|
MRI Foot w/o Contrast Right
|
Facility
|
OP
|
$5,298.00
|
|
|
Service Code
|
CPT 73718 TC,RT
|
| Hospital Charge Code |
1611095
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,542.78 |
| Max. Negotiated Rate |
$5,069.13 |
| Rate for Payer: Aetna Commercial |
$4,958.93
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,738.53
|
| Rate for Payer: Aetna Managed Medicare |
$1,542.78
|
| 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 |
$2,920.26
|
| Rate for Payer: Cash Price |
$1,589.40
|
| Rate for Payer: Cash Price |
$1,589.40
|
| Rate for Payer: Cash Price |
$1,589.40
|
| Rate for Payer: Cigna Commercial |
$5,069.13
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,083.44
|
| Rate for Payer: Health EOS Commercial |
$4,903.83
|
| Rate for Payer: HFN Commercial |
$5,069.13
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,132.44
|
| Rate for Payer: Multiplan Commercial |
$4,407.94
|
| Rate for Payer: NAPHCARE Commercial |
$3,305.95
|
| Rate for Payer: Preferred Network Access Commercial |
$5,069.13
|
| Rate for Payer: Quartz Beloit One Network |
$2,699.86
|
| Rate for Payer: Quartz Commercial |
$3,581.45
|
| Rate for Payer: Quartz Medicare Advantage |
$3,305.95
|
| Rate for Payer: The Alliance Commercial |
$2,754.96
|
| Rate for Payer: United Healthcare PPO |
$3,142.88
|
| Rate for Payer: WEA Trust Commercial |
$3,030.46
|
| Rate for Payer: WPS Commercial |
$4,081.05
|
|
|
MRI Foot w/o Contrast Right
|
Facility
|
OP
|
$4,571.00
|
|
|
Service Code
|
CPT 73718
|
| Hospital Charge Code |
630901
|
| Min. Negotiated Rate |
$251.10 |
| Max. Negotiated Rate |
$4,373.53 |
| Rate for Payer: Aetna Commercial |
$4,278.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,088.30
|
| Rate for Payer: Aetna Managed Medicare |
$251.10
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,090.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,376.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,281.84
|
| Rate for Payer: Anthem Medicare Advantage |
$251.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,519.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$251.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$251.10
|
| Rate for Payer: Cash Price |
$1,371.30
|
| Rate for Payer: Cash Price |
$1,371.30
|
| Rate for Payer: Cigna Commercial |
$4,373.53
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$251.10
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,660.32
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$251.10
|
| Rate for Payer: Health EOS Commercial |
$4,230.92
|
| Rate for Payer: HFN Commercial |
$4,373.53
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$934.08
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$251.10
|
| Rate for Payer: Independent Care Health Plan Medicare |
$251.10
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$251.10
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$251.10
|
| Rate for Payer: Multiplan Commercial |
$3,803.07
|
| Rate for Payer: NAPHCARE Commercial |
$376.65
|
| Rate for Payer: Preferred Network Access Commercial |
$4,373.53
|
| Rate for Payer: Quartz Beloit One Network |
$2,329.38
|
| Rate for Payer: Quartz Commercial |
$3,090.00
|
| Rate for Payer: Quartz Medicare Advantage |
$251.10
|
| Rate for Payer: The Alliance Commercial |
$1,004.39
|
| Rate for Payer: United Healthcare Medicare Advantage |
$251.10
|
| Rate for Payer: WEA Trust Commercial |
$2,614.61
|
| Rate for Payer: Wellcare Medicare |
$251.10
|
| Rate for Payer: WPS Commercial |
$3,521.04
|
|
|
MRI Foot w/ + w/o Contrast Bilateral
|
Facility
|
IP
|
$12,160.00
|
|
|
Service Code
|
CPT 73720
|
| Hospital Charge Code |
630879
|
| Min. Negotiated Rate |
$6,196.74 |
| Max. Negotiated Rate |
$11,634.69 |
| Rate for Payer: Aetna Commercial |
$11,381.76
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,875.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,702.59
|
| Rate for Payer: Cash Price |
$3,648.00
|
| Rate for Payer: Cigna Commercial |
$11,634.69
|
| Rate for Payer: Health EOS Commercial |
$11,255.30
|
| Rate for Payer: HFN Commercial |
$11,634.69
|
| Rate for Payer: Multiplan Commercial |
$10,117.12
|
| Rate for Payer: Preferred Network Access Commercial |
$11,634.69
|
| Rate for Payer: Quartz Beloit One Network |
$6,196.74
|
| Rate for Payer: Quartz Commercial |
$7,587.84
|
| Rate for Payer: WEA Trust Commercial |
$6,955.52
|
| Rate for Payer: WPS Commercial |
$9,366.85
|
|
|
MRI Foot w/ + w/o Contrast Bilateral
|
Professional
|
Both
|
$12,160.00
