|
MRI Tibia/Fibula w/ Contrast Right
|
Facility
|
IP
|
$4,714.00
|
|
|
Service Code
|
CPT 73719 TC,RT
|
| Hospital Charge Code |
1611341
|
|
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
|
Facility
|
OP
|
$4,714.00
|
|
|
Service Code
|
CPT 73719 TC,RT
|
| Hospital Charge Code |
2980098
|
|
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
|
Professional
|
Both
|
$4,714.00
|
|
|
Service Code
|
CPT 73719 TC,RT
|
| Hospital Charge Code |
2980098
|
|
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/o Contrast Bilateral
|
Facility
|
IP
|
$5,298.00
|
|
|
Service Code
|
CPT 73718 TC,LT
|
| Hospital Charge Code |
1611343
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$2,596.02 |
| Max. Negotiated Rate |
$4,874.16 |
| Rate for Payer: Aetna Commercial |
$4,768.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,556.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,807.94
|
| Rate for Payer: Cash Price |
$1,589.40
|
| Rate for Payer: Cigna Commercial |
$4,874.16
|
| Rate for Payer: Health EOS Commercial |
$4,715.22
|
| Rate for Payer: HFN Commercial |
$4,874.16
|
| Rate for Payer: Multiplan Commercial |
$4,238.40
|
| Rate for Payer: NAPHCARE Commercial |
$3,178.80
|
| Rate for Payer: Preferred Network Access Commercial |
$4,874.16
|
| Rate for Payer: Quartz Beloit One Network |
$2,596.02
|
| Rate for Payer: Quartz Commercial |
$3,178.80
|
| Rate for Payer: WEA Trust Commercial |
$2,913.90
|
| Rate for Payer: WPS Commercial |
$3,924.23
|
|
|
MRI Tibia/Fibula w/o Contrast Bilateral
|
Facility
|
OP
|
$5,298.00
|
|
|
Service Code
|
CPT 73718 TC,LT
|
| Hospital Charge Code |
1611343
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$242.20 |
| Max. Negotiated Rate |
$4,874.16 |
| Rate for Payer: Aetna Commercial |
$4,768.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,556.28
|
| 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 |
$2,807.94
|
| 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 |
$1,589.40
|
| 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 |
$4,874.16
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$242.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,964.76
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$242.20
|
| Rate for Payer: Health EOS Commercial |
$4,715.22
|
| Rate for Payer: HFN Commercial |
$4,874.16
|
| 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 |
$4,238.40
|
| Rate for Payer: NAPHCARE Commercial |
$363.30
|
| Rate for Payer: Preferred Network Access Commercial |
$4,874.16
|
| Rate for Payer: Quartz Beloit One Network |
$2,596.02
|
| Rate for Payer: Quartz Commercial |
$3,443.70
|
| 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 |
$2,913.90
|
| Rate for Payer: Wellcare Medicare |
$242.20
|
| Rate for Payer: WPS Commercial |
$3,924.23
|
|
|
MRI Tibia/Fibula w/o Contrast Bilateral
|
Facility
|
IP
|
$9,142.00
|
|
|
Service Code
|
CPT 73718
|
| Hospital Charge Code |
631329
|
| Min. Negotiated Rate |
$4,479.58 |
| Max. Negotiated Rate |
$8,410.64 |
| Rate for Payer: Aetna Commercial |
$8,227.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,862.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,845.26
|
| Rate for Payer: Cash Price |
$2,742.60
|
| Rate for Payer: Cigna Commercial |
$8,410.64
|
| Rate for Payer: Health EOS Commercial |
$8,136.38
|
| Rate for Payer: HFN Commercial |
$8,410.64
|
| Rate for Payer: Multiplan Commercial |
$7,313.60
|
| Rate for Payer: NAPHCARE Commercial |
$5,485.20
|
| Rate for Payer: Preferred Network Access Commercial |
$8,410.64
|
| Rate for Payer: Quartz Beloit One Network |
$4,479.58
|
| Rate for Payer: Quartz Commercial |
$5,485.20
|
| Rate for Payer: WEA Trust Commercial |
$5,028.10
|
| Rate for Payer: WPS Commercial |
$6,771.48
|
|
|
MRI Tibia/Fibula w/o Contrast Bilateral
|
Professional
|
Both
|
$9,142.00
|
|
|
Service Code
|
CPT 73718
|
| Hospital Charge Code |
631329
