|
MRI Femur w/ + w/o Contrast Left
|
Professional
|
Both
|
$6,194.00
|
|
|
Service Code
|
CPT 73720 TC,LT
|
| Hospital Charge Code |
1611063
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,351.51 |
| Max. Negotiated Rate |
$6,119.67 |
| Rate for Payer: Aetna Commercial |
$6,119.67
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,539.91
|
| Rate for Payer: Cash Price |
$1,858.20
|
| Rate for Payer: Cash Price |
$1,858.20
|
| Rate for Payer: Cash Price |
$1,858.20
|
| Rate for Payer: Cigna Commercial |
$6,119.67
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$3,220.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,865.06
|
| Rate for Payer: Health EOS Commercial |
$5,862.00
|
| Rate for Payer: HFN Commercial |
$6,119.67
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,351.51
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,351.51
|
| Rate for Payer: Multiplan Commercial |
$5,153.41
|
| Rate for Payer: Preferred Network Access Commercial |
$6,119.67
|
| Rate for Payer: Quartz Beloit One Network |
$2,834.37
|
| Rate for Payer: Quartz Commercial |
$3,671.80
|
| Rate for Payer: The Alliance Commercial |
$3,220.88
|
| Rate for Payer: WEA Trust Commercial |
$3,542.97
|
| Rate for Payer: WPS Commercial |
$4,771.24
|
|
|
MRI Femur w/ + w/o Contrast Right
|
Facility
|
OP
|
$6,194.00
|
|
|
Service Code
|
CPT 73720 TC,RT
|
| Hospital Charge Code |
1611065
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,803.69 |
| Max. Negotiated Rate |
$5,926.42 |
| Rate for Payer: Aetna Commercial |
$5,797.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,539.91
|
| Rate for Payer: Aetna Managed Medicare |
$1,803.69
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,635.84
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,985.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,835.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,414.13
|
| Rate for Payer: Cash Price |
$1,858.20
|
| Rate for Payer: Cash Price |
$1,858.20
|
| Rate for Payer: Cash Price |
$1,858.20
|
| Rate for Payer: Cigna Commercial |
$5,926.42
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,604.91
|
| Rate for Payer: Health EOS Commercial |
$5,733.17
|
| Rate for Payer: HFN Commercial |
$5,926.42
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,831.32
|
| Rate for Payer: Multiplan Commercial |
$5,153.41
|
| Rate for Payer: NAPHCARE Commercial |
$3,865.06
|
| Rate for Payer: Preferred Network Access Commercial |
$5,926.42
|
| Rate for Payer: Quartz Beloit One Network |
$3,156.46
|
| Rate for Payer: Quartz Commercial |
$4,187.14
|
| Rate for Payer: Quartz Medicare Advantage |
$3,865.06
|
| Rate for Payer: The Alliance Commercial |
$3,220.88
|
| Rate for Payer: United Healthcare PPO |
$3,142.88
|
| Rate for Payer: WEA Trust Commercial |
$3,542.97
|
| Rate for Payer: WPS Commercial |
$4,771.24
|
|
|
MRI Femur w/ + w/o Contrast Right
|
Facility
|
OP
|
$6,080.00
|
|
|
Service Code
|
CPT 73720
|
| Hospital Charge Code |
630865
|
| Min. Negotiated Rate |
$367.15 |
| Max. Negotiated Rate |
$5,817.34 |
| Rate for Payer: Aetna Commercial |
$5,690.88
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,437.95
|
| Rate for Payer: Aetna Managed Medicare |
$367.15
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,110.08
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,161.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,035.14
|
| Rate for Payer: Anthem Medicare Advantage |
$367.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,351.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$367.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$367.15
|
| Rate for Payer: Cash Price |
$1,824.00
|
| Rate for Payer: Cash Price |
$1,824.00
|
| Rate for Payer: Cigna Commercial |
$5,817.34
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$367.15
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,538.56
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$367.15
|
| Rate for Payer: Health EOS Commercial |
$5,627.65
|
| Rate for Payer: HFN Commercial |
$5,817.34
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,365.80
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$367.15
