|
MRI LE Non Joint w/o Contrast Left
|
Facility
|
IP
|
$4,282.00
|
|
|
Service Code
|
CPT 73718 TC,LT
|
| Hospital Charge Code |
1611221
|
|
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 Left
|
Facility
|
IP
|
$4,571.00
|
|
|
Service Code
|
CPT 73718
|
| Hospital Charge Code |
631189
|
| Min. Negotiated Rate |
$2,239.79 |
| 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: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,422.63
|
| Rate for Payer: Cash Price |
$1,371.30
|
| Rate for Payer: Cigna Commercial |
$4,205.32
|
| Rate for Payer: Health EOS Commercial |
$4,068.19
|
| Rate for Payer: HFN Commercial |
$4,205.32
|
| Rate for Payer: Multiplan Commercial |
$3,656.80
|
| Rate for Payer: NAPHCARE Commercial |
$2,742.60
|
| 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 |
$2,742.60
|
| Rate for Payer: WEA Trust Commercial |
$2,514.05
|
| Rate for Payer: WPS Commercial |
$3,385.74
|
|
|
MRI LE Non Joint w/o Contrast Left
|
Facility
|
OP
|
$4,282.00
|
|
|
Service Code
|
CPT 73718 TC,LT
|
| Hospital Charge Code |
1611221
|
|
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
|
Professional
|
Both
|
$4,282.00
|
|
|
Service Code
|
CPT 73718 TC,LT
|
| Hospital Charge Code |
1611221
|
|
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 Left
|
Professional
|
Both
|
$4,571.00
|
|
|
Service Code
|
CPT 73718
|
| Hospital Charge Code |
631189
|
| Min. Negotiated Rate |
$856.87 |
| Max. Negotiated Rate |
$4,342.45 |
| Rate for Payer: Aetna Commercial |
$4,342.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,931.06
|
| Rate for Payer: Cash Price |
$1,371.30
|
| Rate for Payer: Cash Price |
$1,371.30
|
| Rate for Payer: Cash Price |
$1,371.30
|
| Rate for Payer: Cigna Commercial |
$4,342.45
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,285.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,742.60
|
| Rate for Payer: Health EOS Commercial |
$4,159.61
|
| Rate for Payer: HFN Commercial |
$4,342.45
|
| 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 |
$3,656.80
|
| Rate for Payer: Preferred Network Access Commercial |
$4,342.45
|
| Rate for Payer: Quartz Beloit One Network |
$2,011.24
|
| Rate for Payer: Quartz Commercial |
$2,605.47
|
| Rate for Payer: The Alliance Commercial |
$2,285.50
|
| Rate for Payer: WEA Trust Commercial |
$2,514.05
|
| Rate for Payer: WPS Commercial |
$3,385.74
|
|
|
MRI LE Non Joint w/o Contrast Right
|
Facility
|
IP
|
$4,571.00
|
|
|
Service Code
|
CPT 73718
|
| Hospital Charge Code |
631195
|
| Min. Negotiated Rate |
$2,239.79 |
| 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: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,422.63
|
| Rate for Payer: Cash Price |
$1,371.30
|
| Rate for Payer: Cigna Commercial |
$4,205.32
|
| Rate for Payer: Health EOS Commercial |
$4,068.19
|
| Rate for Payer: HFN Commercial |
$4,205.32
|
| Rate for Payer: Multiplan Commercial |
$3,656.80
|
| Rate for Payer: NAPHCARE Commercial |
$2,742.60
|
| 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 |
$2,742.60
|
| Rate for Payer: WEA Trust Commercial |
$2,514.05
|
| Rate for Payer: WPS Commercial |
$3,385.74
|
|
|
MRI LE Non Joint w/o Contrast Right
|
Facility
|
OP
|
$4,571.00
|
|
|
Service Code
|
CPT 73718
|
| Hospital Charge Code |
631195
|
| 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
|
|
|
MRI LE Non Joint w/o Contrast Right
|
Facility
|
IP
|
$4,282.00
|
|
|
Service Code
|
CPT 73718 TC,RT
|
| Hospital Charge Code |
1611223
|
|
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 Right
|
Facility
|
OP
|
$4,282.00
|
|
|
Service Code
|
CPT 73718 TC,RT
|
| Hospital Charge Code |
2980093
|
|
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 Right
|
Facility
|
IP
|
$4,282.00
|
|
|
Service Code
|
CPT 73718 TC,RT
|
| Hospital Charge Code |
2980093
|
|
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 Right
|
Professional
|
Both
|
$4,282.00
|
|
|
Service Code
|
CPT 73718 TC,RT
|
| Hospital Charge Code |
2980093
|
|
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 Right
|
Professional
|
Both
|
$4,571.00
|
|
|
Service Code
|
CPT 73718
|
| Hospital Charge Code |
631195
|
