| Rate for Payer: NAPHCARE Commercial |
$570.18
|
| Rate for Payer: Preferred Network Access Commercial |
$5,791.40
|
| Rate for Payer: Quartz Beloit One Network |
$3,084.55
|
| Rate for Payer: Quartz Commercial |
$4,091.75
|
| Rate for Payer: Quartz Medicare Advantage |
$380.12
|
| Rate for Payer: The Alliance Commercial |
$1,520.48
|
| Rate for Payer: United Healthcare Medicare Advantage |
$380.12
|
| Rate for Payer: United Healthcare PPO |
$3,022.00
|
| Rate for Payer: WEA Trust Commercial |
$3,462.25
|
| Rate for Payer: Wellcare Medicare |
$380.12
|
| Rate for Payer: WPS Commercial |
$4,662.71
|
|
|
MRI Hip w/ + w/o Contrast Left
|
Facility
|
OP
|
$6,080.00
|
|
|
Service Code
|
CPT 73723
|
| Hospital Charge Code |
630981
|
| Min. Negotiated Rate |
$380.12 |
| 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 |
$380.12
|
| 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 |
$380.12
|
| 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 |
$380.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$380.12
|
| 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 |
$380.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,402.37
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$380.12
|
| 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 |
$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 |
$4,864.00
|
| Rate for Payer: NAPHCARE Commercial |
$570.18
|
| 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 |
$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 |
$3,344.00
|
| Rate for Payer: Wellcare Medicare |
$380.12
|
| Rate for Payer: WPS Commercial |
$4,503.46
|
|
|
MRI Hip w/ + w/o Contrast Left
|
Professional
|
Both
|
$6,080.00
|
|
|
Service Code
|
CPT 73723
|
| Hospital Charge Code |
630981
|
| Min. Negotiated Rate |
$1,502.58 |
| 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 |
$1,502.58
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,502.58
|
| 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 Hip w/ + w/o Contrast Left
|
Professional
|
Both
|
$6,295.00
|
|
|
Service Code
|
CPT 73723 TC,LT
|
| Hospital Charge Code |
1611137
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,502.58 |
| Max. Negotiated Rate |
$5,980.25 |
| Rate for Payer: Aetna Commercial |
$5,980.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,413.70
|
| Rate for Payer: Cash Price |
$1,888.50
|
| Rate for Payer: Cash Price |
$1,888.50
|
| Rate for Payer: Cash Price |
$1,888.50
|
| Rate for Payer: Cigna Commercial |
$5,980.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$3,147.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,777.00
|
| Rate for Payer: Health EOS Commercial |
$5,728.45
|
| Rate for Payer: HFN Commercial |
$5,980.25
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,502.58
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,502.58
|
| Rate for Payer: Multiplan Commercial |
$5,036.00
|
| Rate for Payer: Preferred Network Access Commercial |
$5,980.25
|
| Rate for Payer: Quartz Beloit One Network |
$2,769.80
|
| Rate for Payer: Quartz Commercial |
$3,588.15
|
| Rate for Payer: The Alliance Commercial |
$3,147.50
|
| Rate for Payer: WEA Trust Commercial |
$3,462.25
|
| Rate for Payer: WPS Commercial |
$4,662.71
|
|
|
MRI Hip w/ + w/o Contrast Left
|
Facility
|
IP
|
$6,295.00
|
|
|
Service Code
|
CPT 73723 TC,LT
|
| Hospital Charge Code |
1611137
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$3,084.55 |
| Max. Negotiated Rate |
$5,791.40 |
| Rate for Payer: Aetna Commercial |
$5,665.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,413.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,336.35
|
| Rate for Payer: Cash Price |
$1,888.50
|
| Rate for Payer: Cigna Commercial |
$5,791.40
|
| Rate for Payer: Health EOS Commercial |
$5,602.55
|
| Rate for Payer: HFN Commercial |
$5,791.40
|
| Rate for Payer: Multiplan Commercial |
$5,036.00
|
| Rate for Payer: NAPHCARE Commercial |
$3,777.00
|
| Rate for Payer: Preferred Network Access Commercial |
$5,791.40
|
| Rate for Payer: Quartz Beloit One Network |
$3,084.55
|
| Rate for Payer: Quartz Commercial |
$3,777.00
|
| Rate for Payer: WEA Trust Commercial |
$3,462.25
|
| Rate for Payer: WPS Commercial |
$4,662.71
|
|
|
MRI Hip w/ + w/o Contrast Right
|
Facility
|
IP
|
$6,295.00
|
|
|
Service Code
|
CPT 73723 TC,RT
|
| Hospital Charge Code |
1611139
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$3,084.55 |
| Max. Negotiated Rate |
$5,791.40 |
| Rate for Payer: Aetna Commercial |
$5,665.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,413.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,336.35
|
| Rate for Payer: Cash Price |
$1,888.50
|
| Rate for Payer: Cigna Commercial |
$5,791.40
|
| Rate for Payer: Health EOS Commercial |
