|
MRI LE Joint w/ Contrast Right
|
Facility
|
OP
|
$4,988.00
|
|
|
Service Code
|
CPT 73722 TC,RT
|
| Hospital Charge Code |
1611199
|
|
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 LE Joint w/ Contrast Right
|
Facility
|
OP
|
$4,988.00
|
|
|
Service Code
|
CPT 73722 TC,RT
|
| Hospital Charge Code |
2980110
|
|
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 LE Joint w/ Contrast Right
|
Professional
|
Both
|
$4,988.00
|
|
|
Service Code
|
CPT 73722 TC,RT
|
| Hospital Charge Code |
1611199
|
|
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 LE Joint w/ Contrast Right
|
Professional
|
Both
|
$4,988.00
|
|
|
Service Code
|
CPT 73722 TC,RT
|
| Hospital Charge Code |
2980110
|
|
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 LE Joint w/ Contrast Right
|
Professional
|
Both
|
$5,085.00
|
|
|
Service Code
|
CPT 73722
|
| Hospital Charge Code |
631143
|
| Min. Negotiated Rate |
$1,222.30 |
| Max. Negotiated Rate |
$4,830.75 |
| Rate for Payer: Aetna Commercial |
$4,830.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,373.10
|
| Rate for Payer: Cash Price |
$1,525.50
|
| Rate for Payer: Cash Price |
$1,525.50
|
| Rate for Payer: Cash Price |
$1,525.50
|
| Rate for Payer: Cigna Commercial |
$4,830.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,542.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,051.00
|
| Rate for Payer: Health EOS Commercial |
$4,627.35
|
| Rate for Payer: HFN Commercial |
$4,830.75
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,222.30
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,222.30
|
| Rate for Payer: Multiplan Commercial |
$4,068.00
|
| Rate for Payer: Preferred Network Access Commercial |
$4,830.75
|
| Rate for Payer: Quartz Beloit One Network |
$2,237.40
|
| Rate for Payer: Quartz Commercial |
$2,898.45
|
| Rate for Payer: The Alliance Commercial |
$2,542.50
|
| Rate for Payer: WEA Trust Commercial |
$2,796.75
|
| Rate for Payer: WPS Commercial |
$3,766.46
|
|
|
MRI LE Joint w/o Contrast Bilateral
|
Facility
|
IP
|
$9,048.00
|
|
|
Service Code
|
CPT 73721
|
| Hospital Charge Code |
631147
|
| Min. Negotiated Rate |
$4,433.52 |
| Max. Negotiated Rate |
$8,324.16 |
| Rate for Payer: Aetna Commercial |
$8,143.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,781.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,795.44
|
| Rate for Payer: Cash Price |
$2,714.40
|
| Rate for Payer: Cigna Commercial |
$8,324.16
|
| Rate for Payer: Health EOS Commercial |
$8,052.72
|
| Rate for Payer: HFN Commercial |
$8,324.16
|
| Rate for Payer: Multiplan Commercial |
$7,238.40
|
| Rate for Payer: NAPHCARE Commercial |
$5,428.80
|
| Rate for Payer: Preferred Network Access Commercial |
$8,324.16
|
| Rate for Payer: Quartz Beloit One Network |
$4,433.52
|
| Rate for Payer: Quartz Commercial |
$5,428.80
|
| Rate for Payer: WEA Trust Commercial |
$4,976.40
|
| Rate for Payer: WPS Commercial |
$6,701.85
|
|
|
MRI LE Joint w/o Contrast Bilateral
|
Professional
|
Both
|
$9,048.00
|
|
|
Service Code
|
CPT 73721
|
| Hospital Charge Code |
631147
|
| Min. Negotiated Rate |
$762.09 |
| Max. Negotiated Rate |
$8,595.60 |
| Rate for Payer: Aetna Commercial |
$8,595.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,781.28
|
| Rate for Payer: Cash Price |
$2,714.40
|
| Rate for Payer: Cash Price |
$2,714.40
|
| Rate for Payer: Cash Price |
$2,714.40
|
| Rate for Payer: Cigna Commercial |
$8,595.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$4,524.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,428.80
|
| Rate for Payer: Health EOS Commercial |
$8,233.68
|
| Rate for Payer: HFN Commercial |
$8,595.60
|
| 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 |
$7,238.40
|
| Rate for Payer: Preferred Network Access Commercial |
$8,595.60
|
| Rate for Payer: Quartz Beloit One Network |
$3,981.12
|
| Rate for Payer: Quartz Commercial |
$5,157.36
|
| Rate for Payer: The Alliance Commercial |
$4,524.00
|
| Rate for Payer: WEA Trust Commercial |
$4,976.40
|
| Rate for Payer: WPS Commercial |
$6,701.85
|
|
|
MRI LE Joint w/o Contrast Bilateral
|
Professional
|
Both
|
$4,557.00
|
|
|
Service Code
|
CPT 73721 TC,LT
|
| Hospital Charge Code |
1611201
|
|
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 LE Joint w/o Contrast Bilateral
|
Facility
|
OP
|
$4,557.00
|
|
|
Service Code
|
CPT 73721 TC,LT
|
| Hospital Charge Code |
1611201
|
|