| Min. Negotiated Rate |
$856.87 |
| Max. Negotiated Rate |
$4,342.45 |
| Rate for Payer: Aetna Commercial |
$4,342.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,931.06
|
| Rate for Payer: Cash Price |
$1,371.30
|
| Rate for Payer: Cash Price |
$1,371.30
|
| Rate for Payer: Cash Price |
$1,371.30
|
| Rate for Payer: Cigna Commercial |
$4,342.45
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,285.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,742.60
|
| Rate for Payer: Health EOS Commercial |
$4,159.61
|
| Rate for Payer: HFN Commercial |
$4,342.45
|
| 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 |
$3,656.80
|
| Rate for Payer: Preferred Network Access Commercial |
$4,342.45
|
| Rate for Payer: Quartz Beloit One Network |
$2,011.24
|
| Rate for Payer: Quartz Commercial |
$2,605.47
|
| Rate for Payer: The Alliance Commercial |
$2,285.50
|
| Rate for Payer: WEA Trust Commercial |
$2,514.05
|
| Rate for Payer: WPS Commercial |
$3,385.74
|
|
|
MRI LE Non Joint w/o Contrast Right
|
Facility
|
OP
|
$4,282.00
|
|
|
Service Code
|
CPT 73718 TC,RT
|
| Hospital Charge Code |
1611223
|
|
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 Right
|
Professional
|
Both
|
$4,282.00
|
|
|
Service Code
|
CPT 73718 TC,RT
|
| Hospital Charge Code |
1611223
|
|
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/ + w/o Contrast Bilat
|
Professional
|
Both
|
$6,194.00
|
|
|
Service Code
|
CPT 73720 TC,LT
|
| Hospital Charge Code |
1611207
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,299.53 |
| Max. Negotiated Rate |
$5,884.30 |
| Rate for Payer: Aetna Commercial |
$5,884.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,326.84
|
| 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 |
$5,884.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$3,097.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,716.40
|
| Rate for Payer: Health EOS Commercial |
$5,636.54
|
| Rate for Payer: HFN Commercial |
$5,884.30
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,299.53
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,299.53
|
| Rate for Payer: Multiplan Commercial |
$4,955.20
|
| Rate for Payer: Preferred Network Access Commercial |
$5,884.30
|
| Rate for Payer: Quartz Beloit One Network |
$2,725.36
|
| Rate for Payer: Quartz Commercial |
$3,530.58
|
| Rate for Payer: The Alliance Commercial |
$3,097.00
|
| Rate for Payer: WEA Trust Commercial |
$3,406.70
|
| Rate for Payer: WPS Commercial |
$4,587.90
|
|
|
MRI LE Non Joint w/ + w/o Contrast Bilat
|
Facility
|
IP
|
$6,194.00
|
|
|
Service Code
|
CPT 73720 TC,LT
|
| Hospital Charge Code |
1611207
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$3,035.06 |
| Max. Negotiated Rate |
$5,698.48 |
| Rate for Payer: Aetna Commercial |
$5,574.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,326.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,282.82
|
| Rate for Payer: Cash Price |
$1,858.20
|
| Rate for Payer: Cigna Commercial |
$5,698.48
|
| Rate for Payer: Health EOS Commercial |
$5,512.66
|
| Rate for Payer: HFN Commercial |
$5,698.48
|
| Rate for Payer: Multiplan Commercial |
$4,955.20
|
| Rate for Payer: NAPHCARE Commercial |
$3,716.40
|
| Rate for Payer: Preferred Network Access Commercial |
$5,698.48
|
| Rate for Payer: Quartz Beloit One Network |
$3,035.06
|
| Rate for Payer: Quartz Commercial |
$3,716.40
|
| Rate for Payer: WEA Trust Commercial |
$3,406.70
|
| Rate for Payer: WPS Commercial |
$4,587.90
|
|
|
MRI LE Non Joint w/ + w/o Contrast Bilat
|
Facility
|
OP
|
$12,160.00
|
|
|
Service Code
|
CPT 73720
|
| Hospital Charge Code |
631155
|
| Min. Negotiated Rate |
$380.12 |
| Max. Negotiated Rate |
$11,187.20 |
| Rate for Payer: Aetna Commercial |
$10,944.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,457.60
|
| Rate for Payer: Aetna Managed Medicare |
$380.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$7,904.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$6,080.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,836.80
|
| Rate for Payer: Anthem Medicare Advantage |
$380.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,444.80
