|
MRI LE Joint w/ Contrast Bilateral
|
Professional
|
Both
|
$4,988.00
|
|
|
Service Code
|
CPT 73722 TC,LT
|
| Hospital Charge Code |
1611195
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,271.19 |
| Max. Negotiated Rate |
$4,928.14 |
| Rate for Payer: Aetna Commercial |
$4,928.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,461.27
|
| Rate for Payer: Cash Price |
$1,496.40
|
| Rate for Payer: Cash Price |
$1,496.40
|
| Rate for Payer: Cash Price |
$1,496.40
|
| Rate for Payer: Cigna Commercial |
$4,928.14
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,593.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,112.51
|
| Rate for Payer: Health EOS Commercial |
$4,720.64
|
| Rate for Payer: HFN Commercial |
$4,928.14
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,271.19
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,271.19
|
| Rate for Payer: Multiplan Commercial |
$4,150.02
|
| Rate for Payer: Preferred Network Access Commercial |
$4,928.14
|
| Rate for Payer: Quartz Beloit One Network |
$2,282.51
|
| Rate for Payer: Quartz Commercial |
$2,956.89
|
| Rate for Payer: The Alliance Commercial |
$2,593.76
|
| Rate for Payer: WEA Trust Commercial |
$2,853.14
|
| Rate for Payer: WPS Commercial |
$3,842.26
|
|
|
MRI LE Joint w/ Contrast Left
|
Facility
|
IP
|
$4,988.00
|
|
|
Service Code
|
CPT 73722 TC,LT
|
| Hospital Charge Code |
1611197
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$2,541.88 |
| Max. Negotiated Rate |
$4,772.52 |
| Rate for Payer: Aetna Commercial |
$4,668.77
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,461.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,749.39
|
| Rate for Payer: Cash Price |
$1,496.40
|
| Rate for Payer: Cigna Commercial |
$4,772.52
|
| Rate for Payer: Health EOS Commercial |
$4,616.89
|
| Rate for Payer: HFN Commercial |
$4,772.52
|
| Rate for Payer: Multiplan Commercial |
$4,150.02
|
| Rate for Payer: Preferred Network Access Commercial |
$4,772.52
|
| Rate for Payer: Quartz Beloit One Network |
$2,541.88
|
| Rate for Payer: Quartz Commercial |
$3,112.51
|
| Rate for Payer: WEA Trust Commercial |
$2,853.14
|
| Rate for Payer: WPS Commercial |
$3,842.26
|
|
|
MRI LE Joint w/ Contrast Left
|
Facility
|
OP
|
$4,988.00
|
|
|
Service Code
|
CPT 73722 TC,LT
|
| Hospital Charge Code |
1611197
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,452.51 |
| Max. Negotiated Rate |
$4,772.52 |
| Rate for Payer: Aetna Commercial |
$4,668.77
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,461.27
|
| Rate for Payer: Aetna Managed Medicare |
$1,452.51
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,635.84
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,985.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,835.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,749.39
|
| Rate for Payer: Cash Price |
$1,496.40
|
| Rate for Payer: Cash Price |
$1,496.40
|
| Rate for Payer: Cash Price |
$1,496.40
|
| Rate for Payer: Cigna Commercial |
$4,772.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,903.02
|
| Rate for Payer: Health EOS Commercial |
$4,616.89
|
| Rate for Payer: HFN Commercial |
$4,772.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,890.64
|
| Rate for Payer: Multiplan Commercial |
$4,150.02
|
| Rate for Payer: NAPHCARE Commercial |
$3,112.51
|
| Rate for Payer: Preferred Network Access Commercial |
$4,772.52
|
| Rate for Payer: Quartz Beloit One Network |
$2,541.88
|
| Rate for Payer: Quartz Commercial |
$3,371.89
|
| Rate for Payer: Quartz Medicare Advantage |
$3,112.51
|
| Rate for Payer: The Alliance Commercial |
$2,593.76
|
| Rate for Payer: United Healthcare PPO |
$3,142.88
|
| Rate for Payer: WEA Trust Commercial |
$2,853.14
|
| Rate for Payer: WPS Commercial |
$3,842.26
|
|
|
MRI LE Joint w/ Contrast Left
|
Professional
|
Both
|
$5,085.00
|
|
|
Service Code
|
CPT 73722
|
| Hospital Charge Code |
631139
|
| Min. Negotiated Rate |
$313.63 |
| Max. Negotiated Rate |
$5,023.98 |
| Rate for Payer: Aetna Commercial |
$5,023.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,548.02
|
| Rate for Payer: Aetna Managed Medicare |
$313.63
|
| Rate for Payer: Anthem Medicare Advantage |
$313.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$313.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$313.63
|
| Rate for Payer: Cash Price |
$1,525.50
|
| Rate for Payer: Cash Price |
$1,525.50
|
| Rate for Payer: Cash Price |
$1,525.50
|
| Rate for Payer: Cigna Commercial |