|
| Rate for Payer: Independent Care Health Plan Medicare |
$367.15
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$367.15
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$367.15
|
| Rate for Payer: Multiplan Commercial |
$5,058.56
|
| Rate for Payer: NAPHCARE Commercial |
$550.73
|
| Rate for Payer: Preferred Network Access Commercial |
$5,817.34
|
| Rate for Payer: Quartz Beloit One Network |
$3,098.37
|
| Rate for Payer: Quartz Commercial |
$4,110.08
|
| Rate for Payer: Quartz Medicare Advantage |
$367.15
|
| Rate for Payer: The Alliance Commercial |
$1,468.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$367.15
|
| Rate for Payer: WEA Trust Commercial |
$3,477.76
|
| Rate for Payer: Wellcare Medicare |
$367.15
|
| Rate for Payer: WPS Commercial |
$4,683.42
|
|
|
MRI Femur w/ + w/o Contrast Right
|
Professional
|
Both
|
$6,194.00
|
|
|
Service Code
|
CPT 73720 TC,RT
|
| Hospital Charge Code |
1611065
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,351.51 |
| Max. Negotiated Rate |
$6,119.67 |
| Rate for Payer: Aetna Commercial |
$6,119.67
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,539.91
|
| Rate for Payer: Cash Price |
$1,858.20
|
| Rate for Payer: Cash Price |
$1,858.20
|
| Rate for Payer: Cash Price |
$1,858.20
|
| Rate for Payer: Cigna Commercial |
$6,119.67
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$3,220.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,865.06
|
| Rate for Payer: Health EOS Commercial |
$5,862.00
|
| Rate for Payer: HFN Commercial |
$6,119.67
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,351.51
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,351.51
|
| Rate for Payer: Multiplan Commercial |
$5,153.41
|
| Rate for Payer: Preferred Network Access Commercial |
$6,119.67
|
| Rate for Payer: Quartz Beloit One Network |
$2,834.37
|
| Rate for Payer: Quartz Commercial |
$3,671.80
|
| Rate for Payer: The Alliance Commercial |
$3,220.88
|
| Rate for Payer: WEA Trust Commercial |
$3,542.97
|
| Rate for Payer: WPS Commercial |
$4,771.24
|
|
|
MRI Femur w/ + w/o Contrast Right
|
Facility
|
OP
|
$5,965.00
|
|
|
Service Code
|
CPT 73720 TC,RT
|
| Hospital Charge Code |
2980099
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,737.01 |
| Max. Negotiated Rate |
$5,707.31 |
| Rate for Payer: Aetna Commercial |
$5,583.24
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,335.10
|
| Rate for Payer: Aetna Managed Medicare |
$1,737.01
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,635.84
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,985.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,835.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,287.91
|
| 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 |
$5,707.31
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,471.63
|
| Rate for Payer: Health EOS Commercial |
$5,521.20
|
| Rate for Payer: HFN Commercial |
$5,707.31
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,652.70
|
| Rate for Payer: Multiplan Commercial |
$4,962.88
|
| Rate for Payer: NAPHCARE Commercial |
$3,722.16
|
| Rate for Payer: Preferred Network Access Commercial |
$5,707.31
|
| Rate for Payer: Quartz Beloit One Network |
$3,039.76
|
| Rate for Payer: Quartz Commercial |
$4,032.34
|
| Rate for Payer: Quartz Medicare Advantage |
$3,722.16
|
| Rate for Payer: The Alliance Commercial |
$3,101.80
|
| Rate for Payer: United Healthcare PPO |
$3,142.88
|
| Rate for Payer: WEA Trust Commercial |
$3,411.98
|
| Rate for Payer: WPS Commercial |
$4,594.84
|
|
|
MRI Femur w/ + w/o Contrast Right
|
Facility
|
IP
|
$6,194.00
|
|
|
Service Code
|
CPT 73720 TC,RT
|
| Hospital Charge Code |
1611065
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$3,156.46 |
| Max. Negotiated Rate |
$5,926.42 |
| Rate for Payer: Aetna Commercial |
$5,797.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,539.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,414.13
|
| Rate for Payer: Cash Price |
$1,858.20
|
| Rate for Payer: Cigna Commercial |
$5,926.42
|
| Rate for Payer: Health EOS Commercial |
$5,733.17
|
| Rate for Payer: HFN Commercial |