|
| 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 |
$3,648.00
|
| Rate for Payer: Cash Price |
$3,648.00
|
| Rate for Payer: Cigna Commercial |
$11,187.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$380.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,804.74
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$380.12
|
| Rate for Payer: Health EOS Commercial |
$10,822.40
|
| Rate for Payer: HFN Commercial |
$11,187.20
|
| 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 |
$9,728.00
|
| Rate for Payer: NAPHCARE Commercial |
$570.18
|
| Rate for Payer: Preferred Network Access Commercial |
$11,187.20
|
| Rate for Payer: Quartz Beloit One Network |
$5,958.40
|
| Rate for Payer: Quartz Commercial |
$7,904.00
|
| Rate for Payer: Quartz Medicare Advantage |
$380.12
|
| Rate for Payer: The Alliance Commercial |
$1,520.48
|
| Rate for Payer: United Healthcare Medicare Advantage |
$380.12
|
| Rate for Payer: WEA Trust Commercial |
$6,688.00
|
| Rate for Payer: Wellcare Medicare |
$380.12
|
| Rate for Payer: WPS Commercial |
$9,006.91
|
|
|
MRI LE Non Joint w/ + w/o Contrast Bilat
|
Facility
|
IP
|
$12,160.00
|
|
|
Service Code
|
CPT 73720
|
| Hospital Charge Code |
631155
|
| Min. Negotiated Rate |
$5,958.40 |
| Max. Negotiated Rate |
$11,187.20 |
| Rate for Payer: Aetna Commercial |
$10,944.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,457.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,444.80
|
| Rate for Payer: Cash Price |
$3,648.00
|
| Rate for Payer: Cigna Commercial |
$11,187.20
|
| Rate for Payer: Health EOS Commercial |
$10,822.40
|
| Rate for Payer: HFN Commercial |
$11,187.20
|
| Rate for Payer: Multiplan Commercial |
$9,728.00
|
| Rate for Payer: NAPHCARE Commercial |
$7,296.00
|
| Rate for Payer: Preferred Network Access Commercial |
$11,187.20
|
| Rate for Payer: Quartz Beloit One Network |
$5,958.40
|
| Rate for Payer: Quartz Commercial |
$7,296.00
|
| Rate for Payer: WEA Trust Commercial |
$6,688.00
|
| Rate for Payer: WPS Commercial |
$9,006.91
|
|
|
MRI LE Non Joint w/ + w/o Contrast Bilat
|
Facility
|
OP
|
$6,194.00
|
|
|
Service Code
|
CPT 73720 TC,LT
|
| Hospital Charge Code |
1611207
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$380.12 |
| Max. Negotiated Rate |
$5,698.48 |
| Rate for Payer: Aetna Commercial |
$5,574.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,326.84
|
| Rate for Payer: Aetna Managed Medicare |
$380.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,496.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,871.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,726.00
|
| Rate for Payer: Anthem Medicare Advantage |
$380.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,282.82
|
| 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 |
$1,858.20
|
| 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 |
$5,698.48
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$380.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,466.16
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$380.12
|
| Rate for Payer: Health EOS Commercial |
$5,512.66
|
| Rate for Payer: HFN Commercial |
$5,698.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,414.05
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$380.12
|
| Rate for Payer: Independent Care Health Plan Medicare |
$380.12
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$380.12
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$380.12
|
| Rate for Payer: Multiplan Commercial |
$4,955.20
|
| Rate for Payer: NAPHCARE Commercial |
$570.18
|
| Rate for Payer: Preferred Network Access Commercial |
$5,698.48
|
| Rate for Payer: Quartz Beloit One Network |
$3,035.06
|
| Rate for Payer: Quartz Commercial |
$4,026.10
|
| 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 |
$3,406.70
|
| Rate for Payer: Wellcare Medicare |
$380.12
|
| Rate for Payer: WPS Commercial |
$4,587.90
|
|
|
MRI LE Non Joint w/ + w/o Contrast Bilat
|
Professional
|
Both
|
$12,160.00
|
|
|
Service Code
|
CPT 73720
|
| Hospital Charge Code |
631155
|
| Min. Negotiated Rate |
$1,299.53 |
| Max. Negotiated Rate |
$11,552.00 |
