|
MRI LE Non Joint w/ Contrast Bilateral
|
Professional
|
Both
|
$9,612.00
|
|
|
Service Code
|
CPT 73719
|
| Hospital Charge Code |
631171
|
| Min. Negotiated Rate |
$1,008.80 |
| Max. Negotiated Rate |
$9,131.40 |
| Rate for Payer: Aetna Commercial |
$9,131.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,266.32
|
| 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 |
$9,131.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$4,806.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,767.20
|
| Rate for Payer: Health EOS Commercial |
$8,746.92
|
| Rate for Payer: HFN Commercial |
$9,131.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,008.80
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,008.80
|
| Rate for Payer: Multiplan Commercial |
$7,689.60
|
| Rate for Payer: Preferred Network Access Commercial |
$9,131.40
|
| Rate for Payer: Quartz Beloit One Network |
$4,229.28
|
| Rate for Payer: Quartz Commercial |
$5,478.84
|
| Rate for Payer: The Alliance Commercial |
$4,806.00
|
| Rate for Payer: WEA Trust Commercial |
$5,286.60
|
| Rate for Payer: WPS Commercial |
$7,119.61
|
|
|
MRI LE Non Joint w/ Contrast Bilateral
|
Facility
|
OP
|
$4,714.00
|
|
|
Service Code
|
CPT 73719 TC,LT
|
| Hospital Charge Code |
1611213
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$380.12 |
| Max. Negotiated Rate |
$4,336.88 |
| Rate for Payer: Aetna Commercial |
$4,242.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,054.04
|
| 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 |
$2,498.42
|
| 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 |
$1,414.20
|
| 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 |
$4,336.88
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$380.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,637.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$380.12
|
| Rate for Payer: Health EOS Commercial |
$4,195.46
|
| Rate for Payer: HFN Commercial |
$4,336.88
|
| 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 |
$3,771.20
|
| Rate for Payer: NAPHCARE Commercial |
$570.18
|
| Rate for Payer: Preferred Network Access Commercial |
$4,336.88
|
| Rate for Payer: Quartz Beloit One Network |
$2,309.86
|
| Rate for Payer: Quartz Commercial |
$3,064.10
|
| 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 |
$2,592.70
|
| Rate for Payer: Wellcare Medicare |
$380.12
|
| Rate for Payer: WPS Commercial |
$3,491.66
|
|
|
MRI LE Non Joint w/ Contrast Bilateral
|
Facility
|
IP
|
$9,612.00
|
|
|
Service Code
|
CPT 73719
|
| Hospital Charge Code |
631171
|
| Min. Negotiated Rate |
$4,709.88 |
| Max. Negotiated Rate |
$8,843.04 |
| Rate for Payer: Aetna Commercial |
$8,650.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,266.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,094.36
|
| Rate for Payer: Cash Price |
$2,883.60
|
| Rate for Payer: Cigna Commercial |
$8,843.04
|
| Rate for Payer: Health EOS Commercial |
$8,554.68
|
| Rate for Payer: HFN Commercial |
$8,843.04
|
| Rate for Payer: Multiplan Commercial |
$7,689.60
|
| Rate for Payer: NAPHCARE Commercial |
$5,767.20
|
| Rate for Payer: Preferred Network Access Commercial |
$8,843.04
|
| Rate for Payer: Quartz Beloit One Network |
$4,709.88
|
| Rate for Payer: Quartz Commercial |
$5,767.20
|
| Rate for Payer: WEA Trust Commercial |
$5,286.60
|
| Rate for Payer: WPS Commercial |
$7,119.61
|
|
|
MRI LE Non Joint w/ Contrast Left
|
Facility
|
IP
|
$4,806.00
|
|
|
Service Code
|
CPT 73719
|
| Hospital Charge Code |
631175
|
| Min. Negotiated Rate |
$2,354.94 |
| Max. Negotiated Rate |
$4,421.52 |
| Rate for Payer: Aetna Commercial |
$4,325.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,133.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,547.18
|
| Rate for Payer: Cash Price |
$1,441.80
|
| Rate for Payer: Cigna Commercial |
$4,421.52
|
| Rate for Payer: Health EOS Commercial |
$4,277.34
|
| Rate for Payer: HFN Commercial |
$4,421.52
|
| Rate for Payer: Multiplan Commercial |
$3,844.80
|
| Rate for Payer: NAPHCARE Commercial |
$2,883.60
|
| Rate for Payer: Preferred Network Access Commercial |
$4,421.52
|
| Rate for Payer: Quartz Beloit One Network |
$2,354.94
|
| Rate for Payer: Quartz Commercial |
$2,883.60
|
| Rate for Payer: WEA Trust Commercial |
$2,643.30