|
| Min. Negotiated Rate |
$856.87 |
| Max. Negotiated Rate |
$8,684.90 |
| Rate for Payer: Aetna Commercial |
$8,684.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,862.12
|
| Rate for Payer: Cash Price |
$2,742.60
|
| Rate for Payer: Cash Price |
$2,742.60
|
| Rate for Payer: Cash Price |
$2,742.60
|
| Rate for Payer: Cigna Commercial |
$8,684.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$4,571.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,485.20
|
| Rate for Payer: Health EOS Commercial |
$8,319.22
|
| Rate for Payer: HFN Commercial |
$8,684.90
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$856.87
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$856.87
|
| Rate for Payer: Multiplan Commercial |
$7,313.60
|
| Rate for Payer: Preferred Network Access Commercial |
$8,684.90
|
| Rate for Payer: Quartz Beloit One Network |
$4,022.48
|
| Rate for Payer: Quartz Commercial |
$5,210.94
|
| Rate for Payer: The Alliance Commercial |
$4,571.00
|
| Rate for Payer: WEA Trust Commercial |
$5,028.10
|
| Rate for Payer: WPS Commercial |
$6,771.48
|
|
|
MRI Tibia/Fibula w/o Contrast Bilateral
|
Professional
|
Both
|
$5,298.00
|
|
|
Service Code
|
CPT 73718 TC,LT
|
| Hospital Charge Code |
1611343
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$856.87 |
| Max. Negotiated Rate |
$5,033.10 |
| Rate for Payer: Aetna Commercial |
$5,033.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,556.28
|
| 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 |
$5,033.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,649.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,178.80
|
| Rate for Payer: Health EOS Commercial |
$4,821.18
|
| Rate for Payer: HFN Commercial |
$5,033.10
|
| 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 |
$4,238.40
|
| Rate for Payer: Preferred Network Access Commercial |
$5,033.10
|
| Rate for Payer: Quartz Beloit One Network |
$2,331.12
|
| Rate for Payer: Quartz Commercial |
$3,019.86
|
| Rate for Payer: The Alliance Commercial |
$2,649.00
|
| Rate for Payer: WEA Trust Commercial |
$2,913.90
|
| Rate for Payer: WPS Commercial |
$3,924.23
|
|
|
MRI Tibia/Fibula w/o Contrast Bilateral
|
Facility
|
OP
|
$9,142.00
|
|
|
Service Code
|
CPT 73718
|
| Hospital Charge Code |
631329
|
| Min. Negotiated Rate |
$242.20 |
| Max. Negotiated Rate |
$8,410.64 |
| Rate for Payer: Aetna Commercial |
$8,227.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,862.12
|
| Rate for Payer: Aetna Managed Medicare |
$242.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,942.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,571.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,388.16
|
| Rate for Payer: Anthem Medicare Advantage |
$242.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,845.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$242.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$242.20
|
| Rate for Payer: Cash Price |
$2,742.60
|
| Rate for Payer: Cash Price |
$2,742.60
|
| Rate for Payer: Cigna Commercial |
$8,410.64
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$242.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,115.86
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$242.20
|
| Rate for Payer: Health EOS Commercial |
$8,136.38
|
| Rate for Payer: HFN Commercial |
$8,410.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$900.98
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$242.20
|
| Rate for Payer: Independent Care Health Plan Medicare |
$242.20
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$242.20
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$242.20
|
| Rate for Payer: Multiplan Commercial |
$7,313.60
|
| Rate for Payer: NAPHCARE Commercial |
$363.30
|
| Rate for Payer: Preferred Network Access Commercial |
$8,410.64
|
| Rate for Payer: Quartz Beloit One Network |
$4,479.58
|