| Rate for Payer: Aetna Commercial |
$11,552.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,457.60
|
| 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 |
$11,552.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$6,080.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$7,296.00
|
| Rate for Payer: Health EOS Commercial |
$11,065.60
|
| Rate for Payer: HFN Commercial |
$11,552.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,299.53
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,299.53
|
| Rate for Payer: Multiplan Commercial |
$9,728.00
|
| Rate for Payer: Preferred Network Access Commercial |
$11,552.00
|
| Rate for Payer: Quartz Beloit One Network |
$5,350.40
|
| Rate for Payer: Quartz Commercial |
$6,931.20
|
| Rate for Payer: The Alliance Commercial |
$6,080.00
|
| Rate for Payer: WEA Trust Commercial |
$6,688.00
|
| Rate for Payer: WPS Commercial |
$9,006.91
|
|
|
MRI LE Non Joint w/ + w/o Contrast Left
|
Facility
|
OP
|
$6,080.00
|
|
|
Service Code
|
CPT 73720
|
| Hospital Charge Code |
631159
|
| Min. Negotiated Rate |
$380.12 |
| Max. Negotiated Rate |
$5,593.60 |
| Rate for Payer: Aetna Commercial |
$5,472.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,228.80
|
| Rate for Payer: Aetna Managed Medicare |
$380.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,952.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,040.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,918.40
|
| Rate for Payer: Anthem Medicare Advantage |
$380.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,222.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$380.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$380.12
|
| Rate for Payer: Cash Price |
$1,824.00
|
| Rate for Payer: Cash Price |
$1,824.00
|
| Rate for Payer: Cigna Commercial |
$5,593.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$380.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,402.37
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$380.12
|
| Rate for Payer: Health EOS Commercial |
$5,411.20
|
| Rate for Payer: HFN Commercial |
$5,593.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,414.05
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$380.12
|
| Rate for Payer: Independent Care Health Plan Medicare |
$380.12
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$380.12
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$380.12
|
| Rate for Payer: Multiplan Commercial |
$4,864.00
|
| Rate for Payer: NAPHCARE Commercial |
$570.18
|
| Rate for Payer: Preferred Network Access Commercial |
$5,593.60
|
| Rate for Payer: Quartz Beloit One Network |
$2,979.20
|
| Rate for Payer: Quartz Commercial |
$3,952.00
|
| Rate for Payer: Quartz Medicare Advantage |
$380.12
|
| Rate for Payer: The Alliance Commercial |
$1,520.48
|
| Rate for Payer: United Healthcare Medicare Advantage |
$380.12
|
| Rate for Payer: WEA Trust Commercial |
$3,344.00
|
| Rate for Payer: Wellcare Medicare |
$380.12
|
| Rate for Payer: WPS Commercial |
$4,503.46
|
|
|
MRI LE Non Joint w/ + w/o Contrast Left
|
Facility
|
IP
|
$6,194.00
|
|
|
Service Code
|
CPT 73720 TC,LT
|
| Hospital Charge Code |
1611209
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$3,035.06 |
| Max. Negotiated Rate |
$5,698.48 |
| Rate for Payer: Aetna Commercial |
$5,574.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,326.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,282.82
|
| Rate for Payer: Cash Price |
$1,858.20
|
| Rate for Payer: Cigna Commercial |
$5,698.48
|
| Rate for Payer: Health EOS Commercial |
$5,512.66
|
| Rate for Payer: HFN Commercial |
$5,698.48
|
| Rate for Payer: Multiplan Commercial |
$4,955.20
|
| Rate for Payer: NAPHCARE Commercial |
$3,716.40
|
| Rate for Payer: Preferred Network Access Commercial |
$5,698.48
|
| Rate for Payer: Quartz Beloit One Network |
$3,035.06
|
| Rate for Payer: Quartz Commercial |
$3,716.40
|
| Rate for Payer: WEA Trust Commercial |
$3,406.70
|
| Rate for Payer: WPS Commercial |
$4,587.90
|
|
|
MRI LE Non Joint w/ + w/o Contrast Left
|
Facility
|
OP
|
$6,194.00
|
|
|
Service Code
|
CPT 73720 TC,LT
|
| Hospital Charge Code |
