|
MRI Spine Thoracic w/o Contrast
|
Facility
|
IP
|
$5,410.00
|
|
|
Service Code
|
CPT 72146 TC
|
| Hospital Charge Code |
3072643
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$2,756.94 |
| Max. Negotiated Rate |
$5,176.29 |
| Rate for Payer: Aetna Commercial |
$5,063.76
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,838.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,981.99
|
| Rate for Payer: Cash Price |
$1,623.00
|
| Rate for Payer: Cigna Commercial |
$5,176.29
|
| Rate for Payer: Health EOS Commercial |
$5,007.50
|
| Rate for Payer: HFN Commercial |
$5,176.29
|
| Rate for Payer: Multiplan Commercial |
$4,501.12
|
| Rate for Payer: Preferred Network Access Commercial |
$5,176.29
|
| Rate for Payer: Quartz Beloit One Network |
$2,756.94
|
| Rate for Payer: Quartz Commercial |
$3,375.84
|
| Rate for Payer: WEA Trust Commercial |
$3,094.52
|
| Rate for Payer: WPS Commercial |
$4,167.32
|
|
|
MRI Spine Thoracic w/o Contrast
|
Facility
|
OP
|
$4,627.00
|
|
|
Service Code
|
CPT 72146
|
| Hospital Charge Code |
631295
|
| Min. Negotiated Rate |
$251.10 |
| Max. Negotiated Rate |
$4,427.11 |
| Rate for Payer: Aetna Commercial |
$4,330.87
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,138.39
|
| Rate for Payer: Aetna Managed Medicare |
$251.10
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,127.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,406.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,309.80
|
| Rate for Payer: Anthem Medicare Advantage |
$251.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,550.40
|
| 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 |
$1,388.10
|
| Rate for Payer: Cash Price |
$1,388.10
|
| Rate for Payer: Cigna Commercial |
$4,427.11
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$251.10
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,692.91
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$251.10
|
| Rate for Payer: Health EOS Commercial |
$4,282.75
|
| Rate for Payer: HFN Commercial |
$4,427.11
|
| 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 |
$3,849.66
|
| Rate for Payer: NAPHCARE Commercial |
$376.65
|
| Rate for Payer: Preferred Network Access Commercial |
$4,427.11
|
| Rate for Payer: Quartz Beloit One Network |
$2,357.92
|
| Rate for Payer: Quartz Commercial |
$3,127.85
|
| 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 |
$2,646.64
|
| Rate for Payer: Wellcare Medicare |
$251.10
|
| Rate for Payer: WPS Commercial |
$3,564.18
|
|
|
MRI Spine Thoracic w/o Contrast
|
Facility
|
IP
|
$5,410.00
|
|
|
Service Code
|
CPT 72146 TC
|
| Hospital Charge Code |
1611321
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$2,756.94 |
| Max. Negotiated Rate |
$5,176.29 |
| Rate for Payer: Aetna Commercial |
$5,063.76
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,838.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,981.99
|
| Rate for Payer: Cash Price |
$1,623.00
|
| Rate for Payer: Cigna Commercial |
$5,176.29
|
| Rate for Payer: Health EOS Commercial |
$5,007.50
|
| Rate for Payer: HFN Commercial |
$5,176.29
|
| Rate for Payer: Multiplan Commercial |
$4,501.12
|
| Rate for Payer: Preferred Network Access Commercial |
$5,176.29
|
| Rate for Payer: Quartz Beloit One Network |
$2,756.94
|
| Rate for Payer: Quartz Commercial |
$3,375.84
|
| Rate for Payer: WEA Trust Commercial |
$3,094.52
|
| Rate for Payer: WPS Commercial |
$4,167.32
|
|
|
MRI Spine Thoracic w/ + w/o Contrast
|
Professional
|
Both
|
$6,670.00
|
|
|
Service Code
|
CPT 72157 TC
|
| Hospital Charge Code |
3072644
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$211.64 |
| Max. Negotiated Rate |
$6,589.96 |
| Rate for Payer: Aetna Commercial |
$6,589.96
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,965.65
|
| Rate for Payer: Aetna Managed Medicare |
$211.64
|
| Rate for Payer: Anthem Medicare Advantage |
$211.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$211.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$211.64
|
| 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 |
$6,589.96
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$3,468.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$211.64
|
| Rate for Payer: Health EOS Commercial |
$6,312.49
|
| Rate for Payer: HFN Commercial |
$6,589.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$876.83
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$876.83
|
| Rate for Payer: Independent Care Health Plan Medicare |
$211.64
|
| Rate for Payer: Multiplan Commercial |
$5,549.44
|
| Rate for Payer: NAPHCARE Commercial |
$317.46
|
| Rate for Payer: Preferred Network Access Commercial |
$6,589.96
|
| Rate for Payer: Quartz Beloit One Network |
$3,052.19
|
| Rate for Payer: Quartz Commercial |
$3,953.98
|
| Rate for Payer: Quartz Medicare Advantage |
$211.64
|
| Rate for Payer: The Alliance Commercial |
$804.23
|
| Rate for Payer: United Healthcare Medicare Advantage |
$211.64
|
| Rate for Payer: WEA Trust Commercial |
$3,815.24
|
| Rate for Payer: WPS Commercial |
$1,058.20
|
|
|
MRI Spine Thoracic w/ + w/o Contrast
|
Professional
|
Both
|
$6,235.00
|
|
|
Service Code
|
CPT 72157
|
| Hospital Charge Code |
631293
|
| Min. Negotiated Rate |
$317.12 |
| Max. Negotiated Rate |
$6,160.18 |
| Rate for Payer: Aetna Commercial |
$6,160.18
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,576.58
|
| Rate for Payer: Aetna Managed Medicare |
$317.12
|
| Rate for Payer: Anthem Medicare Advantage |