$5,602.55
|
| Rate for Payer: HFN Commercial |
$5,791.40
|
| Rate for Payer: Multiplan Commercial |
$5,036.00
|
| Rate for Payer: NAPHCARE Commercial |
$3,777.00
|
| Rate for Payer: Preferred Network Access Commercial |
$5,791.40
|
| Rate for Payer: Quartz Beloit One Network |
$3,084.55
|
| Rate for Payer: Quartz Commercial |
$3,777.00
|
| Rate for Payer: WEA Trust Commercial |
$3,462.25
|
| Rate for Payer: WPS Commercial |
$4,662.71
|
|
|
MRI Hip w/ + w/o Contrast Right
|
Facility
|
OP
|
$6,080.00
|
|
|
Service Code
|
CPT 73723
|
| Hospital Charge Code |
630985
|
| Min. Negotiated Rate |
$380.12 |
| 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 |
$380.12
|
| 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 |
$380.12
|
| 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 |
$380.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$380.12
|
| 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 |
$380.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,402.37
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$380.12
|
| 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 |
$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 |
$4,864.00
|
| Rate for Payer: NAPHCARE Commercial |
$570.18
|
| 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 |
$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 |
$3,344.00
|
| Rate for Payer: Wellcare Medicare |
$380.12
|
| Rate for Payer: WPS Commercial |
$4,503.46
|
|
|
MRI Hip w/ + w/o Contrast Right
|
Professional
|
Both
|
$5,965.00
|
|
|
Service Code
|
CPT 73723 TC,RT
|
| Hospital Charge Code |
3072752
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,502.58 |
| Max. Negotiated Rate |
$5,666.75 |
| Rate for Payer: Aetna Commercial |
$5,666.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,129.90
|
| Rate for Payer: Cash Price |
$1,789.50
|
| Rate for Payer: Cash Price |
$1,789.50
|
| Rate for Payer: Cash Price |
$1,789.50
|
| Rate for Payer: Cigna Commercial |
$5,666.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,982.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,579.00
|
| Rate for Payer: Health EOS Commercial |
$5,428.15
|
| Rate for Payer: HFN Commercial |
$5,666.75
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,502.58
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,502.58
|
| Rate for Payer: Multiplan Commercial |
$4,772.00
|
| Rate for Payer: Preferred Network Access Commercial |
$5,666.75
|
| Rate for Payer: Quartz Beloit One Network |
$2,624.60
|
| Rate for Payer: Quartz Commercial |
$3,400.05
|
| Rate for Payer: The Alliance Commercial |
$2,982.50
|
| Rate for Payer: WEA Trust Commercial |
$3,280.75
|
| Rate for Payer: WPS Commercial |
$4,418.28
|
|
|
MRI Hip w/ + w/o Contrast Right
|
Facility
|
OP
|
$6,295.00
|
|
|
Service Code
|
CPT 73723 TC,RT
|
| Hospital Charge Code |
1611139
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$380.12 |
| Max. Negotiated Rate |
$5,791.40 |
| Rate for Payer: Aetna Commercial |
$5,665.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,413.70
|
| 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 |
$3,336.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$380.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$380.12
|
| Rate for Payer: Cash Price |
$1,888.50
|
| Rate for Payer: Cash Price |
$1,888.50
|
| Rate for Payer: Cash Price |
$1,888.50
|
| Rate for Payer: Cash Price |
$1,888.50
|
| Rate for Payer: Cigna Commercial |
$5,791.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$380.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,522.68
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$380.12
|
| Rate for Payer: Health EOS Commercial |
$5,602.55
|
| Rate for Payer: HFN Commercial |
$5,791.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,414.05
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$380.12
|
| Rate for Payer: Independent Care Health Plan Medicare |
$380.12
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$380.12
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$380.12
|
| Rate for Payer: Multiplan Commercial |
$5,036.00
|
| Rate for Payer: NAPHCARE Commercial |
$570.18
|
| Rate for Payer: Preferred Network Access Commercial |
$5,791.40
|
| Rate for Payer: Quartz Beloit One Network |
$3,084.55
|
| Rate for Payer: Quartz Commercial |
$4,091.75
|
| Rate for Payer: Quartz Medicare Advantage |
$380.12
|
| Rate for Payer: The Alliance Commercial |
$1,520.48
|
| Rate for Payer: United Healthcare Medicare Advantage |
$380.12
|
| Rate for Payer: United Healthcare PPO |
$3,022.00
|
| Rate for Payer: WEA Trust Commercial |
$3,462.25
|
| Rate for Payer: Wellcare Medicare |
$380.12
|
| Rate for Payer: WPS Commercial |
$4,662.71
|
|