$5,926.42
|
| Rate for Payer: Multiplan Commercial |
$5,153.41
|
| Rate for Payer: Preferred Network Access Commercial |
$5,926.42
|
| Rate for Payer: Quartz Beloit One Network |
$3,156.46
|
| Rate for Payer: Quartz Commercial |
$3,865.06
|
| Rate for Payer: WEA Trust Commercial |
$3,542.97
|
| Rate for Payer: WPS Commercial |
$4,771.24
|
|
|
MRI Femur w/ + w/o Contrast Right
|
Professional
|
Both
|
$5,965.00
|
|
|
Service Code
|
CPT 73720 TC,RT
|
| Hospital Charge Code |
2980099
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,351.51 |
| Max. Negotiated Rate |
$5,893.42 |
| Rate for Payer: Aetna Commercial |
$5,893.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,335.10
|
| 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 |
$5,893.42
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$3,101.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,722.16
|
| Rate for Payer: Health EOS Commercial |
$5,645.28
|
| Rate for Payer: HFN Commercial |
$5,893.42
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,351.51
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,351.51
|
| Rate for Payer: Multiplan Commercial |
$4,962.88
|
| Rate for Payer: Preferred Network Access Commercial |
$5,893.42
|
| Rate for Payer: Quartz Beloit One Network |
$2,729.58
|
| Rate for Payer: Quartz Commercial |
$3,536.05
|
| Rate for Payer: The Alliance Commercial |
$3,101.80
|
| Rate for Payer: WEA Trust Commercial |
$3,411.98
|
| Rate for Payer: WPS Commercial |
$4,594.84
|
|
|
MRI Femur w/ + w/o Contrast Right
|
Facility
|
IP
|
$5,965.00
|
|
|
Service Code
|
CPT 73720 TC,RT
|
| Hospital Charge Code |
2980099
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$3,039.76 |
| Max. Negotiated Rate |
$5,707.31 |
| Rate for Payer: Aetna Commercial |
$5,583.24
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,335.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,287.91
|
| Rate for Payer: Cash Price |
$1,789.50
|
| Rate for Payer: Cigna Commercial |
$5,707.31
|
| Rate for Payer: Health EOS Commercial |
$5,521.20
|
| Rate for Payer: HFN Commercial |
$5,707.31
|
| Rate for Payer: Multiplan Commercial |
$4,962.88
|
| Rate for Payer: Preferred Network Access Commercial |
$5,707.31
|
| Rate for Payer: Quartz Beloit One Network |
$3,039.76
|
| Rate for Payer: Quartz Commercial |
$3,722.16
|
| Rate for Payer: WEA Trust Commercial |
$3,411.98
|
| Rate for Payer: WPS Commercial |
$4,594.84
|
|
|
MRI Femur w/ + w/o Contrast Right
|
Professional
|
Both
|
$6,080.00
|
|
|
Service Code
|
CPT 73720
|
| Hospital Charge Code |
630865
|
| Min. Negotiated Rate |
$333.46 |
| Max. Negotiated Rate |
$6,007.04 |
| Rate for Payer: Aetna Commercial |
$6,007.04
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,437.95
|
| Rate for Payer: Aetna Managed Medicare |
$333.46
|
| Rate for Payer: Anthem Medicare Advantage |
$333.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$333.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$333.46
|
| 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 |
$6,007.04
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$3,161.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$333.46
|
| Rate for Payer: Health EOS Commercial |
$5,754.11
|
| Rate for Payer: HFN Commercial |
$6,007.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,351.51
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,351.51
|
| Rate for Payer: Independent Care Health Plan Medicare |
$333.46
|
| Rate for Payer: Multiplan Commercial |
$5,058.56
|
| Rate for Payer: NAPHCARE Commercial |
$500.18
|
| Rate for Payer: Preferred Network Access Commercial |
$6,007.04
|
| Rate for Payer: Quartz Beloit One Network |
$2,782.21
|
| Rate for Payer: Quartz Commercial |
$3,604.22
|
| Rate for Payer: Quartz Medicare Advantage |
$333.46
|
| Rate for Payer: The Alliance Commercial |
$1,267.13
|
| Rate for Payer: United Healthcare Medicare Advantage |
$333.46
|
| Rate for Payer: WEA Trust Commercial |
$3,477.76
|
| Rate for Payer: WPS Commercial |
$1,667.28
|
|
|
MRI Femur w/ + w/o Contrast Right
|
Facility
|
IP
|
$6,080.00
|
|
|
Service Code
|
CPT 73720
|
| Hospital Charge Code |