$5,023.98
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,644.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$313.63
|
| Rate for Payer: Health EOS Commercial |
$4,812.44
|
| Rate for Payer: HFN Commercial |
$5,023.98
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,271.19
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,271.19
|
| Rate for Payer: Independent Care Health Plan Medicare |
$313.63
|
| Rate for Payer: Multiplan Commercial |
$4,230.72
|
| Rate for Payer: NAPHCARE Commercial |
$470.45
|
| Rate for Payer: Preferred Network Access Commercial |
$5,023.98
|
| Rate for Payer: Quartz Beloit One Network |
$2,326.90
|
| Rate for Payer: Quartz Commercial |
$3,014.39
|
| Rate for Payer: Quartz Medicare Advantage |
$313.63
|
| Rate for Payer: The Alliance Commercial |
$1,191.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$313.63
|
| Rate for Payer: WEA Trust Commercial |
$2,908.62
|
| Rate for Payer: WPS Commercial |
$1,568.16
|
|
|
MRI LE Joint w/ Contrast Left
|
Facility
|
IP
|
$5,085.00
|
|
|
Service Code
|
CPT 73722
|
| Hospital Charge Code |
631139
|
| Min. Negotiated Rate |
$2,591.32 |
| Max. Negotiated Rate |
$4,865.33 |
| Rate for Payer: Aetna Commercial |
$4,759.56
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,548.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,802.85
|
| Rate for Payer: Cash Price |
$1,525.50
|
| Rate for Payer: Cigna Commercial |
$4,865.33
|
| Rate for Payer: Health EOS Commercial |
$4,706.68
|
| Rate for Payer: HFN Commercial |
$4,865.33
|
| Rate for Payer: Multiplan Commercial |
$4,230.72
|
| Rate for Payer: Preferred Network Access Commercial |
$4,865.33
|
| Rate for Payer: Quartz Beloit One Network |
$2,591.32
|
| Rate for Payer: Quartz Commercial |
$3,173.04
|
| Rate for Payer: WEA Trust Commercial |
$2,908.62
|
| Rate for Payer: WPS Commercial |
$3,916.98
|
|
|
MRI LE Joint w/ Contrast Left
|
Professional
|
Both
|
$4,988.00
|
|
|
Service Code
|
CPT 73722 TC,LT
|
| Hospital Charge Code |
1611197
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,271.19 |
| Max. Negotiated Rate |
$4,928.14 |
| Rate for Payer: Aetna Commercial |
$4,928.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,461.27
|
| Rate for Payer: Cash Price |
$1,496.40
|
| Rate for Payer: Cash Price |
$1,496.40
|
| Rate for Payer: Cash Price |
$1,496.40
|
| Rate for Payer: Cigna Commercial |
$4,928.14
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,593.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,112.51
|
| Rate for Payer: Health EOS Commercial |
$4,720.64
|
| Rate for Payer: HFN Commercial |
$4,928.14
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,271.19
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,271.19
|
| Rate for Payer: Multiplan Commercial |
$4,150.02
|
| Rate for Payer: Preferred Network Access Commercial |
$4,928.14
|
| Rate for Payer: Quartz Beloit One Network |
$2,282.51
|
| Rate for Payer: Quartz Commercial |
$2,956.89
|
| Rate for Payer: The Alliance Commercial |
$2,593.76
|
| Rate for Payer: WEA Trust Commercial |
$2,853.14
|
| Rate for Payer: WPS Commercial |
$3,842.26
|
|
|
MRI LE Joint w/ Contrast Left
|
Facility
|
OP
|
$5,085.00
|
|
|
Service Code
|
CPT 73722
|
| Hospital Charge Code |
631139
|
| Min. Negotiated Rate |
$824.99 |
| Max. Negotiated Rate |
$4,865.33 |
| Rate for Payer: Aetna Commercial |
$4,759.56
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,548.02
|
| Rate for Payer: Aetna Managed Medicare |
$824.99
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,437.46
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,644.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,538.43
|
| Rate for Payer: Anthem Medicare Advantage |
$824.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,802.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$824.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$824.99
|
| Rate for Payer: Cash Price |
$1,525.50
|
| Rate for Payer: Cash Price |
$1,525.50
|
| Rate for Payer: Cigna Commercial |
$4,865.33
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$824.99
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,959.47
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$824.99
|
| Rate for Payer: Health EOS Commercial |
$4,706.68
|
| Rate for Payer: HFN Commercial |
$4,865.33
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,068.96
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$824.99
|
| Rate for Payer: Independent Care Health Plan Medicare |