|
|
|
Service Code
|
CPT 73720
|
| Hospital Charge Code |
630879
|
| Min. Negotiated Rate |
$333.46 |
| Max. Negotiated Rate |
$12,014.08 |
| Rate for Payer: Aetna Commercial |
$12,014.08
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,875.90
|
| 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 |
$3,648.00
|
| Rate for Payer: Cash Price |
$3,648.00
|
| Rate for Payer: Cash Price |
$3,648.00
|
| Rate for Payer: Cigna Commercial |
$12,014.08
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$6,323.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$333.46
|
| Rate for Payer: Health EOS Commercial |
$11,508.22
|
| Rate for Payer: HFN Commercial |
$12,014.08
|
| 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 |
$10,117.12
|
| Rate for Payer: NAPHCARE Commercial |
$500.18
|
| Rate for Payer: Preferred Network Access Commercial |
$12,014.08
|
| Rate for Payer: Quartz Beloit One Network |
$5,564.42
|
| Rate for Payer: Quartz Commercial |
$7,208.45
|
| 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 |
$6,955.52
|
| Rate for Payer: WPS Commercial |
$1,667.28
|
|
|
MRI Foot w/ + w/o Contrast Bilateral
|
Facility
|
OP
|
$12,160.00
|
|
|
Service Code
|
CPT 73720
|
| Hospital Charge Code |
630879
|
| Min. Negotiated Rate |
$367.15 |
| Max. Negotiated Rate |
$11,634.69 |
| Rate for Payer: Aetna Commercial |
$11,381.76
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,875.90
|
| Rate for Payer: Aetna Managed Medicare |
$367.15
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$8,220.16
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$6,323.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$6,070.27
|
| Rate for Payer: Anthem Medicare Advantage |
$367.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,702.59
|
| 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 |
$3,648.00
|
| Rate for Payer: Cash Price |
$3,648.00
|
| Rate for Payer: Cigna Commercial |
$11,634.69
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$367.15
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$7,077.12
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$367.15
|
| Rate for Payer: Health EOS Commercial |
$11,255.30
|
| Rate for Payer: HFN Commercial |
$11,634.69
|
| 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 |
$10,117.12
|
| Rate for Payer: NAPHCARE Commercial |
$550.73
|
| Rate for Payer: Preferred Network Access Commercial |
$11,634.69
|
| Rate for Payer: Quartz Beloit One Network |
$6,196.74
|
| Rate for Payer: Quartz Commercial |
$8,220.16
|
| 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 |
$6,955.52
|
| Rate for Payer: Wellcare Medicare |
$367.15
|
| Rate for Payer: WPS Commercial |
$9,366.85
|
|
|
MRI Foot w/ + w/o Contrast Bilateral
|
Facility
|
IP
|
$5,965.00
|
|
|
Service Code
|
CPT 73720 TC,LT
|
| Hospital Charge Code |
1611079
|
|
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 Foot w/ + w/o Contrast Bilateral
|
Facility
|
OP
|
$5,965.00
|
|
|
Service Code
|
CPT 73720 TC,LT
|
| Hospital Charge Code |
1611079
|
|
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 Foot w/ + w/o Contrast Bilateral
|
Professional
|
Both
|
$5,965.00
|
|
|
Service Code
|
CPT 73720 TC,LT
|
| Hospital Charge Code |
1611079
|
|
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 Foot w/ + w/o Contrast Left
|
Facility
|
IP
|
$6,194.00
|
|
|
Service Code
|
CPT 73720 TC,LT
|
| Hospital Charge Code |
1611081
|
|
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 Foot w/ + w/o Contrast Left
|
Professional
|
Both
|
$6,080.00
|
|
|
Service Code
|
CPT 73720
|
| Hospital Charge Code |
630881
|
| 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 Foot w/ + w/o Contrast Left
|
Professional
|
Both
|
$6,194.00
|
|
|
Service Code
|
CPT 73720 TC,LT
|
| Hospital Charge Code |
1611081
|
|
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 Foot w/ + w/o Contrast Left
|
Facility
|
OP
|
$6,194.00
|
|
|
Service Code
|
CPT 73720 TC,LT
|
| Hospital Charge Code |
1611081
|
|
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 Foot w/ + w/o Contrast Left
|
Facility
|
OP
|
$6,080.00
|
|
|
Service Code
|
CPT 73720
|
| Hospital Charge Code |
630881
|
| 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 Foot w/ + w/o Contrast Left
|
Facility
|
IP
|
$6,080.00
|
|
|
Service Code
|
CPT 73720
|
| Hospital Charge Code |
630881
|
| 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/ + w/o Contrast Right
|
Professional
|
Both
|
$6,080.00
|
|
|
Service Code
|
CPT 73720
|
| Hospital Charge Code |
