|
MRI Spine Thoracic w/ + w/o Contrast
|
Professional
|
Both
|
$6,670.00
|
|
|
Service Code
|
CPT 72157 TC
|
| Hospital Charge Code |
1611317
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$843.11 |
| Max. Negotiated Rate |
$6,336.50 |
| Rate for Payer: Aetna Commercial |
$6,336.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,736.20
|
| Rate for Payer: Cash Price |
$2,001.00
|
| Rate for Payer: Cash Price |
$2,001.00
|
| Rate for Payer: Cash Price |
$2,001.00
|
| Rate for Payer: Cigna Commercial |
$6,336.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$3,335.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,002.00
|
| Rate for Payer: Health EOS Commercial |
$6,069.70
|
| Rate for Payer: HFN Commercial |
$6,336.50
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$843.11
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$843.11
|
| Rate for Payer: Multiplan Commercial |
$5,336.00
|
| Rate for Payer: Preferred Network Access Commercial |
$6,336.50
|
| Rate for Payer: Quartz Beloit One Network |
$2,934.80
|
| Rate for Payer: Quartz Commercial |
$3,801.90
|
| Rate for Payer: The Alliance Commercial |
$3,335.00
|
| Rate for Payer: WEA Trust Commercial |
$3,668.50
|
| Rate for Payer: WPS Commercial |
$4,940.47
|
|
|
MRI Sternum w/o Contrast
|
Facility
|
OP
|
$6,652.00
|
|
|
Service Code
|
CPT 71550 TC
|
| Hospital Charge Code |
5724178
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$242.20 |
| Max. Negotiated Rate |
$6,119.84 |
| Rate for Payer: Aetna Commercial |
$5,986.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,720.72
|
| 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 |
$3,525.56
|
| 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 |
$1,995.60
|
| Rate for Payer: Cash Price |
$1,995.60
|
| Rate for Payer: Cash Price |
$1,995.60
|
| Rate for Payer: Cash Price |
$1,995.60
|
| Rate for Payer: Cigna Commercial |
$6,119.84
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$242.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,722.46
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$242.20
|
| Rate for Payer: Health EOS Commercial |
$5,920.28
|
| Rate for Payer: HFN Commercial |
$6,119.84
|
| 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 |
$5,321.60
|
| Rate for Payer: NAPHCARE Commercial |
$363.30
|
| Rate for Payer: Preferred Network Access Commercial |
$6,119.84
|
| Rate for Payer: Quartz Beloit One Network |
$3,259.48
|
| Rate for Payer: Quartz Commercial |
$4,323.80
|
| Rate for Payer: Quartz Medicare Advantage |
$242.20
|
| Rate for Payer: The Alliance Commercial |
$968.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$242.20
|
| Rate for Payer: United Healthcare PPO |
$3,022.00
|
| Rate for Payer: WEA Trust Commercial |
$3,658.60
|
| Rate for Payer: Wellcare Medicare |
$242.20
|
| Rate for Payer: WPS Commercial |
$4,927.14
|
|
|
MRI Sternum w/o Contrast
|
Facility
|
IP
|
$6,652.00
|
|
|
Service Code
|
CPT 71550 TC
|
| Hospital Charge Code |
5724178
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$3,259.48 |
| Max. Negotiated Rate |
$6,119.84 |
| Rate for Payer: Aetna Commercial |
$5,986.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,720.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,525.56
|
| Rate for Payer: Cash Price |
$1,995.60
|
| Rate for Payer: Cigna Commercial |
$6,119.84
|
| Rate for Payer: Health EOS Commercial |
$5,920.28
|
| Rate for Payer: HFN Commercial |
$6,119.84
|
| Rate for Payer: Multiplan Commercial |
$5,321.60
|
| Rate for Payer: NAPHCARE Commercial |
$3,991.20
|
| Rate for Payer: Preferred Network Access Commercial |
$6,119.84
|
| Rate for Payer: Quartz Beloit One Network |
$3,259.48
|
| Rate for Payer: Quartz Commercial |
$3,991.20
|
| Rate for Payer: WEA Trust Commercial |
$3,658.60
|
| Rate for Payer: WPS Commercial |
$4,927.14
|
|
|
MRI Sternum w/o Contrast
|
Professional
|
Both
|
$6,652.00
|
|
|
Service Code
|
CPT 71550 TC
|
| Hospital Charge Code |
5724178
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,075.17 |
| Max. Negotiated Rate |
$6,319.40 |
| Rate for Payer: Aetna Commercial |
$6,319.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,720.72
|
| Rate for Payer: Cash Price |
$1,995.60
|
| Rate for Payer: Cash Price |
$1,995.60
|
| Rate for Payer: Cash Price |
$1,995.60
|
| Rate for Payer: Cigna Commercial |
$6,319.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$3,326.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,991.20