$824.99
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$824.99
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$824.99
|
| Rate for Payer: Multiplan Commercial |
$4,230.72
|
| Rate for Payer: NAPHCARE Commercial |
$1,237.49
|
| Rate for Payer: Preferred Network Access Commercial |
$4,865.33
|
| Rate for Payer: Quartz Beloit One Network |
$2,591.32
|
| Rate for Payer: Quartz Commercial |
$3,437.46
|
| Rate for Payer: Quartz Medicare Advantage |
$824.99
|
| Rate for Payer: The Alliance Commercial |
$3,299.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$824.99
|
| Rate for Payer: WEA Trust Commercial |
$2,908.62
|
| Rate for Payer: Wellcare Medicare |
$824.99
|
| Rate for Payer: WPS Commercial |
$3,916.98
|
|
|
MRI LE Joint w/ Contrast Right
|
Facility
|
IP
|
$4,988.00
|
|
|
Service Code
|
CPT 73722 TC,RT
|
| Hospital Charge Code |
2980110
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$2,541.88 |
| Max. Negotiated Rate |
$4,772.52 |
| Rate for Payer: Aetna Commercial |
$4,668.77
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,461.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,749.39
|
| Rate for Payer: Cash Price |
$1,496.40
|
| Rate for Payer: Cigna Commercial |
$4,772.52
|
| Rate for Payer: Health EOS Commercial |
$4,616.89
|
| Rate for Payer: HFN Commercial |
$4,772.52
|
| Rate for Payer: Multiplan Commercial |
$4,150.02
|
| Rate for Payer: Preferred Network Access Commercial |
$4,772.52
|
| Rate for Payer: Quartz Beloit One Network |
$2,541.88
|
| Rate for Payer: Quartz Commercial |
$3,112.51
|
| Rate for Payer: WEA Trust Commercial |
$2,853.14
|
| Rate for Payer: WPS Commercial |
$3,842.26
|
|
|
MRI LE Joint w/ Contrast Right
|
Professional
|
Both
|
$5,085.00
|
|
|
Service Code
|
CPT 73722
|
| Hospital Charge Code |
631143
|
| Min. Negotiated Rate |
$313.63 |
| Max. Negotiated Rate |
$5,023.98 |
| Rate for Payer: Aetna Commercial |
$5,023.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,548.02
|
| Rate for Payer: Aetna Managed Medicare |
$313.63
|
| Rate for Payer: Anthem Medicare Advantage |
$313.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$313.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$313.63
|
| Rate for Payer: Cash Price |
$1,525.50
|
| Rate for Payer: Cash Price |
$1,525.50
|
| Rate for Payer: Cash Price |
$1,525.50
|
| Rate for Payer: Cigna Commercial |
$5,023.98
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,644.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$313.63
|
| Rate for Payer: Health EOS Commercial |
$4,812.44
|
| Rate for Payer: HFN Commercial |
$5,023.98
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,271.19
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,271.19
|
| Rate for Payer: Independent Care Health Plan Medicare |
$313.63
|
| Rate for Payer: Multiplan Commercial |
$4,230.72
|
| Rate for Payer: NAPHCARE Commercial |
$470.45
|
| Rate for Payer: Preferred Network Access Commercial |
$5,023.98
|
| Rate for Payer: Quartz Beloit One Network |
$2,326.90
|
| Rate for Payer: Quartz Commercial |
$3,014.39
|
| Rate for Payer: Quartz Medicare Advantage |
$313.63
|
| Rate for Payer: The Alliance Commercial |
$1,191.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$313.63
|
| Rate for Payer: WEA Trust Commercial |
$2,908.62
|
| Rate for Payer: WPS Commercial |
$1,568.16
|
|
|
MRI LE Joint w/ Contrast Right
|
Facility
|
OP
|
$5,085.00
|
|
|
Service Code
|
CPT 73722
|
| Hospital Charge Code |
631143
|
| Min. Negotiated Rate |
$824.99 |
| Max. Negotiated Rate |
$4,865.33 |
| Rate for Payer: Aetna Commercial |
$4,759.56
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,548.02
|
| Rate for Payer: Aetna Managed Medicare |
$824.99
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,437.46
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,644.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,538.43
|
| Rate for Payer: Anthem Medicare Advantage |
$824.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,802.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$824.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$824.99
|
| Rate for Payer: Cash Price |
$1,525.50
|
| Rate for Payer: Cash Price |
$1,525.50
|
| Rate for Payer: Cigna Commercial |
$4,865.33
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$824.99
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,959.47
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$824.99
|