|
| Rate for Payer: WPS Commercial |
$3,559.80
|
|
|
MRI LE Non Joint w/ Contrast Left
|
Facility
|
IP
|
$4,714.00
|
|
|
Service Code
|
CPT 73719 TC,LT
|
| Hospital Charge Code |
1611215
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$2,309.86 |
| Max. Negotiated Rate |
$4,336.88 |
| Rate for Payer: Aetna Commercial |
$4,242.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,054.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,498.42
|
| Rate for Payer: Cash Price |
$1,414.20
|
| Rate for Payer: Cigna Commercial |
$4,336.88
|
| Rate for Payer: Health EOS Commercial |
$4,195.46
|
| Rate for Payer: HFN Commercial |
$4,336.88
|
| Rate for Payer: Multiplan Commercial |
$3,771.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,828.40
|
| Rate for Payer: Preferred Network Access Commercial |
$4,336.88
|
| Rate for Payer: Quartz Beloit One Network |
$2,309.86
|
| Rate for Payer: Quartz Commercial |
$2,828.40
|
| Rate for Payer: WEA Trust Commercial |
$2,592.70
|
| Rate for Payer: WPS Commercial |
$3,491.66
|
|
|
MRI LE Non Joint w/ Contrast Left
|
Facility
|
OP
|
$4,806.00
|
|
|
Service Code
|
CPT 73719
|
| Hospital Charge Code |
631175
|
| Min. Negotiated Rate |
$380.12 |
| Max. Negotiated Rate |
$4,421.52 |
| Rate for Payer: Aetna Commercial |
$4,325.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,133.16
|
| Rate for Payer: Aetna Managed Medicare |
$380.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,123.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,403.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,306.88
|
| Rate for Payer: Anthem Medicare Advantage |
$380.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,547.18
|
| 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 |
$1,441.80
|
| Rate for Payer: Cash Price |
$1,441.80
|
| Rate for Payer: Cigna Commercial |
$4,421.52
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$380.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,689.44
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$380.12
|
| Rate for Payer: Health EOS Commercial |
$4,277.34
|
| Rate for Payer: HFN Commercial |
$4,421.52
|
| 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 |
$3,844.80
|
| Rate for Payer: NAPHCARE Commercial |
$570.18
|
| Rate for Payer: Preferred Network Access Commercial |
$4,421.52
|
| Rate for Payer: Quartz Beloit One Network |
$2,354.94
|
| Rate for Payer: Quartz Commercial |
$3,123.90
|
| 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 |
$2,643.30
|
| Rate for Payer: Wellcare Medicare |
$380.12
|
| Rate for Payer: WPS Commercial |
$3,559.80
|
|
|
MRI LE Non Joint w/ Contrast Left
|
Facility
|
OP
|
$4,714.00
|
|
|
Service Code
|
CPT 73719 TC,LT
|
| Hospital Charge Code |
1611215
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$380.12 |
| Max. Negotiated Rate |
$4,336.88 |
| Rate for Payer: Aetna Commercial |
$4,242.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,054.04
|
| 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 |
$2,498.42
|
| 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 |
$1,414.20
|
| 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 |
$4,336.88
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$380.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,637.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$380.12
|
| Rate for Payer: Health EOS Commercial |
$4,195.46
|
| Rate for Payer: HFN Commercial |
$4,336.88
|
| 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 |
$3,771.20
|
| Rate for Payer: NAPHCARE Commercial |
$570.18
|
| Rate for Payer: Preferred Network Access Commercial |
$4,336.88
|
| Rate for Payer: Quartz Beloit One Network |
$2,309.86
|
| Rate for Payer: Quartz Commercial |
$3,064.10
|
| 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 |
$2,592.70
|
| Rate for Payer: Wellcare Medicare |
$380.12
|
| Rate for Payer: WPS Commercial |
$3,491.66
|
|
|
MRI LE Non Joint w/ Contrast Left
|
Professional
|
Both
|
$4,714.00
|
|
|
Service Code
|
CPT 73719 TC,LT
|
| Hospital Charge Code |
1611215
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,008.80 |
| Max. Negotiated Rate |
$4,478.30 |
| Rate for Payer: Aetna Commercial |
$4,478.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,054.04
|