|
| Rate for Payer: Health EOS Commercial |
$6,053.32
|
| Rate for Payer: HFN Commercial |
$6,319.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,075.17
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,075.17
|
| Rate for Payer: Multiplan Commercial |
$5,321.60
|
| Rate for Payer: Preferred Network Access Commercial |
$6,319.40
|
| Rate for Payer: Quartz Beloit One Network |
$2,926.88
|
| Rate for Payer: Quartz Commercial |
$3,791.64
|
| Rate for Payer: The Alliance Commercial |
$3,326.00
|
| Rate for Payer: WEA Trust Commercial |
$3,658.60
|
| Rate for Payer: WPS Commercial |
$4,927.14
|
|
|
MRI Sternum w + w/o Contrast
|
Facility
|
IP
|
$8,950.00
|
|
|
Service Code
|
CPT 71552 TC
|
| Hospital Charge Code |
5724175
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$4,385.50 |
| Max. Negotiated Rate |
$8,234.00 |
| Rate for Payer: Aetna Commercial |
$8,055.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,697.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,743.50
|
| Rate for Payer: Cash Price |
$2,685.00
|
| Rate for Payer: Cigna Commercial |
$8,234.00
|
| Rate for Payer: Health EOS Commercial |
$7,965.50
|
| Rate for Payer: HFN Commercial |
$8,234.00
|
| Rate for Payer: Multiplan Commercial |
$7,160.00
|
| Rate for Payer: NAPHCARE Commercial |
$5,370.00
|
| Rate for Payer: Preferred Network Access Commercial |
$8,234.00
|
| Rate for Payer: Quartz Beloit One Network |
$4,385.50
|
| Rate for Payer: Quartz Commercial |
$5,370.00
|
| Rate for Payer: WEA Trust Commercial |
$4,922.50
|
| Rate for Payer: WPS Commercial |
$6,629.26
|
|
|
MRI Sternum w + w/o Contrast
|
Facility
|
OP
|
$8,950.00
|
|
|
Service Code
|
CPT 71552 TC
|
| Hospital Charge Code |
5724175
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$380.12 |
| Max. Negotiated Rate |
$8,234.00 |
| Rate for Payer: Aetna Commercial |
$8,055.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,697.00
|
| 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 |
$4,743.50
|
| 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 |
$2,685.00
|
| Rate for Payer: Cash Price |
$2,685.00
|
| Rate for Payer: Cash Price |
$2,685.00
|
| Rate for Payer: Cash Price |
$2,685.00
|
| Rate for Payer: Cigna Commercial |
$8,234.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$380.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,008.42
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$380.12
|
| Rate for Payer: Health EOS Commercial |
$7,965.50
|
| Rate for Payer: HFN Commercial |
$8,234.00
|
| 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 |
$7,160.00
|
| Rate for Payer: NAPHCARE Commercial |
$570.18
|
| Rate for Payer: Preferred Network Access Commercial |
$8,234.00
|
| Rate for Payer: Quartz Beloit One Network |
$4,385.50
|
| Rate for Payer: Quartz Commercial |
$5,817.50
|
| 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 |
$4,922.50
|
| Rate for Payer: Wellcare Medicare |
$380.12
|
| Rate for Payer: WPS Commercial |
$6,629.26
|
|
|
MRI Sternum w + w/o Contrast
|
Professional
|
Both
|
$8,950.00
|
|
|
Service Code
|
CPT 71552 TC
|
| Hospital Charge Code |
5724175
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,466.89 |
| Max. Negotiated Rate |
$8,502.50 |
| Rate for Payer: Aetna Commercial |
$8,502.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,697.00
|
| Rate for Payer: Cash Price |
$2,685.00
|
| Rate for Payer: Cash Price |
$2,685.00
|
| Rate for Payer: Cash Price |
$2,685.00
|
| Rate for Payer: Cigna Commercial |
$8,502.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$4,475.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,370.00
|
| Rate for Payer: Health EOS Commercial |
$8,144.50
|
| Rate for Payer: HFN Commercial |
$8,502.50
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,466.89
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,466.89
|
| Rate for Payer: Multiplan Commercial |
$7,160.00
|
| Rate for Payer: Preferred Network Access Commercial |
$8,502.50
|
| Rate for Payer: Quartz Beloit One Network |
$3,938.00
|
| Rate for Payer: Quartz Commercial |
$5,101.50
|
| Rate for Payer: The Alliance Commercial |
$4,475.00
|
| Rate for Payer: WEA Trust Commercial |
$4,922.50
|
| Rate for Payer: WPS Commercial |
$6,629.26
|
|
|
MRI Tibia/Fibula w/ Contrast Bilateral
|
Facility
|
IP
|
$4,714.00
|
|
|
Service Code
|
CPT 73719 TC,LT
|
| Hospital Charge Code |
1611337
|
|