| Rate for Payer: Health EOS Commercial |
$4,706.68
|
| Rate for Payer: HFN Commercial |
$4,865.33
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,068.96
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$824.99
|
| Rate for Payer: Independent Care Health Plan Medicare |
$824.99
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$824.99
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$824.99
|
| Rate for Payer: Multiplan Commercial |
$4,230.72
|
| Rate for Payer: NAPHCARE Commercial |
$1,237.49
|
| Rate for Payer: Preferred Network Access Commercial |
$4,865.33
|
| Rate for Payer: Quartz Beloit One Network |
$2,591.32
|
| Rate for Payer: Quartz Commercial |
$3,437.46
|
| Rate for Payer: Quartz Medicare Advantage |
$824.99
|
| Rate for Payer: The Alliance Commercial |
$3,299.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$824.99
|
| Rate for Payer: WEA Trust Commercial |
$2,908.62
|
| Rate for Payer: Wellcare Medicare |
$824.99
|
| Rate for Payer: WPS Commercial |
$3,916.98
|
|
|
MRI LE Joint w/ Contrast Right
|
Facility
|
OP
|
$4,988.00
|
|
|
Service Code
|
CPT 73722 TC,RT
|
| Hospital Charge Code |
2980110
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,452.51 |
| Max. Negotiated Rate |
$4,772.52 |
| Rate for Payer: Aetna Commercial |
$4,668.77
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,461.27
|
| Rate for Payer: Aetna Managed Medicare |
$1,452.51
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,635.84
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,985.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,835.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,749.39
|
| Rate for Payer: Cash Price |
$1,496.40
|
| Rate for Payer: Cash Price |
$1,496.40
|
| Rate for Payer: Cash Price |
$1,496.40
|
| Rate for Payer: Cigna Commercial |
$4,772.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,903.02
|
| Rate for Payer: Health EOS Commercial |
$4,616.89
|
| Rate for Payer: HFN Commercial |
$4,772.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,890.64
|
| Rate for Payer: Multiplan Commercial |
$4,150.02
|
| Rate for Payer: NAPHCARE Commercial |
$3,112.51
|
| Rate for Payer: Preferred Network Access Commercial |
$4,772.52
|
| Rate for Payer: Quartz Beloit One Network |
$2,541.88
|
| Rate for Payer: Quartz Commercial |
$3,371.89
|
| Rate for Payer: Quartz Medicare Advantage |
$3,112.51
|
| Rate for Payer: The Alliance Commercial |
$2,593.76
|
| Rate for Payer: United Healthcare PPO |
$3,142.88
|
| Rate for Payer: WEA Trust Commercial |
$2,853.14
|
| Rate for Payer: WPS Commercial |
$3,842.26
|
|
|
MRI LE Joint w/ Contrast Right
|
Facility
|
IP
|
$5,085.00
|
|
|
Service Code
|
CPT 73722
|
| Hospital Charge Code |
631143
|
| Min. Negotiated Rate |
$2,591.32 |
| Max. Negotiated Rate |
$4,865.33 |
| Rate for Payer: Aetna Commercial |
$4,759.56
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,548.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,802.85
|
| Rate for Payer: Cash Price |
$1,525.50
|
| Rate for Payer: Cigna Commercial |
$4,865.33
|
| Rate for Payer: Health EOS Commercial |
$4,706.68
|
| Rate for Payer: HFN Commercial |
$4,865.33
|
| Rate for Payer: Multiplan Commercial |
$4,230.72
|
| Rate for Payer: Preferred Network Access Commercial |
$4,865.33
|
| Rate for Payer: Quartz Beloit One Network |
$2,591.32
|
| Rate for Payer: Quartz Commercial |
$3,173.04
|
| Rate for Payer: WEA Trust Commercial |
$2,908.62
|
| Rate for Payer: WPS Commercial |
$3,916.98
|
|
|
MRI LE Joint w/ Contrast Right
|
Professional
|
Both
|
$4,988.00
|
|
|
Service Code
|
CPT 73722 TC,RT
|
| Hospital Charge Code |
1611199
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,271.19 |
| Max. Negotiated Rate |
$4,928.14 |
| Rate for Payer: Aetna Commercial |
$4,928.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,461.27
|
| Rate for Payer: Cash Price |
$1,496.40
|
| Rate for Payer: Cash Price |
$1,496.40
|
| Rate for Payer: Cash Price |
$1,496.40
|
| Rate for Payer: Cigna Commercial |
$4,928.14
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,593.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,112.51
|
| Rate for Payer: Health EOS Commercial |
$4,720.64
|
| Rate for Payer: HFN Commercial |
$4,928.14
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,271.19
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,271.19
|
| Rate for Payer: Multiplan Commercial |
$4,150.02
|
| Rate for Payer: Preferred Network Access Commercial |
$4,928.14
|