| 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 |
$4,478.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,357.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,828.40
|
| Rate for Payer: Health EOS Commercial |
$4,289.74
|
| Rate for Payer: HFN Commercial |
$4,478.30
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,008.80
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,008.80
|
| Rate for Payer: Multiplan Commercial |
$3,771.20
|
| Rate for Payer: Preferred Network Access Commercial |
$4,478.30
|
| Rate for Payer: Quartz Beloit One Network |
$2,074.16
|
| Rate for Payer: Quartz Commercial |
$2,686.98
|
| Rate for Payer: The Alliance Commercial |
$2,357.00
|
| Rate for Payer: WEA Trust Commercial |
$2,592.70
|
| Rate for Payer: WPS Commercial |
$3,491.66
|
|
|
MRI LE Non Joint w/ Contrast Left
|
Professional
|
Both
|
$4,806.00
|
|
|
Service Code
|
CPT 73719
|
| Hospital Charge Code |
631175
|
| Min. Negotiated Rate |
$1,008.80 |
| Max. Negotiated Rate |
$4,565.70 |
| Rate for Payer: Aetna Commercial |
$4,565.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,133.16
|
| 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 |
$4,565.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,403.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,883.60
|
| Rate for Payer: Health EOS Commercial |
$4,373.46
|
| Rate for Payer: HFN Commercial |
$4,565.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,008.80
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,008.80
|
| Rate for Payer: Multiplan Commercial |
$3,844.80
|
| Rate for Payer: Preferred Network Access Commercial |
$4,565.70
|
| Rate for Payer: Quartz Beloit One Network |
$2,114.64
|
| Rate for Payer: Quartz Commercial |
$2,739.42
|
| Rate for Payer: The Alliance Commercial |
$2,403.00
|
| Rate for Payer: WEA Trust Commercial |
$2,643.30
|
| Rate for Payer: WPS Commercial |
$3,559.80
|
|
|
MRI LE Non Joint w/ Contrast Right
|
Facility
|
IP
|
$4,806.00
|
|
|
Service Code
|
CPT 73719
|
| Hospital Charge Code |
631179
|
| Min. Negotiated Rate |
$2,354.94 |
| Max. Negotiated Rate |
$4,421.52 |
| Rate for Payer: Aetna Commercial |
$4,325.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,133.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,547.18
|
| Rate for Payer: Cash Price |
$1,441.80
|
| Rate for Payer: Cigna Commercial |
$4,421.52
|
| Rate for Payer: Health EOS Commercial |
$4,277.34
|
| Rate for Payer: HFN Commercial |
$4,421.52
|
| Rate for Payer: Multiplan Commercial |
$3,844.80
|
| Rate for Payer: NAPHCARE Commercial |
$2,883.60
|
| Rate for Payer: Preferred Network Access Commercial |
$4,421.52
|
| Rate for Payer: Quartz Beloit One Network |
$2,354.94
|
| Rate for Payer: Quartz Commercial |
$2,883.60
|
| Rate for Payer: WEA Trust Commercial |
$2,643.30
|
| Rate for Payer: WPS Commercial |
$3,559.80
|
|
|
MRI LE Non Joint w/ Contrast Right
|
Facility
|
OP
|
$4,806.00
|
|
|
Service Code
|
CPT 73719
|
| Hospital Charge Code |
631179
|
| Min. Negotiated Rate |
$380.12 |
| Max. Negotiated Rate |
$4,421.52 |
| Rate for Payer: Aetna Commercial |
$4,325.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,133.16
|
| Rate for Payer: Aetna Managed Medicare |
$380.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,123.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,403.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,306.88
|
| Rate for Payer: Anthem Medicare Advantage |
$380.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,547.18
|
| 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 |
$1,441.80
|
| Rate for Payer: Cash Price |
$1,441.80
|
| Rate for Payer: Cigna Commercial |
$4,421.52
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$380.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,689.44
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$380.12
|
| Rate for Payer: Health EOS Commercial |
$4,277.34
|
| Rate for Payer: HFN Commercial |
$4,421.52
|
| 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 |
$3,844.80
|
| Rate for Payer: NAPHCARE Commercial |
$570.18
|
| Rate for Payer: Preferred Network Access Commercial |
$4,421.52
|
| Rate for Payer: Quartz Beloit One Network |
$2,354.94
|
| Rate for Payer: Quartz Commercial |
$3,123.90
|
| 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 |