630865
|
| Min. Negotiated Rate |
$3,098.37 |
| Max. Negotiated Rate |
$5,817.34 |
| Rate for Payer: Aetna Commercial |
$5,690.88
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,437.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,351.30
|
| Rate for Payer: Cash Price |
$1,824.00
|
| Rate for Payer: Cigna Commercial |
$5,817.34
|
| Rate for Payer: Health EOS Commercial |
$5,627.65
|
| Rate for Payer: HFN Commercial |
$5,817.34
|
| Rate for Payer: Multiplan Commercial |
$5,058.56
|
| Rate for Payer: Preferred Network Access Commercial |
$5,817.34
|
| Rate for Payer: Quartz Beloit One Network |
$3,098.37
|
| Rate for Payer: Quartz Commercial |
$3,793.92
|
| Rate for Payer: WEA Trust Commercial |
$3,477.76
|
| Rate for Payer: WPS Commercial |
$4,683.42
|
|
|
MRI Foot w/ Contrast Bilateral
|
Facility
|
IP
|
$9,612.00
|
|
|
Service Code
|
CPT 73719
|
| Hospital Charge Code |
630885
|
| Min. Negotiated Rate |
$4,898.28 |
| Max. Negotiated Rate |
$9,196.76 |
| Rate for Payer: Aetna Commercial |
$8,996.83
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,596.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,298.13
|
| Rate for Payer: Cash Price |
$2,883.60
|
| Rate for Payer: Cigna Commercial |
$9,196.76
|
| Rate for Payer: Health EOS Commercial |
$8,896.87
|
| Rate for Payer: HFN Commercial |
$9,196.76
|
| Rate for Payer: Multiplan Commercial |
$7,997.18
|
| Rate for Payer: Preferred Network Access Commercial |
$9,196.76
|
| Rate for Payer: Quartz Beloit One Network |
$4,898.28
|
| Rate for Payer: Quartz Commercial |
$5,997.89
|
| Rate for Payer: WEA Trust Commercial |
$5,498.06
|
| Rate for Payer: WPS Commercial |
$7,404.12
|
|
|
MRI Foot w/ Contrast Bilateral
|
Facility
|
OP
|
$4,714.00
|
|
|
Service Code
|
CPT 73719 LT,TC
|
| Hospital Charge Code |
1611085
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,372.72 |
| Max. Negotiated Rate |
$4,510.36 |
| Rate for Payer: Aetna Commercial |
$4,412.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,216.20
|
| Rate for Payer: Aetna Managed Medicare |
$1,372.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,635.84
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,985.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,835.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,598.36
|
| Rate for Payer: Cash Price |
$1,414.20
|
| Rate for Payer: Cash Price |
$1,414.20
|
| Rate for Payer: Cash Price |
$1,414.20
|
| Rate for Payer: Cigna Commercial |
$4,510.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,743.55
|
| Rate for Payer: Health EOS Commercial |
$4,363.28
|
| Rate for Payer: HFN Commercial |
$4,510.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,676.92
|
| Rate for Payer: Multiplan Commercial |
$3,922.05
|
| Rate for Payer: NAPHCARE Commercial |
$2,941.54
|
| Rate for Payer: Preferred Network Access Commercial |
$4,510.36
|
| Rate for Payer: Quartz Beloit One Network |
$2,402.25
|
| Rate for Payer: Quartz Commercial |
$3,186.66
|
| Rate for Payer: Quartz Medicare Advantage |
$2,941.54
|
| Rate for Payer: The Alliance Commercial |
$2,451.28
|
| Rate for Payer: United Healthcare PPO |
$3,142.88
|
| Rate for Payer: WEA Trust Commercial |
$2,696.41
|
| Rate for Payer: WPS Commercial |
$3,631.19
|
|
|
MRI Foot w/ Contrast Bilateral
|
Facility
|
OP
|
$9,612.00
|
|
|
Service Code
|
CPT 73719
|
| Hospital Charge Code |
630885
|
| Min. Negotiated Rate |
$367.15 |
| Max. Negotiated Rate |
$9,196.76 |
| Rate for Payer: Aetna Commercial |
$8,996.83
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,596.97
|
| Rate for Payer: Aetna Managed Medicare |
$367.15
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,497.71
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,998.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,798.31
|
| Rate for Payer: Anthem Medicare Advantage |
$367.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,298.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$367.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$367.15
|
| Rate for Payer: Cash Price |
$2,883.60
|
| Rate for Payer: Cash Price |
$2,883.60
|
| Rate for Payer: Cigna Commercial |