| Rate for Payer: Quartz Commercial |
$5,942.30
|
| Rate for Payer: Quartz Medicare Advantage |
$242.20
|
| Rate for Payer: The Alliance Commercial |
$968.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$242.20
|
| Rate for Payer: WEA Trust Commercial |
$5,028.10
|
| Rate for Payer: Wellcare Medicare |
$242.20
|
| Rate for Payer: WPS Commercial |
$6,771.48
|
|
|
MRI Tibia/Fibula w/o Contrast Left
|
Facility
|
OP
|
$4,571.00
|
|
|
Service Code
|
CPT 73718
|
| Hospital Charge Code |
631335
|
| 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 Tibia/Fibula w/o Contrast Left
|
Professional
|
Both
|
$4,571.00
|
|
|
Service Code
|
CPT 73718
|
| Hospital Charge Code |
631335
|
| 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 Tibia/Fibula w/o Contrast Left
|
Professional
|
Both
|
$5,298.00
|
|
|
Service Code
|
CPT 73718 TC,LT
|
| Hospital Charge Code |
1611345
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$856.87 |
| Max. Negotiated Rate |
$5,033.10 |
| Rate for Payer: Aetna Commercial |
$5,033.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,556.28
|
| 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 |
$5,033.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,649.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,178.80
|
| Rate for Payer: Health EOS Commercial |
$4,821.18
|
| Rate for Payer: HFN Commercial |
$5,033.10
|
| 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 |
$4,238.40
|
| Rate for Payer: Preferred Network Access Commercial |
$5,033.10
|
| Rate for Payer: Quartz Beloit One Network |
$2,331.12
|
| Rate for Payer: Quartz Commercial |
$3,019.86
|
| Rate for Payer: The Alliance Commercial |
$2,649.00
|
| Rate for Payer: WEA Trust Commercial |
$2,913.90
|
| Rate for Payer: WPS Commercial |
$3,924.23
|
|
|
MRI Tibia/Fibula w/o Contrast Left
|
Facility
|
OP
|
$5,298.00
|
|
|
Service Code
|
CPT 73718 TC,LT
|
| Hospital Charge Code |
1611345
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$242.20 |
| Max. Negotiated Rate |
$4,874.16 |
| Rate for Payer: Aetna Commercial |
$4,768.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,556.28
|
| 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 |
$2,807.94
|
| 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 |
$1,589.40
|
| 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 |
$4,874.16
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$242.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,964.76
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$242.20
|
| Rate for Payer: Health EOS Commercial |
$4,715.22
|
| Rate for Payer: HFN Commercial |
$4,874.16
|
| 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 |
$4,238.40
|
| Rate for Payer: NAPHCARE Commercial |
$363.30
|
| Rate for Payer: Preferred Network Access Commercial |
$4,874.16
|
| Rate for Payer: Quartz Beloit One Network |
$2,596.02
|
| Rate for Payer: Quartz Commercial |
$3,443.70
|
| 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 |
$2,913.90
|
| Rate for Payer: Wellcare Medicare |
$242.20
|
| Rate for Payer: WPS Commercial |
$3,924.23
|
|
|
MRI Tibia/Fibula w/o Contrast Left
|
Facility
|
IP
|
$4,571.00
|
|
|
Service Code
|
CPT 73718
|
| Hospital Charge Code |
631335
|
| 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 Tibia/Fibula w/o Contrast Left
|
Facility
|
IP
|
$5,298.00
|
|
|
Service Code
|
CPT 73718 TC,LT
|
| Hospital Charge Code |
1611345
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$2,596.02 |
| Max. Negotiated Rate |
$4,874.16 |
| Rate for Payer: Aetna Commercial |
$4,768.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,556.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,807.94
|
| Rate for Payer: Cash Price |
$1,589.40
|
| Rate for Payer: Cigna Commercial |
$4,874.16
|
| Rate for Payer: Health EOS Commercial |
$4,715.22
|
| Rate for Payer: HFN Commercial |
$4,874.16
|
| Rate for Payer: Multiplan Commercial |