| Rate for Payer: Quartz Beloit One Network |
$2,282.51
|
| Rate for Payer: Quartz Commercial |
$2,956.89
|
| Rate for Payer: The Alliance Commercial |
$2,593.76
|
| Rate for Payer: WEA Trust Commercial |
$2,853.14
|
| Rate for Payer: WPS Commercial |
$3,842.26
|
|
|
MRI LE Joint w/ Contrast Right
|
Professional
|
Both
|
$4,988.00
|
|
|
Service Code
|
CPT 73722 TC,RT
|
| Hospital Charge Code |
2980110
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,271.19 |
| Max. Negotiated Rate |
$4,928.14 |
| Rate for Payer: Aetna Commercial |
$4,928.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,461.27
|
| Rate for Payer: Cash Price |
$1,496.40
|
| Rate for Payer: Cash Price |
$1,496.40
|
| Rate for Payer: Cash Price |
$1,496.40
|
| Rate for Payer: Cigna Commercial |
$4,928.14
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,593.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,112.51
|
| Rate for Payer: Health EOS Commercial |
$4,720.64
|
| Rate for Payer: HFN Commercial |
$4,928.14
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,271.19
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,271.19
|
| Rate for Payer: Multiplan Commercial |
$4,150.02
|
| Rate for Payer: Preferred Network Access Commercial |
$4,928.14
|
| Rate for Payer: Quartz Beloit One Network |
$2,282.51
|
| Rate for Payer: Quartz Commercial |
$2,956.89
|
| Rate for Payer: The Alliance Commercial |
$2,593.76
|
| Rate for Payer: WEA Trust Commercial |
$2,853.14
|
| Rate for Payer: WPS Commercial |
$3,842.26
|
|
|
MRI LE Joint w/ Contrast Right
|
Facility
|
IP
|
$4,988.00
|
|
|
Service Code
|
CPT 73722 TC,RT
|
| Hospital Charge Code |
1611199
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$2,541.88 |
| Max. Negotiated Rate |
$4,772.52 |
| Rate for Payer: Aetna Commercial |
$4,668.77
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,461.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,749.39
|
| Rate for Payer: Cash Price |
$1,496.40
|
| Rate for Payer: Cigna Commercial |
$4,772.52
|
| Rate for Payer: Health EOS Commercial |
$4,616.89
|
| Rate for Payer: HFN Commercial |
$4,772.52
|
| Rate for Payer: Multiplan Commercial |
$4,150.02
|
| Rate for Payer: Preferred Network Access Commercial |
$4,772.52
|
| Rate for Payer: Quartz Beloit One Network |
$2,541.88
|
| Rate for Payer: Quartz Commercial |
$3,112.51
|
| Rate for Payer: WEA Trust Commercial |
$2,853.14
|
| Rate for Payer: WPS Commercial |
$3,842.26
|
|
|
MRI LE Joint w/ Contrast Right
|
Facility
|
OP
|
$4,988.00
|
|
|
Service Code
|
CPT 73722 TC,RT
|
| Hospital Charge Code |
1611199
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,452.51 |
| Max. Negotiated Rate |
$4,772.52 |
| Rate for Payer: Aetna Commercial |
$4,668.77
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,461.27
|
| Rate for Payer: Aetna Managed Medicare |
$1,452.51
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,635.84
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,985.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,835.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,749.39
|
| Rate for Payer: Cash Price |
$1,496.40
|
| Rate for Payer: Cash Price |
$1,496.40
|
| Rate for Payer: Cash Price |
$1,496.40
|
| Rate for Payer: Cigna Commercial |
$4,772.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,903.02
|
| Rate for Payer: Health EOS Commercial |
$4,616.89
|
| Rate for Payer: HFN Commercial |
$4,772.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,890.64
|
| Rate for Payer: Multiplan Commercial |
$4,150.02
|
| Rate for Payer: NAPHCARE Commercial |
$3,112.51
|
| Rate for Payer: Preferred Network Access Commercial |
$4,772.52
|
| Rate for Payer: Quartz Beloit One Network |
$2,541.88
|
| Rate for Payer: Quartz Commercial |
$3,371.89
|
| Rate for Payer: Quartz Medicare Advantage |
$3,112.51
|
| Rate for Payer: The Alliance Commercial |
$2,593.76
|
| Rate for Payer: United Healthcare PPO |
$3,142.88
|
| Rate for Payer: WEA Trust Commercial |
$2,853.14
|
| Rate for Payer: WPS Commercial |
$3,842.26
|
|
|
MRI LE Joint w/o Contrast Bilateral
|
Facility
|
IP
|
$4,557.00
|
|
|
Service Code
|
CPT 73721 TC,LT
|
| Hospital Charge Code |
1611201
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$2,322.25 |
| Max. Negotiated Rate |
$4,360.14 |
| Rate for Payer: Aetna Commercial |
$4,265.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,075.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,511.82
|
| Rate for Payer: Cash Price |
$1,367.10
|