$9,196.76
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$367.15
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,594.18
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$367.15
|
| Rate for Payer: Health EOS Commercial |
$8,896.87
|
| Rate for Payer: HFN Commercial |
$9,196.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,365.80
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$367.15
|
| Rate for Payer: Independent Care Health Plan Medicare |
$367.15
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$367.15
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$367.15
|
| Rate for Payer: Multiplan Commercial |
$7,997.18
|
| Rate for Payer: NAPHCARE Commercial |
$550.73
|
| Rate for Payer: Preferred Network Access Commercial |
$9,196.76
|
| Rate for Payer: Quartz Beloit One Network |
$4,898.28
|
| Rate for Payer: Quartz Commercial |
$6,497.71
|
| Rate for Payer: Quartz Medicare Advantage |
$367.15
|
| Rate for Payer: The Alliance Commercial |
$1,468.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$367.15
|
| Rate for Payer: WEA Trust Commercial |
$5,498.06
|
| Rate for Payer: Wellcare Medicare |
$367.15
|
| Rate for Payer: WPS Commercial |
$7,404.12
|
|
|
MRI Foot w/ Contrast Bilateral
|
Facility
|
IP
|
$4,714.00
|
|
|
Service Code
|
CPT 73719 LT,TC
|
| Hospital Charge Code |
1611085
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$2,402.25 |
| Max. Negotiated Rate |
$4,510.36 |
| Rate for Payer: Aetna Commercial |
$4,412.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,216.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,598.36
|
| Rate for Payer: Cash Price |
$1,414.20
|
| Rate for Payer: Cigna Commercial |
$4,510.36
|
| Rate for Payer: Health EOS Commercial |
$4,363.28
|
| Rate for Payer: HFN Commercial |
$4,510.36
|
| Rate for Payer: Multiplan Commercial |
$3,922.05
|
| Rate for Payer: Preferred Network Access Commercial |
$4,510.36
|
| Rate for Payer: Quartz Beloit One Network |
$2,402.25
|
| Rate for Payer: Quartz Commercial |
$2,941.54
|
| Rate for Payer: WEA Trust Commercial |
$2,696.41
|
| Rate for Payer: WPS Commercial |
$3,631.19
|
|
|
MRI Foot w/ Contrast Bilateral
|
Professional
|
Both
|
$4,714.00
|
|
|
Service Code
|
CPT 73719 LT,TC
|
| Hospital Charge Code |
1611085
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,049.15 |
| Max. Negotiated Rate |
$4,657.43 |
| Rate for Payer: Aetna Commercial |
$4,657.43
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,216.20
|
| Rate for Payer: Cash Price |
$1,414.20
|
| Rate for Payer: Cash Price |
$1,414.20
|
| Rate for Payer: Cash Price |
$1,414.20
|
| Rate for Payer: Cigna Commercial |
$4,657.43
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,451.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,941.54
|
| Rate for Payer: Health EOS Commercial |
$4,461.33
|
| Rate for Payer: HFN Commercial |
$4,657.43
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,049.15
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,049.15
|
| Rate for Payer: Multiplan Commercial |
$3,922.05
|
| Rate for Payer: Preferred Network Access Commercial |
$4,657.43
|
| Rate for Payer: Quartz Beloit One Network |
$2,157.13
|
| Rate for Payer: Quartz Commercial |
$2,794.46
|
| Rate for Payer: The Alliance Commercial |
$2,451.28
|
| Rate for Payer: WEA Trust Commercial |
$2,696.41
|
| Rate for Payer: WPS Commercial |
$3,631.19
|
|
|
MRI Foot w/ Contrast Bilateral
|
Professional
|
Both
|
$9,612.00
|
|
|
Service Code
|
CPT 73719
|
| Hospital Charge Code |
630885
|
| Min. Negotiated Rate |
$260.05 |
| Max. Negotiated Rate |
$9,496.66 |
| Rate for Payer: Aetna Commercial |
$9,496.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,596.97
|
| Rate for Payer: Aetna Managed Medicare |
$260.05
|
| Rate for Payer: Anthem Medicare Advantage |
$260.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$260.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$260.05
|
| Rate for Payer: Cash Price |
$2,883.60
|
| Rate for Payer: Cash Price |
$2,883.60
|
| Rate for Payer: Cash Price |
$2,883.60
|
| Rate for Payer: Cigna Commercial |
$9,496.66