$2,643.30
|
| Rate for Payer: Wellcare Medicare |
$380.12
|
| Rate for Payer: WPS Commercial |
$3,559.80
|
|
|
MRI LE Non Joint w/ Contrast Right
|
Professional
|
Both
|
$4,714.00
|
|
|
Service Code
|
CPT 73719 TC,RT
|
| Hospital Charge Code |
2980097
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,008.80 |
| Max. Negotiated Rate |
$4,478.30 |
| Rate for Payer: Aetna Commercial |
$4,478.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,054.04
|
| 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 |
$4,478.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,357.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,828.40
|
| Rate for Payer: Health EOS Commercial |
$4,289.74
|
| Rate for Payer: HFN Commercial |
$4,478.30
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,008.80
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,008.80
|
| Rate for Payer: Multiplan Commercial |
$3,771.20
|
| Rate for Payer: Preferred Network Access Commercial |
$4,478.30
|
| Rate for Payer: Quartz Beloit One Network |
$2,074.16
|
| Rate for Payer: Quartz Commercial |
$2,686.98
|
| Rate for Payer: The Alliance Commercial |
$2,357.00
|
| Rate for Payer: WEA Trust Commercial |
$2,592.70
|
| Rate for Payer: WPS Commercial |
$3,491.66
|
|
|
MRI LE Non Joint w/ Contrast Right
|
Facility
|
IP
|
$4,714.00
|
|
|
Service Code
|
CPT 73719 TC,RT
|
| Hospital Charge Code |
1611217
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$2,309.86 |
| Max. Negotiated Rate |
$4,336.88 |
| Rate for Payer: Aetna Commercial |
$4,242.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,054.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,498.42
|
| Rate for Payer: Cash Price |
$1,414.20
|
| Rate for Payer: Cigna Commercial |
$4,336.88
|
| Rate for Payer: Health EOS Commercial |
$4,195.46
|
| Rate for Payer: HFN Commercial |
$4,336.88
|
| Rate for Payer: Multiplan Commercial |
$3,771.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,828.40
|
| Rate for Payer: Preferred Network Access Commercial |
$4,336.88
|
| Rate for Payer: Quartz Beloit One Network |
$2,309.86
|
| Rate for Payer: Quartz Commercial |
$2,828.40
|
| Rate for Payer: WEA Trust Commercial |
$2,592.70
|
| Rate for Payer: WPS Commercial |
$3,491.66
|
|
|
MRI LE Non Joint w/ Contrast Right
|
Professional
|
Both
|
$4,806.00
|
|
|
Service Code
|
CPT 73719
|
| Hospital Charge Code |
631179
|
| Min. Negotiated Rate |
$1,008.80 |
| Max. Negotiated Rate |
$4,565.70 |
| Rate for Payer: Aetna Commercial |
$4,565.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,133.16
|
| 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 |
$4,565.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,403.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,883.60
|
| Rate for Payer: Health EOS Commercial |
$4,373.46
|
| Rate for Payer: HFN Commercial |
$4,565.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,008.80
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,008.80
|
| Rate for Payer: Multiplan Commercial |
$3,844.80
|
| Rate for Payer: Preferred Network Access Commercial |
$4,565.70
|
| Rate for Payer: Quartz Beloit One Network |
$2,114.64
|
| Rate for Payer: Quartz Commercial |
$2,739.42
|
| Rate for Payer: The Alliance Commercial |
$2,403.00
|
| Rate for Payer: WEA Trust Commercial |
$2,643.30
|
| Rate for Payer: WPS Commercial |
$3,559.80
|
|
|
MRI LE Non Joint w/ Contrast Right
|
Facility
|
OP
|
$4,714.00
|
|
|
Service Code
|
CPT 73719 TC,RT
|
| Hospital Charge Code |
2980097
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$380.12 |
| Max. Negotiated Rate |
$4,336.88 |
| Rate for Payer: Aetna Commercial |
$4,242.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,054.04
|
| 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 |
$2,498.42
|
| 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 |
$1,414.20
|
| 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 |
$4,336.88
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$380.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,637.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$380.12
|
| Rate for Payer: Health EOS Commercial |
$4,195.46
|
| Rate for Payer: HFN Commercial |
$4,336.88
|
| 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 |