| Rate for Payer: Cigna Commercial |
$4,360.14
|
| Rate for Payer: Health EOS Commercial |
$4,217.96
|
| Rate for Payer: HFN Commercial |
$4,360.14
|
| Rate for Payer: Multiplan Commercial |
$3,791.42
|
| Rate for Payer: Preferred Network Access Commercial |
$4,360.14
|
| Rate for Payer: Quartz Beloit One Network |
$2,322.25
|
| Rate for Payer: Quartz Commercial |
$2,843.57
|
| Rate for Payer: WEA Trust Commercial |
$2,606.60
|
| Rate for Payer: WPS Commercial |
$3,510.26
|
|
|
MRI LE Joint w/o Contrast Bilateral
|
Facility
|
IP
|
$9,048.00
|
|
|
Service Code
|
CPT 73721
|
| Hospital Charge Code |
631147
|
| Min. Negotiated Rate |
$4,610.86 |
| Max. Negotiated Rate |
$8,657.13 |
| Rate for Payer: Aetna Commercial |
$8,468.93
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,092.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,987.26
|
| Rate for Payer: Cash Price |
$2,714.40
|
| Rate for Payer: Cigna Commercial |
$8,657.13
|
| Rate for Payer: Health EOS Commercial |
$8,374.83
|
| Rate for Payer: HFN Commercial |
$8,657.13
|
| Rate for Payer: Multiplan Commercial |
$7,527.94
|
| Rate for Payer: Preferred Network Access Commercial |
$8,657.13
|
| Rate for Payer: Quartz Beloit One Network |
$4,610.86
|
| Rate for Payer: Quartz Commercial |
$5,645.95
|
| Rate for Payer: WEA Trust Commercial |
$5,175.46
|
| Rate for Payer: WPS Commercial |
$6,969.67
|
|
|
MRI LE Joint w/o Contrast Bilateral
|
Facility
|
OP
|
$4,557.00
|
|
|
Service Code
|
CPT 73721 TC,LT
|
| Hospital Charge Code |
1611201
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,327.00 |
| Max. Negotiated Rate |
$4,360.14 |
| Rate for Payer: Aetna Commercial |
$4,265.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,075.78
|
| Rate for Payer: Aetna Managed Medicare |
$1,327.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,635.84
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,985.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,835.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,511.82
|
| Rate for Payer: Cash Price |
$1,367.10
|
| Rate for Payer: Cash Price |
$1,367.10
|
| Rate for Payer: Cash Price |
$1,367.10
|
| Rate for Payer: Cigna Commercial |
$4,360.14
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,652.17
|
| Rate for Payer: Health EOS Commercial |
$4,217.96
|
| Rate for Payer: HFN Commercial |
$4,360.14
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,554.46
|
| Rate for Payer: Multiplan Commercial |
$3,791.42
|
| Rate for Payer: NAPHCARE Commercial |
$2,843.57
|
| Rate for Payer: Preferred Network Access Commercial |
$4,360.14
|
| Rate for Payer: Quartz Beloit One Network |
$2,322.25
|
| Rate for Payer: Quartz Commercial |
$3,080.53
|
| Rate for Payer: Quartz Medicare Advantage |
$2,843.57
|
| Rate for Payer: The Alliance Commercial |
$2,369.64
|
| Rate for Payer: United Healthcare PPO |
$3,142.88
|
| Rate for Payer: WEA Trust Commercial |
$2,606.60
|
| Rate for Payer: WPS Commercial |
$3,510.26
|
|
|
MRI LE Joint w/o Contrast Bilateral
|
Professional
|
Both
|
$9,048.00
|
|
|
Service Code
|
CPT 73721
|
| Hospital Charge Code |
631147
|
| Min. Negotiated Rate |
$203.56 |
| Max. Negotiated Rate |
$8,939.42 |
| Rate for Payer: Aetna Commercial |
$8,939.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,092.53
|
| Rate for Payer: Aetna Managed Medicare |
$203.56
|
| Rate for Payer: Anthem Medicare Advantage |
$203.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$203.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$203.56
|
| Rate for Payer: Cash Price |
$2,714.40
|
| Rate for Payer: Cash Price |
$2,714.40
|
| Rate for Payer: Cash Price |
$2,714.40
|
| Rate for Payer: Cigna Commercial |
$8,939.42
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$4,704.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$203.56
|
| Rate for Payer: Health EOS Commercial |
$8,563.03
|
| Rate for Payer: HFN Commercial |
$8,939.42
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$792.57
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$792.57
|
| Rate for Payer: Independent Care Health Plan Medicare |
$203.56
|
| Rate for Payer: Multiplan Commercial |
$7,527.94
|
| Rate for Payer: NAPHCARE Commercial |
$305.34
|
| Rate for Payer: Preferred Network Access Commercial |
$8,939.42
|
| Rate for Payer: Quartz Beloit One Network |
$4,140.36
|
| Rate for Payer: Quartz Commercial |
$5,363.65
|
| Rate for Payer: Quartz Medicare Advantage |
$203.56
|
| Rate for Payer: The Alliance Commercial |