1611209
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$380.12 |
| Max. Negotiated Rate |
$5,698.48 |
| Rate for Payer: Aetna Commercial |
$5,574.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,326.84
|
| Rate for Payer: Aetna Managed Medicare |
$380.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,496.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,871.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,726.00
|
| Rate for Payer: Anthem Medicare Advantage |
$380.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,282.82
|
| 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 |
$1,858.20
|
| 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 |
$5,698.48
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$380.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,466.16
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$380.12
|
| Rate for Payer: Health EOS Commercial |
$5,512.66
|
| Rate for Payer: HFN Commercial |
$5,698.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,414.05
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$380.12
|
| Rate for Payer: Independent Care Health Plan Medicare |
$380.12
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$380.12
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$380.12
|
| Rate for Payer: Multiplan Commercial |
$4,955.20
|
| Rate for Payer: NAPHCARE Commercial |
$570.18
|
| Rate for Payer: Preferred Network Access Commercial |
$5,698.48
|
| Rate for Payer: Quartz Beloit One Network |
$3,035.06
|
| Rate for Payer: Quartz Commercial |
$4,026.10
|
| 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 |
$3,406.70
|
| Rate for Payer: Wellcare Medicare |
$380.12
|
| Rate for Payer: WPS Commercial |
$4,587.90
|
|
|
MRI LE Non Joint w/ + w/o Contrast Left
|
Professional
|
Both
|
$6,080.00
|
|
|
Service Code
|
CPT 73720
|
| Hospital Charge Code |
631159
|
| Min. Negotiated Rate |
$1,299.53 |
| Max. Negotiated Rate |
$5,776.00 |
| Rate for Payer: Aetna Commercial |
$5,776.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,228.80
|
| Rate for Payer: Cash Price |
$1,824.00
|
| Rate for Payer: Cash Price |
$1,824.00
|
| Rate for Payer: Cash Price |
$1,824.00
|
| Rate for Payer: Cigna Commercial |
$5,776.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$3,040.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,648.00
|
| Rate for Payer: Health EOS Commercial |
$5,532.80
|
| Rate for Payer: HFN Commercial |
$5,776.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,299.53
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,299.53
|
| Rate for Payer: Multiplan Commercial |
$4,864.00
|
| Rate for Payer: Preferred Network Access Commercial |
$5,776.00
|
| Rate for Payer: Quartz Beloit One Network |
$2,675.20
|
| Rate for Payer: Quartz Commercial |
$3,465.60
|
| Rate for Payer: The Alliance Commercial |
$3,040.00
|
| Rate for Payer: WEA Trust Commercial |
$3,344.00
|
| Rate for Payer: WPS Commercial |
$4,503.46
|
|
|
MRI LE Non Joint w/ + w/o Contrast Left
|
Professional
|
Both
|
$6,194.00
|
|
|
Service Code
|
CPT 73720 TC,LT
|
| Hospital Charge Code |
1611209
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,299.53 |
| Max. Negotiated Rate |
$5,884.30 |
| Rate for Payer: Aetna Commercial |
$5,884.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,326.84
|
| 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 |
$5,884.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$3,097.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,716.40
|
| Rate for Payer: Health EOS Commercial |
$5,636.54
|
| Rate for Payer: HFN Commercial |
$5,884.30
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,299.53
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,299.53
|
| Rate for Payer: Multiplan Commercial |
$4,955.20
|
| Rate for Payer: Preferred Network Access Commercial |
$5,884.30
|
| Rate for Payer: Quartz Beloit One Network |
$2,725.36
|
| Rate for Payer: Quartz Commercial |
$3,530.58
|
| Rate for Payer: The Alliance Commercial |
$3,097.00
|
| Rate for Payer: WEA Trust Commercial |
$3,406.70
|
| Rate for Payer: WPS Commercial |
$4,587.90
|
|