$3,771.20
|
| Rate for Payer: NAPHCARE Commercial |
$570.18
|
| Rate for Payer: Preferred Network Access Commercial |
$4,336.88
|
| Rate for Payer: Quartz Beloit One Network |
$2,309.86
|
| Rate for Payer: Quartz Commercial |
$3,064.10
|
| 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 |
$2,592.70
|
| Rate for Payer: Wellcare Medicare |
$380.12
|
| Rate for Payer: WPS Commercial |
$3,491.66
|
|
|
MRI LE Non Joint w/ Contrast Right
|
Professional
|
Both
|
$4,714.00
|
|
|
Service Code
|
CPT 73719 TC,RT
|
| Hospital Charge Code |
1611217
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,008.80 |
| Max. Negotiated Rate |
$4,478.30 |
| Rate for Payer: Aetna Commercial |
$4,478.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,054.04
|
| 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 |
$4,478.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,357.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,828.40
|
| Rate for Payer: Health EOS Commercial |
$4,289.74
|
| Rate for Payer: HFN Commercial |
$4,478.30
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,008.80
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,008.80
|
| Rate for Payer: Multiplan Commercial |
$3,771.20
|
| Rate for Payer: Preferred Network Access Commercial |
$4,478.30
|
| Rate for Payer: Quartz Beloit One Network |
$2,074.16
|
| Rate for Payer: Quartz Commercial |
$2,686.98
|
| Rate for Payer: The Alliance Commercial |
$2,357.00
|
| Rate for Payer: WEA Trust Commercial |
$2,592.70
|
| Rate for Payer: WPS Commercial |
$3,491.66
|
|
|
MRI LE Non Joint w/ Contrast Right
|
Facility
|
OP
|
$4,714.00
|
|
|
Service Code
|
CPT 73719 TC,RT
|
| Hospital Charge Code |
1611217
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$380.12 |
| Max. Negotiated Rate |
$4,336.88 |
| Rate for Payer: Aetna Commercial |
$4,242.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,054.04
|
| 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 |
$2,498.42
|
| 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 |
$1,414.20
|
| 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 |
$4,336.88
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$380.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,637.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$380.12
|
| Rate for Payer: Health EOS Commercial |
$4,195.46
|
| Rate for Payer: HFN Commercial |
$4,336.88
|
| 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 |
$3,771.20
|
| Rate for Payer: NAPHCARE Commercial |
$570.18
|
| Rate for Payer: Preferred Network Access Commercial |
$4,336.88
|
| Rate for Payer: Quartz Beloit One Network |
$2,309.86
|
| Rate for Payer: Quartz Commercial |
$3,064.10
|
| 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 |
$2,592.70
|
| Rate for Payer: Wellcare Medicare |
$380.12
|
| Rate for Payer: WPS Commercial |
$3,491.66
|
|
|
MRI LE Non Joint w/ Contrast Right
|
Facility
|
IP
|
$4,714.00
|
|
|
Service Code
|
CPT 73719 TC,RT
|
| Hospital Charge Code |
2980097
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$2,309.86 |
| Max. Negotiated Rate |
$4,336.88 |
| Rate for Payer: Aetna Commercial |
$4,242.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,054.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,498.42
|
| Rate for Payer: Cash Price |
$1,414.20
|
| Rate for Payer: Cigna Commercial |
$4,336.88
|
| Rate for Payer: Health EOS Commercial |
$4,195.46
|
| Rate for Payer: HFN Commercial |
$4,336.88
|
| Rate for Payer: Multiplan Commercial |
$3,771.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,828.40
|
| Rate for Payer: Preferred Network Access Commercial |
$4,336.88
|
| Rate for Payer: Quartz Beloit One Network |
$2,309.86
|
| Rate for Payer: Quartz Commercial |
$2,828.40
|
| Rate for Payer: WEA Trust Commercial |
$2,592.70
|
| Rate for Payer: WPS Commercial |
$3,491.66
|
|
|
MRI LE Non Joint w/o Contrast Bilat
|
Facility
|
IP
|
$9,142.00
|
|
|
Service Code
|
CPT 73718
|
| Hospital Charge Code |
631181
|
| Min. Negotiated Rate |
$4,479.58 |
| Max. Negotiated Rate |
$8,410.64 |
| Rate for Payer: Aetna Commercial |
$8,227.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,862.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,845.26
|
| Rate for Payer: Cash Price |
$2,742.60
|