630883
|
| 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 Foot w/ + w/o Contrast Right
|
Facility
|
OP
|
$6,080.00
|
|
|
Service Code
|
CPT 73720
|
| Hospital Charge Code |
630883
|
| 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 Foot w/ + w/o Contrast Right
|
Facility
|
OP
|
$5,965.00
|
|
|
Service Code
|
CPT 73720 TC,RT
|
| Hospital Charge Code |
2980100
|
|
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 Foot w/ + w/o Contrast Right
|
Facility
|
IP
|
$6,080.00
|
|
|
Service Code
|
CPT 73720
|
| Hospital Charge Code |
630883
|
| 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/ + w/o Contrast Right
|
Professional
|
Both
|
$5,965.00
|
|
|
Service Code
|
CPT 73720 TC,RT
|
| Hospital Charge Code |
2980100
|
|
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 Foot w/ + w/o Contrast Right
|
Professional
|
Both
|
$6,194.00
|
|
|
Service Code
|
CPT 73720 TC,RT
|
| Hospital Charge Code |
1611083
|
|
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 Foot w/ + w/o Contrast Right
|
Facility
|
OP
|
$6,194.00
|
|
|
Service Code
|
CPT 73720 TC,RT
|
| Hospital Charge Code |
1611083
|
|
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 Foot w/ + w/o Contrast Right
|
Facility
|
IP
|
$5,965.00
|
|
|
Service Code
|
CPT 73720 TC,RT
|
| Hospital Charge Code |
2980100
|
|
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 Foot w/ + w/o Contrast Right
|
Facility
|
IP
|
$6,194.00
|
|
|
Service Code
|
CPT 73720 TC,RT
|
| Hospital Charge Code |
1611083
|
|
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 Forearm w/ Contrast Bilateral
|
Professional
|
Both
|
$10,322.00
|
|
|
Service Code
|
CPT 73219
|
| Hospital Charge Code |
630917
|
| Min. Negotiated Rate |
$328.28 |
| Max. Negotiated Rate |
$10,198.14 |
| Rate for Payer: Aetna Commercial |
$10,198.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,232.00
|
| Rate for Payer: Aetna Managed Medicare |
$328.28
|
| Rate for Payer: Anthem Medicare Advantage |
$328.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$328.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$328.28
|
| Rate for Payer: Cash Price |
$3,096.60
|
| Rate for Payer: Cash Price |
$3,096.60
|
| Rate for Payer: Cash Price |
$3,096.60
|
| Rate for Payer: Cigna Commercial |
$10,198.14
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$5,367.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$328.28
|
| Rate for Payer: Health EOS Commercial |
$9,768.74
|
| Rate for Payer: HFN Commercial |
$10,198.14
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,339.95
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,339.95
|
| Rate for Payer: Independent Care Health Plan Medicare |
$328.28
|
| Rate for Payer: Multiplan Commercial |
$8,587.90
|
| Rate for Payer: NAPHCARE Commercial |
$492.41
|
| Rate for Payer: Preferred Network Access Commercial |
$10,198.14
|
| Rate for Payer: Quartz Beloit One Network |
$4,723.35
|
| Rate for Payer: Quartz Commercial |
$6,118.88
|
| Rate for Payer: Quartz Medicare Advantage |
$328.28
|
| Rate for Payer: The Alliance Commercial |
$1,247.45
|
| Rate for Payer: United Healthcare Medicare Advantage |
$328.28
|
| Rate for Payer: WEA Trust Commercial |
$5,904.18
|
| Rate for Payer: WPS Commercial |
$1,641.38
|
|
|
MRI Forearm w/ Contrast Bilateral
|
Professional
|
Both
|
$5,063.00
|
|
|
Service Code
|
CPT 73219 TC,LT
|
| Hospital Charge Code |
1611103
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,339.95 |
| Max. Negotiated Rate |
$5,002.24 |
| Rate for Payer: Aetna Commercial |
$5,002.24
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,528.35
|
| Rate for Payer: Cash Price |
$1,518.90
|
| Rate for Payer: Cash Price |
$1,518.90
|
| Rate for Payer: Cash Price |
$1,518.90
|
| Rate for Payer: Cigna Commercial |
$5,002.24
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,632.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,159.31
|
| Rate for Payer: Health EOS Commercial |
$4,791.62
|
| Rate for Payer: HFN Commercial |
$5,002.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,339.95
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,339.95
|
| Rate for Payer: Multiplan Commercial |
$4,212.42
|
| Rate for Payer: Preferred Network Access Commercial |
$5,002.24
|
| Rate for Payer: Quartz Beloit One Network |
$2,316.83
|
| Rate for Payer: Quartz Commercial |
$3,001.35
|
| Rate for Payer: The Alliance Commercial |
$2,632.76
|
| Rate for Payer: WEA Trust Commercial |
$2,896.04
|
| Rate for Payer: WPS Commercial |
$3,900.03
|
|