$773.52
|
| Rate for Payer: United Healthcare Medicare Advantage |
$203.56
|
| Rate for Payer: WEA Trust Commercial |
$5,175.46
|
| Rate for Payer: WPS Commercial |
$1,017.80
|
|
|
MRI LE Joint w/o Contrast Bilateral
|
Facility
|
OP
|
$9,048.00
|
|
|
Service Code
|
CPT 73721
|
| Hospital Charge Code |
631147
|
| Min. Negotiated Rate |
$251.10 |
| Max. Negotiated Rate |
$8,657.13 |
| Rate for Payer: Aetna Commercial |
$8,468.93
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,092.53
|
| Rate for Payer: Aetna Managed Medicare |
$251.10
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,116.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,704.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,516.76
|
| Rate for Payer: Anthem Medicare Advantage |
$251.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,987.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$251.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$251.10
|
| Rate for Payer: Cash Price |
$2,714.40
|
| Rate for Payer: Cash Price |
$2,714.40
|
| Rate for Payer: Cigna Commercial |
$8,657.13
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$251.10
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,265.94
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$251.10
|
| Rate for Payer: Health EOS Commercial |
$8,374.83
|
| Rate for Payer: HFN Commercial |
$8,657.13
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$934.08
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$251.10
|
| Rate for Payer: Independent Care Health Plan Medicare |
$251.10
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$251.10
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$251.10
|
| Rate for Payer: Multiplan Commercial |
$7,527.94
|
| Rate for Payer: NAPHCARE Commercial |
$376.65
|
| Rate for Payer: Preferred Network Access Commercial |
$8,657.13
|
| Rate for Payer: Quartz Beloit One Network |
$4,610.86
|
| Rate for Payer: Quartz Commercial |
$6,116.45
|
| Rate for Payer: Quartz Medicare Advantage |
$251.10
|
| Rate for Payer: The Alliance Commercial |
$1,004.39
|
| Rate for Payer: United Healthcare Medicare Advantage |
$251.10
|
| Rate for Payer: WEA Trust Commercial |
$5,175.46
|
| Rate for Payer: Wellcare Medicare |
$251.10
|
| Rate for Payer: WPS Commercial |
$6,969.67
|
|
|
MRI LE Joint w/o Contrast Bilateral
|
Professional
|
Both
|
$4,557.00
|
|
|
Service Code
|
CPT 73721 TC,LT
|
| Hospital Charge Code |
1611201
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$792.57 |
| Max. Negotiated Rate |
$4,502.32 |
| Rate for Payer: Aetna Commercial |
$4,502.32
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,075.78
|
| Rate for Payer: Cash Price |
$1,367.10
|
| Rate for Payer: Cash Price |
$1,367.10
|
| Rate for Payer: Cash Price |
$1,367.10
|
| Rate for Payer: Cigna Commercial |
$4,502.32
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,369.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,843.57
|
| Rate for Payer: Health EOS Commercial |
$4,312.74
|
| Rate for Payer: HFN Commercial |
$4,502.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$792.57
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$792.57
|
| Rate for Payer: Multiplan Commercial |
$3,791.42
|
| Rate for Payer: Preferred Network Access Commercial |
$4,502.32
|
| Rate for Payer: Quartz Beloit One Network |
$2,085.28
|
| Rate for Payer: Quartz Commercial |
$2,701.39
|
| Rate for Payer: The Alliance Commercial |
$2,369.64
|
| Rate for Payer: WEA Trust Commercial |
$2,606.60
|
| Rate for Payer: WPS Commercial |
$3,510.26
|
|
|
MRI LE Joint w/o Contrast Left
|
Facility
|
OP
|
$4,524.00
|
|
|
Service Code
|
CPT 73721
|
| Hospital Charge Code |
631149
|
| Min. Negotiated Rate |
$251.10 |
| Max. Negotiated Rate |
$4,328.56 |
| Rate for Payer: Aetna Commercial |
$4,234.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,046.27
|
| Rate for Payer: Aetna Managed Medicare |
$251.10
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,058.22
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,352.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,258.38
|
| Rate for Payer: Anthem Medicare Advantage |
$251.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,493.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$251.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$251.10
|
| Rate for Payer: Cash Price |
$1,357.20
|
| Rate for Payer: Cash Price |
$1,357.20
|
| Rate for Payer: Cigna Commercial |
$4,328.56