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$4,998.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$260.05
|
| Rate for Payer: Health EOS Commercial |
$9,096.80
|
| Rate for Payer: HFN Commercial |
$9,496.66
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,049.15
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,049.15
|
| Rate for Payer: Independent Care Health Plan Medicare |
$260.05
|
| Rate for Payer: Multiplan Commercial |
$7,997.18
|
| Rate for Payer: NAPHCARE Commercial |
$390.08
|
| Rate for Payer: Preferred Network Access Commercial |
$9,496.66
|
| Rate for Payer: Quartz Beloit One Network |
$4,398.45
|
| Rate for Payer: Quartz Commercial |
$5,697.99
|
| Rate for Payer: Quartz Medicare Advantage |
$260.05
|
| Rate for Payer: The Alliance Commercial |
$988.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$260.05
|
| Rate for Payer: WEA Trust Commercial |
$5,498.06
|
| Rate for Payer: WPS Commercial |
$1,300.26
|
|
|
MRI Foot w/ Contrast Left
|
Facility
|
OP
|
$4,806.00
|
|
|
Service Code
|
CPT 73719
|
| Hospital Charge Code |
630887
|
| Min. Negotiated Rate |
$367.15 |
| Max. Negotiated Rate |
$4,598.38 |
| Rate for Payer: Aetna Commercial |
$4,498.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,298.49
|
| Rate for Payer: Aetna Managed Medicare |
$367.15
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,248.86
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,499.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,399.16
|
| Rate for Payer: Anthem Medicare Advantage |
$367.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,649.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$367.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$367.15
|
| Rate for Payer: Cash Price |
$1,441.80
|
| Rate for Payer: Cash Price |
$1,441.80
|
| Rate for Payer: Cigna Commercial |
$4,598.38
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$367.15
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,797.09
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$367.15
|
| Rate for Payer: Health EOS Commercial |
$4,448.43
|
| Rate for Payer: HFN Commercial |
$4,598.38
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,365.80
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$367.15
|
| Rate for Payer: Independent Care Health Plan Medicare |
$367.15
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$367.15
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$367.15
|
| Rate for Payer: Multiplan Commercial |
$3,998.59
|
| Rate for Payer: NAPHCARE Commercial |
$550.73
|
| Rate for Payer: Preferred Network Access Commercial |
$4,598.38
|
| Rate for Payer: Quartz Beloit One Network |
$2,449.14
|
| Rate for Payer: Quartz Commercial |
$3,248.86
|
| Rate for Payer: Quartz Medicare Advantage |
$367.15
|
| Rate for Payer: The Alliance Commercial |
$1,468.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$367.15
|
| Rate for Payer: WEA Trust Commercial |
$2,749.03
|
| Rate for Payer: Wellcare Medicare |
$367.15
|
| Rate for Payer: WPS Commercial |
$3,702.06
|
|
|
MRI Foot w/ Contrast Left
|
Facility
|
OP
|
$4,714.00
|
|
|
Service Code
|
CPT 73719 TC,LT
|
| Hospital Charge Code |
1611087
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,372.72 |
| Max. Negotiated Rate |
$4,510.36 |
| Rate for Payer: Aetna Commercial |
$4,412.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,216.20
|
| Rate for Payer: Aetna Managed Medicare |
$1,372.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,635.84
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,985.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,835.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,598.36
|
| Rate for Payer: Cash Price |
$1,414.20
|
| Rate for Payer: Cash Price |
$1,414.20
|
| Rate for Payer: Cash Price |
$1,414.20
|
| Rate for Payer: Cigna Commercial |
$4,510.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,743.55
|
| Rate for Payer: Health EOS Commercial |
$4,363.28
|
| Rate for Payer: HFN Commercial |
$4,510.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,676.92
|
| Rate for Payer: Multiplan Commercial |
$3,922.05
|
| Rate for Payer: NAPHCARE Commercial |