| Rate for Payer: Cigna Commercial |
$8,410.64
|
| Rate for Payer: Health EOS Commercial |
$8,136.38
|
| Rate for Payer: HFN Commercial |
$8,410.64
|
| Rate for Payer: Multiplan Commercial |
$7,313.60
|
| Rate for Payer: NAPHCARE Commercial |
$5,485.20
|
| Rate for Payer: Preferred Network Access Commercial |
$8,410.64
|
| Rate for Payer: Quartz Beloit One Network |
$4,479.58
|
| Rate for Payer: Quartz Commercial |
$5,485.20
|
| Rate for Payer: WEA Trust Commercial |
$5,028.10
|
| Rate for Payer: WPS Commercial |
$6,771.48
|
|
|
MRI LE Non Joint w/o Contrast Bilat
|
Facility
|
IP
|
$4,282.00
|
|
|
Service Code
|
CPT 73718 TC,LT
|
| Hospital Charge Code |
1611219
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$2,098.18 |
| Max. Negotiated Rate |
$3,939.44 |
| Rate for Payer: Aetna Commercial |
$3,853.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,682.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,269.46
|
| Rate for Payer: Cash Price |
$1,284.60
|
| Rate for Payer: Cigna Commercial |
$3,939.44
|
| Rate for Payer: Health EOS Commercial |
$3,810.98
|
| Rate for Payer: HFN Commercial |
$3,939.44
|
| Rate for Payer: Multiplan Commercial |
$3,425.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,569.20
|
| Rate for Payer: Preferred Network Access Commercial |
$3,939.44
|
| Rate for Payer: Quartz Beloit One Network |
$2,098.18
|
| Rate for Payer: Quartz Commercial |
$2,569.20
|
| Rate for Payer: WEA Trust Commercial |
$2,355.10
|
| Rate for Payer: WPS Commercial |
$3,171.68
|
|
|
MRI LE Non Joint w/o Contrast Bilat
|
Professional
|
Both
|
$4,282.00
|
|
|
Service Code
|
CPT 73718 TC,LT
|
| Hospital Charge Code |
1611219
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$856.87 |
| Max. Negotiated Rate |
$4,067.90 |
| Rate for Payer: Aetna Commercial |
$4,067.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,682.52
|
| Rate for Payer: Cash Price |
$1,284.60
|
| Rate for Payer: Cash Price |
$1,284.60
|
| Rate for Payer: Cash Price |
$1,284.60
|
| Rate for Payer: Cigna Commercial |
$4,067.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,141.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,569.20
|
| Rate for Payer: Health EOS Commercial |
$3,896.62
|
| Rate for Payer: HFN Commercial |
$4,067.90
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$856.87
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$856.87
|
| Rate for Payer: Multiplan Commercial |
$3,425.60
|
| Rate for Payer: Preferred Network Access Commercial |
$4,067.90
|
| Rate for Payer: Quartz Beloit One Network |
$1,884.08
|
| Rate for Payer: Quartz Commercial |
$2,440.74
|
| Rate for Payer: The Alliance Commercial |
$2,141.00
|
| Rate for Payer: WEA Trust Commercial |
$2,355.10
|
| Rate for Payer: WPS Commercial |
$3,171.68
|
|
|
MRI LE Non Joint w/o Contrast Bilat
|
Professional
|
Both
|
$9,142.00
|
|
|
Service Code
|
CPT 73718
|
| Hospital Charge Code |
631181
|
| Min. Negotiated Rate |
$856.87 |
| Max. Negotiated Rate |
$8,684.90 |
| Rate for Payer: Aetna Commercial |
$8,684.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,862.12
|
| Rate for Payer: Cash Price |
$2,742.60
|
| Rate for Payer: Cash Price |
$2,742.60
|
| Rate for Payer: Cash Price |
$2,742.60
|
| Rate for Payer: Cigna Commercial |
$8,684.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$4,571.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,485.20
|
| Rate for Payer: Health EOS Commercial |
$8,319.22
|
| Rate for Payer: HFN Commercial |
$8,684.90
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$856.87
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$856.87
|
| Rate for Payer: Multiplan Commercial |
$7,313.60
|
| Rate for Payer: Preferred Network Access Commercial |
$8,684.90
|
| Rate for Payer: Quartz Beloit One Network |
$4,022.48
|
| Rate for Payer: Quartz Commercial |
$5,210.94
|
| Rate for Payer: The Alliance Commercial |
$4,571.00
|
| Rate for Payer: WEA Trust Commercial |
$5,028.10
|
| Rate for Payer: WPS Commercial |
$6,771.48
|
|
|
MRI LE Non Joint w/o Contrast Bilat
|
Facility
|
OP
|
$9,142.00
|
|
|
Service Code
|
CPT 73718
|
| Hospital Charge Code |
631181
|
| Min. Negotiated Rate |
$242.20 |
| Max. Negotiated Rate |
$8,410.64 |
| Rate for Payer: Aetna Commercial |