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 LE Joint w/o Contrast Bilateral
|
Facility
|
IP
|
$4,557.00
|
|
|
Service Code
|
CPT 73721 TC,LT
|
| Hospital Charge Code |
1611201
|
|
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 LE Joint w/o Contrast Bilateral
|
Facility
|
OP
|
$9,048.00
|
|
|
Service Code
|
CPT 73721
|
| Hospital Charge Code |
631147
|
| Min. Negotiated Rate |
$242.20 |
| Max. Negotiated Rate |
$8,324.16 |
| Rate for Payer: Aetna Commercial |
$8,143.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,781.28
|
| Rate for Payer: Aetna Managed Medicare |
$242.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,881.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,524.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,343.04
|
| Rate for Payer: Anthem Medicare Advantage |
$242.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,795.44
|
| 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 |
$2,714.40
|
| Rate for Payer: Cash Price |
$2,714.40
|
| Rate for Payer: Cigna Commercial |
$8,324.16
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$242.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,063.26
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$242.20
|
| Rate for Payer: Health EOS Commercial |
$8,052.72
|
| Rate for Payer: HFN Commercial |
$8,324.16
|
| 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 |
$7,238.40
|
| Rate for Payer: NAPHCARE Commercial |
$363.30
|
| Rate for Payer: Preferred Network Access Commercial |
$8,324.16
|
| Rate for Payer: Quartz Beloit One Network |
$4,433.52
|
| Rate for Payer: Quartz Commercial |
$5,881.20
|
| 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 |
$4,976.40
|
| Rate for Payer: Wellcare Medicare |
$242.20
|
| Rate for Payer: WPS Commercial |
$6,701.85
|
|
|
MRI LE Joint w/o Contrast Left
|
Facility
|
IP
|
$4,524.00
|
|
|
Service Code
|
CPT 73721
|
| Hospital Charge Code |
631149
|
| 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 LE Joint w/o Contrast Left
|
Facility
|
IP
|
$4,732.00
|
|
|
Service Code
|
CPT 73721 TC,LT
|
| Hospital Charge Code |
1611203
|
|
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 LE Joint w/o Contrast Left
|
Professional
|
Both
|
$4,524.00
|
|
|
Service Code
|
CPT 73721
|
| Hospital Charge Code |
631149
|
| 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 LE Joint w/o Contrast Left
|
Facility
|
OP
|
$4,524.00
|
|
|
Service Code
|
CPT 73721
|
| Hospital Charge Code |
631149
|
| 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 LE Joint w/o Contrast Left
|
Facility
|
OP
|
$4,732.00
|
|
|
Service Code
|
CPT 73721 TC,LT
|
| Hospital Charge Code |
1611203
|
|
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 LE Joint w/o Contrast Left
|
Professional
|
Both
|
$4,732.00
|
|
|
Service Code
|
CPT 73721 TC,LT
|
| Hospital Charge Code |
1611203
|
|
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 LE Joint w/o Contrast Right
|
Professional
|
Both
|
$4,557.00
|
|
|
Service Code
|
CPT 73721 TC,RT
|
| Hospital Charge Code |
2980106
|
|
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 LE Joint w/o Contrast Right
|
Facility
|
OP
|
$4,557.00
|
|
|
Service Code
|
CPT 73721 TC,RT
|
| Hospital Charge Code |
1611205
|
|
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 LE Joint w/o Contrast Right
|
Facility
|
IP
|
$4,557.00
|
|
|
Service Code
|
CPT 73721 TC,RT
|
| Hospital Charge Code |
1611205
|
|
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 LE Joint w/o Contrast Right
|
Facility
|
OP
|
$4,524.00
|
|
|
Service Code
|
CPT 73721
|
| Hospital Charge Code |
631153
|
| 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 LE Joint w/o Contrast Right
|
Facility
|
IP
|
$4,524.00
|
|
|
Service Code
|
CPT 73721
|
| Hospital Charge Code |
631153
|
| 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 LE Joint w/o Contrast Right
|
Professional
|
Both
|
$4,557.00
|
|
|
Service Code
|
CPT 73721 TC,RT
|
| Hospital Charge Code |
1611205
|
|
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 LE Joint w/o Contrast Right
|
Facility
|
IP
|
$4,557.00
|
|
|
Service Code
|
CPT 73721 TC,RT
|
| Hospital Charge Code |
2980106
|
|
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 LE Joint w/o Contrast Right
|
Facility
|
OP
|
$4,557.00
|
|
|
Service Code
|
CPT 73721 TC,RT
|
| Hospital Charge Code |
2980106
|
|
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
|
|