$2,941.54
|
| Rate for Payer: Preferred Network Access Commercial |
$4,510.36
|
| Rate for Payer: Quartz Beloit One Network |
$2,402.25
|
| Rate for Payer: Quartz Commercial |
$3,186.66
|
| Rate for Payer: Quartz Medicare Advantage |
$2,941.54
|
| Rate for Payer: The Alliance Commercial |
$2,451.28
|
| Rate for Payer: United Healthcare PPO |
$3,142.88
|
| Rate for Payer: WEA Trust Commercial |
$2,696.41
|
| Rate for Payer: WPS Commercial |
$3,631.19
|
|
|
MRI Foot w/ Contrast Left
|
Professional
|
Both
|
$4,806.00
|
|
|
Service Code
|
CPT 73719
|
| Hospital Charge Code |
630887
|
| Min. Negotiated Rate |
$260.05 |
| Max. Negotiated Rate |
$4,748.33 |
| Rate for Payer: Aetna Commercial |
$4,748.33
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,298.49
|
| Rate for Payer: Aetna Managed Medicare |
$260.05
|
| Rate for Payer: Anthem Medicare Advantage |
$260.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$260.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$260.05
|
| Rate for Payer: Cash Price |
$1,441.80
|
| Rate for Payer: Cash Price |
$1,441.80
|
| Rate for Payer: Cash Price |
$1,441.80
|
| Rate for Payer: Cigna Commercial |
$4,748.33
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,499.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$260.05
|
| Rate for Payer: Health EOS Commercial |
$4,548.40
|
| Rate for Payer: HFN Commercial |
$4,748.33
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,049.15
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,049.15
|
| Rate for Payer: Independent Care Health Plan Medicare |
$260.05
|
| Rate for Payer: Multiplan Commercial |
$3,998.59
|
| Rate for Payer: NAPHCARE Commercial |
$390.08
|
| Rate for Payer: Preferred Network Access Commercial |
$4,748.33
|
| Rate for Payer: Quartz Beloit One Network |
$2,199.23
|
| Rate for Payer: Quartz Commercial |
$2,849.00
|
| Rate for Payer: Quartz Medicare Advantage |
$260.05
|
| Rate for Payer: The Alliance Commercial |
$988.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$260.05
|
| Rate for Payer: WEA Trust Commercial |
$2,749.03
|
| Rate for Payer: WPS Commercial |
$1,300.26
|
|
|
MRI Foot w/ Contrast Left
|
Facility
|
IP
|
$4,806.00
|
|
|
Service Code
|
CPT 73719
|
| Hospital Charge Code |
630887
|
| Min. Negotiated Rate |
$2,449.14 |
| Max. Negotiated Rate |
$4,598.38 |
| Rate for Payer: Aetna Commercial |
$4,498.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,298.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,649.07
|
| Rate for Payer: Cash Price |
$1,441.80
|
| Rate for Payer: Cigna Commercial |
$4,598.38
|
| Rate for Payer: Health EOS Commercial |
$4,448.43
|
| Rate for Payer: HFN Commercial |
$4,598.38
|
| Rate for Payer: Multiplan Commercial |
$3,998.59
|
| Rate for Payer: Preferred Network Access Commercial |
$4,598.38
|
| Rate for Payer: Quartz Beloit One Network |
$2,449.14
|
| Rate for Payer: Quartz Commercial |
$2,998.94
|
| Rate for Payer: WEA Trust Commercial |
$2,749.03
|
| Rate for Payer: WPS Commercial |
$3,702.06
|
|
|
MRI Foot w/ Contrast Left
|
Professional
|
Both
|
$4,714.00
|
|
|
Service Code
|
CPT 73719 TC,LT
|
| Hospital Charge Code |
1611087
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,049.15 |
| Max. Negotiated Rate |
$4,657.43 |
| Rate for Payer: Aetna Commercial |
$4,657.43
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,216.20
|
| Rate for Payer: Cash Price |
$1,414.20
|
| Rate for Payer: Cash Price |
$1,414.20
|
| Rate for Payer: Cash Price |
$1,414.20
|
| Rate for Payer: Cigna Commercial |
$4,657.43
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,451.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,941.54
|
| Rate for Payer: Health EOS Commercial |
$4,461.33
|
| Rate for Payer: HFN Commercial |
$4,657.43
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,049.15
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,049.15
|
| Rate for Payer: Multiplan Commercial |
$3,922.05
|
| Rate for Payer: Preferred Network Access Commercial |
$4,657.43
|
| Rate for Payer: Quartz Beloit One Network |
$2,157.13
|
| Rate for Payer: Quartz Commercial |
$2,794.46
|
| Rate for Payer: The Alliance Commercial |