$8,227.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,862.12
|
| Rate for Payer: Aetna Managed Medicare |
$242.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,942.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,571.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,388.16
|
| Rate for Payer: Anthem Medicare Advantage |
$242.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,845.26
|
| 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 |
$2,742.60
|
| Rate for Payer: Cash Price |
$2,742.60
|
| Rate for Payer: Cigna Commercial |
$8,410.64
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$242.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,115.86
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$242.20
|
| Rate for Payer: Health EOS Commercial |
$8,136.38
|
| Rate for Payer: HFN Commercial |
$8,410.64
|
| 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 |
$7,313.60
|
| Rate for Payer: NAPHCARE Commercial |
$363.30
|
| Rate for Payer: Preferred Network Access Commercial |
$8,410.64
|
| Rate for Payer: Quartz Beloit One Network |
$4,479.58
|
| Rate for Payer: Quartz Commercial |
$5,942.30
|
| 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 |
$5,028.10
|
| Rate for Payer: Wellcare Medicare |
$242.20
|
| Rate for Payer: WPS Commercial |
$6,771.48
|
|
|
MRI LE Non Joint w/o Contrast Bilat
|
Facility
|
OP
|
$4,282.00
|
|
|
Service Code
|
CPT 73718 TC,LT
|
| Hospital Charge Code |
1611219
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$242.20 |
| Max. Negotiated Rate |
$3,939.44 |
| Rate for Payer: Aetna Commercial |
$3,853.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,682.52
|
| 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 |
$2,269.46
|
| 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 |
$1,284.60
|
| Rate for Payer: Cash Price |
$1,284.60
|
| Rate for Payer: Cash Price |
$1,284.60
|
| Rate for Payer: Cash Price |
$1,284.60
|
| Rate for Payer: Cigna Commercial |
$3,939.44
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$242.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,396.21
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$242.20
|
| Rate for Payer: Health EOS Commercial |
$3,810.98
|
| Rate for Payer: HFN Commercial |
$3,939.44
|
| 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 |
$3,425.60
|
| Rate for Payer: NAPHCARE Commercial |
$363.30
|
| Rate for Payer: Preferred Network Access Commercial |
$3,939.44
|
| Rate for Payer: Quartz Beloit One Network |
$2,098.18
|
| Rate for Payer: Quartz Commercial |
$2,783.30
|
| 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 |
$2,355.10
|
| Rate for Payer: Wellcare Medicare |
$242.20
|
| Rate for Payer: WPS Commercial |
$3,171.68
|
|
|
MRI LE Non Joint w/o Contrast Left
|
Facility
|
OP
|
$4,571.00
|
|
|
Service Code
|
CPT 73718
|
| Hospital Charge Code |
631189
|
| Min. Negotiated Rate |
$242.20 |
| Max. Negotiated Rate |
$4,205.32 |
| Rate for Payer: Aetna Commercial |
$4,113.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,931.06
|
| Rate for Payer: Aetna Managed Medicare |
$242.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,971.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,285.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,194.08
|
| Rate for Payer: Anthem Medicare Advantage |
$242.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,422.63
|
| 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 |
$1,371.30
|
| Rate for Payer: Cash Price |
$1,371.30
|
| Rate for Payer: Cigna Commercial |
$4,205.32
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$242.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,557.93
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$242.20
|
| Rate for Payer: Health EOS Commercial |
$4,068.19
|
| Rate for Payer: HFN Commercial |
$4,205.32
|
| 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 |
$3,656.80
|
| Rate for Payer: NAPHCARE Commercial |
$363.30
|
| Rate for Payer: Preferred Network Access Commercial |
$4,205.32
|
| Rate for Payer: Quartz Beloit One Network |
$2,239.79
|
| Rate for Payer: Quartz Commercial |
$2,971.15
|
| 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 |
$2,514.05
|
| Rate for Payer: Wellcare Medicare |
$242.20
|
| Rate for Payer: WPS Commercial |
$3,385.74
|
|