$4,238.40
|
| Rate for Payer: NAPHCARE Commercial |
$3,178.80
|
| Rate for Payer: Preferred Network Access Commercial |
$4,874.16
|
| Rate for Payer: Quartz Beloit One Network |
$2,596.02
|
| Rate for Payer: Quartz Commercial |
$3,178.80
|
| Rate for Payer: WEA Trust Commercial |
$2,913.90
|
| Rate for Payer: WPS Commercial |
$3,924.23
|
|
|
MRI Tibia/Fibula w/o Contrast Right
|
Facility
|
IP
|
$5,298.00
|
|
|
Service Code
|
CPT 73718 TC,RT
|
| Hospital Charge Code |
2980094
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$2,596.02 |
| Max. Negotiated Rate |
$4,874.16 |
| Rate for Payer: Aetna Commercial |
$4,768.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,556.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,807.94
|
| Rate for Payer: Cash Price |
$1,589.40
|
| Rate for Payer: Cigna Commercial |
$4,874.16
|
| Rate for Payer: Health EOS Commercial |
$4,715.22
|
| Rate for Payer: HFN Commercial |
$4,874.16
|
| Rate for Payer: Multiplan Commercial |
$4,238.40
|
| Rate for Payer: NAPHCARE Commercial |
$3,178.80
|
| Rate for Payer: Preferred Network Access Commercial |
$4,874.16
|
| Rate for Payer: Quartz Beloit One Network |
$2,596.02
|
| Rate for Payer: Quartz Commercial |
$3,178.80
|
| Rate for Payer: WEA Trust Commercial |
$2,913.90
|
| Rate for Payer: WPS Commercial |
$3,924.23
|
|
|
MRI Tibia/Fibula w/o Contrast Right
|
Professional
|
Both
|
$5,298.00
|
|
|
Service Code
|
CPT 73718 TC,RT
|
| Hospital Charge Code |
1611347
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$856.87 |
| Max. Negotiated Rate |
$5,033.10 |
| Rate for Payer: Aetna Commercial |
$5,033.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,556.28
|
| 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 |
$5,033.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,649.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,178.80
|
| Rate for Payer: Health EOS Commercial |
$4,821.18
|
| Rate for Payer: HFN Commercial |
$5,033.10
|
| 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 |
$4,238.40
|
| Rate for Payer: Preferred Network Access Commercial |
$5,033.10
|
| Rate for Payer: Quartz Beloit One Network |
$2,331.12
|
| Rate for Payer: Quartz Commercial |
$3,019.86
|
| Rate for Payer: The Alliance Commercial |
$2,649.00
|
| Rate for Payer: WEA Trust Commercial |
$2,913.90
|
| Rate for Payer: WPS Commercial |
$3,924.23
|
|
|
MRI Tibia/Fibula w/o Contrast Right
|
Professional
|
Both
|
$5,298.00
|
|
|
Service Code
|
CPT 73718 TC,RT
|
| Hospital Charge Code |
2980094
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$856.87 |
| Max. Negotiated Rate |
$5,033.10 |
| Rate for Payer: Aetna Commercial |
$5,033.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,556.28
|
| 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 |
$5,033.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,649.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,178.80
|
| Rate for Payer: Health EOS Commercial |
$4,821.18
|
| Rate for Payer: HFN Commercial |
$5,033.10
|
| 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 |
$4,238.40
|
| Rate for Payer: Preferred Network Access Commercial |
$5,033.10
|
| Rate for Payer: Quartz Beloit One Network |
$2,331.12
|
| Rate for Payer: Quartz Commercial |
$3,019.86
|
| Rate for Payer: The Alliance Commercial |
$2,649.00
|
| Rate for Payer: WEA Trust Commercial |
$2,913.90
|
| Rate for Payer: WPS Commercial |
$3,924.23
|
|
|
MRI Tibia/Fibula w/o Contrast Right
|
Facility
|
OP
|
$5,298.00
|
|
|
Service Code
|
CPT 73718 TC,RT
|
| Hospital Charge Code |
2980094
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$242.20 |
| Max. Negotiated Rate |
$4,874.16 |
| Rate for Payer: Aetna Commercial |
$4,768.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,556.28
|
| 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 |
$2,807.94
|
| 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 |