$2,451.28
|
| Rate for Payer: WEA Trust Commercial |
$2,696.41
|
| Rate for Payer: WPS Commercial |
$3,631.19
|
|
|
MRI Foot w/ Contrast Left
|
Facility
|
IP
|
$4,714.00
|
|
|
Service Code
|
CPT 73719 TC,LT
|
| Hospital Charge Code |
1611087
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$2,402.25 |
| Max. Negotiated Rate |
$4,510.36 |
| Rate for Payer: Aetna Commercial |
$4,412.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,216.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,598.36
|
| Rate for Payer: Cash Price |
$1,414.20
|
| Rate for Payer: Cigna Commercial |
$4,510.36
|
| Rate for Payer: Health EOS Commercial |
$4,363.28
|
| Rate for Payer: HFN Commercial |
$4,510.36
|
| Rate for Payer: Multiplan Commercial |
$3,922.05
|
| Rate for Payer: Preferred Network Access Commercial |
$4,510.36
|
| Rate for Payer: Quartz Beloit One Network |
$2,402.25
|
| Rate for Payer: Quartz Commercial |
$2,941.54
|
| Rate for Payer: WEA Trust Commercial |
$2,696.41
|
| Rate for Payer: WPS Commercial |
$3,631.19
|
|
|
MRI Foot w/ Contrast Right
|
Professional
|
Both
|
$4,714.00
|
|
|
Service Code
|
CPT 73719 TC,RT
|
| Hospital Charge Code |
1611089
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,049.15 |
| Max. Negotiated Rate |
$4,657.43 |
| Rate for Payer: Aetna Commercial |
$4,657.43
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,216.20
|
| Rate for Payer: Cash Price |
$1,414.20
|
| Rate for Payer: Cash Price |
$1,414.20
|
| Rate for Payer: Cash Price |
$1,414.20
|
| Rate for Payer: Cigna Commercial |
$4,657.43
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,451.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,941.54
|
| Rate for Payer: Health EOS Commercial |
$4,461.33
|
| Rate for Payer: HFN Commercial |
$4,657.43
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,049.15
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,049.15
|
| Rate for Payer: Multiplan Commercial |
$3,922.05
|
| Rate for Payer: Preferred Network Access Commercial |
$4,657.43
|
| Rate for Payer: Quartz Beloit One Network |
$2,157.13
|
| Rate for Payer: Quartz Commercial |
$2,794.46
|
| Rate for Payer: The Alliance Commercial |
$2,451.28
|
| Rate for Payer: WEA Trust Commercial |
$2,696.41
|
| Rate for Payer: WPS Commercial |
$3,631.19
|
|
|
MRI Foot w/ Contrast Right
|
Facility
|
IP
|
$4,714.00
|
|
|
Service Code
|
CPT 73719 TC,RT
|
| Hospital Charge Code |
2980096
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$2,402.25 |
| Max. Negotiated Rate |
$4,510.36 |
| Rate for Payer: Aetna Commercial |
$4,412.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,216.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,598.36
|
| Rate for Payer: Cash Price |
$1,414.20
|
| Rate for Payer: Cigna Commercial |
$4,510.36
|
| Rate for Payer: Health EOS Commercial |
$4,363.28
|
| Rate for Payer: HFN Commercial |
$4,510.36
|
| Rate for Payer: Multiplan Commercial |
$3,922.05
|
| Rate for Payer: Preferred Network Access Commercial |
$4,510.36
|
| Rate for Payer: Quartz Beloit One Network |
$2,402.25
|
| Rate for Payer: Quartz Commercial |
$2,941.54
|
| Rate for Payer: WEA Trust Commercial |
$2,696.41
|
| Rate for Payer: WPS Commercial |
$3,631.19
|
|
|
MRI Foot w/ Contrast Right
|
Facility
|
IP
|
$4,714.00
|
|
|
Service Code
|
CPT 73719 TC,RT
|
| Hospital Charge Code |
1611089
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$2,402.25 |
| Max. Negotiated Rate |
$4,510.36 |
| Rate for Payer: Aetna Commercial |
$4,412.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,216.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,598.36
|
| Rate for Payer: Cash Price |
$1,414.20
|
| Rate for Payer: Cigna Commercial |
$4,510.36
|
| Rate for Payer: Health EOS Commercial |
$4,363.28
|
| Rate for Payer: HFN Commercial |
$4,510.36
|
| Rate for Payer: Multiplan Commercial |
$3,922.05
|
| Rate for Payer: Preferred Network Access Commercial |
$4,510.36
|
| Rate for Payer: Quartz Beloit One Network |
$2,402.25
|
| Rate for Payer: Quartz Commercial |
$2,941.54
|
| Rate for Payer: WEA Trust Commercial |
$2,696.41
|
| Rate for Payer: WPS Commercial |
$3,631.19
|
|