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$251.10
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,632.97
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$251.10
|
| Rate for Payer: Health EOS Commercial |
$4,187.41
|
| Rate for Payer: HFN Commercial |
$4,328.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$934.08
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$251.10
|
| Rate for Payer: Independent Care Health Plan Medicare |
$251.10
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$251.10
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$251.10
|
| Rate for Payer: Multiplan Commercial |
$3,763.97
|
| Rate for Payer: NAPHCARE Commercial |
$376.65
|
| Rate for Payer: Preferred Network Access Commercial |
$4,328.56
|
| Rate for Payer: Quartz Beloit One Network |
$2,305.43
|
| Rate for Payer: Quartz Commercial |
$3,058.22
|
| Rate for Payer: Quartz Medicare Advantage |
$251.10
|
| Rate for Payer: The Alliance Commercial |
$1,004.39
|
| Rate for Payer: United Healthcare Medicare Advantage |
$251.10
|
| Rate for Payer: WEA Trust Commercial |
$2,587.73
|
| Rate for Payer: Wellcare Medicare |
$251.10
|
| Rate for Payer: WPS Commercial |
$3,484.84
|
|
|
MRI LE Joint w/o Contrast Left
|
Professional
|
Both
|
$4,524.00
|
|
|
Service Code
|
CPT 73721
|
| Hospital Charge Code |
631149
|
| Min. Negotiated Rate |
$203.56 |
| Max. Negotiated Rate |
$4,469.71 |
| Rate for Payer: Aetna Commercial |
$4,469.71
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,046.27
|
| Rate for Payer: Aetna Managed Medicare |
$203.56
|
| Rate for Payer: Anthem Medicare Advantage |
$203.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$203.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$203.56
|
| Rate for Payer: Cash Price |
$1,357.20
|
| Rate for Payer: Cash Price |
$1,357.20
|
| Rate for Payer: Cash Price |
$1,357.20
|
| Rate for Payer: Cigna Commercial |
$4,469.71
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,352.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$203.56
|
| Rate for Payer: Health EOS Commercial |
$4,281.51
|
| Rate for Payer: HFN Commercial |
$4,469.71
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$792.57
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$792.57
|
| Rate for Payer: Independent Care Health Plan Medicare |
$203.56
|
| Rate for Payer: Multiplan Commercial |
$3,763.97
|
| Rate for Payer: NAPHCARE Commercial |
$305.34
|
| Rate for Payer: Preferred Network Access Commercial |
$4,469.71
|
| Rate for Payer: Quartz Beloit One Network |
$2,070.18
|
| Rate for Payer: Quartz Commercial |
$2,681.83
|
| Rate for Payer: Quartz Medicare Advantage |
$203.56
|
| Rate for Payer: The Alliance Commercial |
$773.52
|
| Rate for Payer: United Healthcare Medicare Advantage |
$203.56
|
| Rate for Payer: WEA Trust Commercial |
$2,587.73
|
| Rate for Payer: WPS Commercial |
$1,017.80
|
|
|
MRI LE Joint w/o Contrast Left
|
Facility
|
OP
|
$4,732.00
|
|
|
Service Code
|
CPT 73721 TC,LT
|
| Hospital Charge Code |
1611203
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,377.96 |
| Max. Negotiated Rate |
$4,527.58 |
| Rate for Payer: Aetna Commercial |
$4,429.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,232.30
|
| Rate for Payer: Aetna Managed Medicare |
$1,377.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,635.84
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,985.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,835.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,608.28
|
| Rate for Payer: Cash Price |
$1,419.60
|
| Rate for Payer: Cash Price |
$1,419.60
|
| Rate for Payer: Cash Price |
$1,419.60
|
| Rate for Payer: Cigna Commercial |
$4,527.58
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,754.02
|
| Rate for Payer: Health EOS Commercial |
$4,379.94
|
| Rate for Payer: HFN Commercial |
$4,527.58
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,690.96
|
| Rate for Payer: Multiplan Commercial |
$3,937.02
|
| Rate for Payer: NAPHCARE Commercial |
$2,952.77
|
| Rate for Payer: Preferred Network Access Commercial |
$4,527.58
|
| Rate for Payer: Quartz Beloit One Network |
$2,411.43
|
| Rate for Payer: Quartz Commercial |
$3,198.83
|
| Rate for Payer: Quartz Medicare Advantage |
$2,952.77
|
| Rate for Payer: The Alliance Commercial |
$2,460.64
|
| Rate for Payer: United Healthcare PPO |
$3,142.88
|
| Rate for Payer: WEA Trust Commercial |
$2,706.70
|
| Rate for Payer: WPS Commercial |
$3,645.06
|
|