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 Tibia/Fibula w/ Contrast Bilateral
|
Professional
|
Both
|
$4,714.00
|
|
|
Service Code
|
CPT 73719 TC,LT
|
| Hospital Charge Code |
1611337
|
|
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 Tibia/Fibula w/ Contrast Bilateral
|
Facility
|
OP
|
$4,714.00
|
|
|
Service Code
|
CPT 73719 TC,LT
|
| Hospital Charge Code |
1611337
|
|
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 Tibia/Fibula w/ Contrast Bilateral
|
Facility
|
IP
|
$9,612.00
|
|
|
Service Code
|
CPT 73719
|
| Hospital Charge Code |
631315
|
| 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 Tibia/Fibula w/ Contrast Bilateral
|
Facility
|
OP
|
$9,612.00
|
|
|
Service Code
|
CPT 73719
|
| Hospital Charge Code |
631315
|
| Min. Negotiated Rate |
$380.12 |
| 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: Aetna Managed Medicare |
$380.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,247.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,806.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,613.76
|
| Rate for Payer: Anthem Medicare Advantage |
$380.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,094.36
|
| 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 |
$2,883.60
|
| Rate for Payer: Cash Price |
$2,883.60
|
| Rate for Payer: Cigna Commercial |
$8,843.04
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$380.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,378.88
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$380.12
|
| Rate for Payer: Health EOS Commercial |
$8,554.68
|
| Rate for Payer: HFN Commercial |
$8,843.04
|
| 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 |
$7,689.60
|
| Rate for Payer: NAPHCARE Commercial |
$570.18
|
| 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 |
$6,247.80
|
| 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 |
$5,286.60
|
| Rate for Payer: Wellcare Medicare |
$380.12
|
| Rate for Payer: WPS Commercial |
$7,119.61
|
|
|
MRI Tibia/Fibula w/ Contrast Bilateral
|
Professional
|
Both
|
$9,612.00
|
|
|
Service Code
|
CPT 73719
|
| Hospital Charge Code |
631315
|
| 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 Tibia/Fibula w/ Contrast Left
|
Facility
|
IP
|
$4,714.00
|
|
|
Service Code
|
CPT 73719 TC,LT
|
| Hospital Charge Code |
1611339
|
|
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 Tibia/Fibula w/ Contrast Left
|
Facility
|
OP
|
$4,714.00
|
|
|
Service Code
|
CPT 73719 TC,LT
|
| Hospital Charge Code |
1611339
|
|
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 Tibia/Fibula w/ Contrast Left
|
Facility
|
OP
|
$4,806.00
|
|
|
Service Code
|
CPT 73719
|
| Hospital Charge Code |
631319
|
| 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 Tibia/Fibula w/ Contrast Left
|
Facility
|
IP
|
$4,806.00
|
|
|
Service Code
|
CPT 73719
|
| Hospital Charge Code |
631319
|
| 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 Tibia/Fibula w/ Contrast Left
|
Professional
|
Both
|
$4,806.00
|
|
|
Service Code
|
CPT 73719
|
| Hospital Charge Code |
631319
|
| 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 Tibia/Fibula w/ Contrast Left
|
Professional
|
Both
|
$4,714.00
|
|
|
Service Code
|
CPT 73719 TC,LT
|
| Hospital Charge Code |
1611339
|
|
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 Tibia/Fibula w/ Contrast Right
|
Facility
|
IP
|
$4,714.00
|
|
|
Service Code
|
CPT 73719 TC,RT
|
| Hospital Charge Code |
2980098
|
|
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 Tibia/Fibula w/ Contrast Right
|
Professional
|
Both
|
$4,714.00
|
|
|
Service Code
|
CPT 73719 TC,RT
|
| Hospital Charge Code |
1611341
|
|
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 Tibia/Fibula w/ Contrast Right
|
Professional
|
Both
|
$4,806.00
|
|
|
Service Code
|
CPT 73719
|
| Hospital Charge Code |
631325
|
| 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 Tibia/Fibula w/ Contrast Right
|
Facility
|
OP
|
$4,806.00
|
|
|
Service Code
|
CPT 73719
|
| Hospital Charge Code |
631325
|
| 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 Tibia/Fibula w/ Contrast Right
|
Facility
|
OP
|
$4,714.00
|
|
|
Service Code
|
CPT 73719 TC,RT
|
| Hospital Charge Code |
1611341
|
|
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 Tibia/Fibula w/ Contrast Right
|
Facility
|
IP
|
$4,806.00
|
|
|
Service Code
|
CPT 73719
|
| Hospital Charge Code |
631325
|
| 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
|
|