$1,589.40
|
| 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 |
$4,874.16
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$242.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,964.76
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$242.20
|
| Rate for Payer: Health EOS Commercial |
$4,715.22
|
| Rate for Payer: HFN Commercial |
$4,874.16
|
| 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 |
$4,238.40
|
| Rate for Payer: NAPHCARE Commercial |
$363.30
|
| Rate for Payer: Preferred Network Access Commercial |
$4,874.16
|
| Rate for Payer: Quartz Beloit One Network |
$2,596.02
|
| Rate for Payer: Quartz Commercial |
$3,443.70
|
| 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 |
$2,913.90
|
| Rate for Payer: Wellcare Medicare |
$242.20
|
| Rate for Payer: WPS Commercial |
$3,924.23
|
|
|
MRI Tibia/Fibula w/o Contrast Right
|
Facility
|
OP
|
$5,298.00
|
|
|
Service Code
|
CPT 73718 TC,RT
|
| Hospital Charge Code |
1611347
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$242.20 |
| Max. Negotiated Rate |
$4,874.16 |
| Rate for Payer: Aetna Commercial |
$4,768.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,556.28
|
| 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 |
$2,807.94
|
| 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 |
$1,589.40
|
| 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 |
$4,874.16
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$242.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,964.76
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$242.20
|
| Rate for Payer: Health EOS Commercial |
$4,715.22
|
| Rate for Payer: HFN Commercial |
$4,874.16
|
| 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 |
$4,238.40
|
| Rate for Payer: NAPHCARE Commercial |
$363.30
|
| Rate for Payer: Preferred Network Access Commercial |
$4,874.16
|
| Rate for Payer: Quartz Beloit One Network |
$2,596.02
|
| Rate for Payer: Quartz Commercial |
$3,443.70
|
| 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 |
$2,913.90
|
| Rate for Payer: Wellcare Medicare |
$242.20
|
| Rate for Payer: WPS Commercial |
$3,924.23
|
|
|
MRI Tibia/Fibula w/o Contrast Right
|
Facility
|
IP
|
$5,298.00
|
|
|
Service Code
|
CPT 73718 TC,RT
|
| Hospital Charge Code |
1611347
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$2,596.02 |
| Max. Negotiated Rate |
$4,874.16 |
| Rate for Payer: Aetna Commercial |
$4,768.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,556.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,807.94
|
| Rate for Payer: Cash Price |
$1,589.40
|
| Rate for Payer: Cigna Commercial |
$4,874.16
|
| Rate for Payer: Health EOS Commercial |
$4,715.22
|
| Rate for Payer: HFN Commercial |
$4,874.16
|
| Rate for Payer: Multiplan Commercial |
$4,238.40
|
| Rate for Payer: NAPHCARE Commercial |
$3,178.80
|
| Rate for Payer: Preferred Network Access Commercial |
$4,874.16
|
| Rate for Payer: Quartz Beloit One Network |
$2,596.02
|
| Rate for Payer: Quartz Commercial |
$3,178.80
|
| Rate for Payer: WEA Trust Commercial |
$2,913.90
|
| Rate for Payer: WPS Commercial |
$3,924.23
|
|
|
MRI Tibia/Fibula w/o Contrast Right
|
Facility
|
IP
|
$4,571.00
|
|
|
Service Code
|
CPT 73718
|
| Hospital Charge Code |
631341
|
| 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 Tibia/Fibula w/o Contrast Right
|
Facility
|
OP
|
$4,571.00
|
|
|
Service Code
|
CPT 73718
|
| Hospital Charge Code |
631341
|
| 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 Tibia/Fibula w/o Contrast Right
|
Professional
|
Both
|
$4,571.00
|
|
|
Service Code
|
CPT 73718
|
| Hospital Charge Code |
631341
|
| 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 Tibia/Fibula w/ + w/o Contrast Bilat
|
Facility
|
OP
|
$12,160.00
|
|
|
Service Code
|
CPT 73720
|
| Hospital Charge Code |
631299
|
| 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
|
|