$317.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$317.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$317.12
|
| Rate for Payer: Cash Price |
$1,870.50
|
| Rate for Payer: Cash Price |
$1,870.50
|
| Rate for Payer: Cash Price |
$1,870.50
|
| Rate for Payer: Cigna Commercial |
$6,160.18
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$3,242.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$317.12
|
| Rate for Payer: Health EOS Commercial |
$5,900.80
|
| Rate for Payer: HFN Commercial |
$6,160.18
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,274.49
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,274.49
|
| Rate for Payer: Independent Care Health Plan Medicare |
$317.12
|
| Rate for Payer: Multiplan Commercial |
$5,187.52
|
| Rate for Payer: NAPHCARE Commercial |
$475.68
|
| Rate for Payer: Preferred Network Access Commercial |
$6,160.18
|
| Rate for Payer: Quartz Beloit One Network |
$2,853.14
|
| Rate for Payer: Quartz Commercial |
$3,696.11
|
| Rate for Payer: Quartz Medicare Advantage |
$317.12
|
| Rate for Payer: The Alliance Commercial |
$1,205.04
|
| Rate for Payer: United Healthcare Medicare Advantage |
$317.12
|
| Rate for Payer: WEA Trust Commercial |
$3,566.42
|
| Rate for Payer: WPS Commercial |
$1,585.58
|
|
|
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 |
$211.64 |
| Max. Negotiated Rate |
$6,589.96 |
| Rate for Payer: Aetna Commercial |
$6,589.96
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,965.65
|
| Rate for Payer: Aetna Managed Medicare |
$211.64
|
| Rate for Payer: Anthem Medicare Advantage |
$211.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$211.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$211.64
|
| 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 |
$6,589.96
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$3,468.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$211.64
|
| Rate for Payer: Health EOS Commercial |
$6,312.49
|
| Rate for Payer: HFN Commercial |
$6,589.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$876.83
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$876.83
|
| Rate for Payer: Independent Care Health Plan Medicare |
$211.64
|
| Rate for Payer: Multiplan Commercial |
$5,549.44
|
| Rate for Payer: NAPHCARE Commercial |
$317.46
|
| Rate for Payer: Preferred Network Access Commercial |
$6,589.96
|
| Rate for Payer: Quartz Beloit One Network |
$3,052.19
|
| Rate for Payer: Quartz Commercial |
$3,953.98
|
| Rate for Payer: Quartz Medicare Advantage |
$211.64
|
| Rate for Payer: The Alliance Commercial |
$804.23
|
| Rate for Payer: United Healthcare Medicare Advantage |
$211.64
|
| Rate for Payer: WEA Trust Commercial |
$3,815.24
|
| Rate for Payer: WPS Commercial |
$1,058.20
|
|
|
MRI Spine Thoracic w/ + w/o Contrast
|
Facility
|
OP
|
$6,670.00
|
|
|
Service Code
|
CPT 72157 TC
|
| Hospital Charge Code |
1611317
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$846.56 |
| Max. Negotiated Rate |
$6,381.86 |
| Rate for Payer: Aetna Commercial |
$6,243.12
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,965.65
|
| Rate for Payer: Aetna Managed Medicare |
$1,942.30
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,635.84
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,985.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,835.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,676.50
|
| 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: Cash Price |
$2,001.00
|
| Rate for Payer: Cigna Commercial |
$6,381.86
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,881.94
|
| Rate for Payer: Health EOS Commercial |
$6,173.75
|
| Rate for Payer: HFN Commercial |
$6,381.86
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,202.60
|
| Rate for Payer: Multiplan Commercial |
$5,549.44
|
| Rate for Payer: NAPHCARE Commercial |
$4,162.08
|
| Rate for Payer: Preferred Network Access Commercial |
$6,381.86
|
| Rate for Payer: Quartz Beloit One Network |
$3,399.03
|
| Rate for Payer: Quartz Commercial |
$4,508.92
|
| Rate for Payer: Quartz Medicare Advantage |
$4,162.08
|
| Rate for Payer: The Alliance Commercial |
$846.56
|
| Rate for Payer: United Healthcare PPO |
$3,142.88
|
| Rate for Payer: WEA Trust Commercial |
$3,815.24
|
| Rate for Payer: WPS Commercial |
$1,481.48
|
|
|
MRI Spine Thoracic w/ + w/o Contrast
|
Facility
|
OP
|
$6,670.00
|
|
|
Service Code
|
CPT 72157 TC
|
| Hospital Charge Code |
3072644
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$846.56 |
| Max. Negotiated Rate |
$6,381.86 |
| Rate for Payer: Aetna Commercial |
$6,243.12
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,965.65
|
| Rate for Payer: Aetna Managed Medicare |
$1,942.30
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,635.84
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,985.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,835.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,676.50
|
| 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: Cash Price |
$2,001.00
|
| Rate for Payer: Cigna Commercial |
$6,381.86
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,881.94
|
| Rate for Payer: Health EOS Commercial |
$6,173.75
|
| Rate for Payer: HFN Commercial |
$6,381.86
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,202.60
|
| Rate for Payer: Multiplan Commercial |
$5,549.44
|
| Rate for Payer: NAPHCARE Commercial |
$4,162.08
|
| Rate for Payer: Preferred Network Access Commercial |
$6,381.86
|
| Rate for Payer: Quartz Beloit One Network |
$3,399.03
|
| Rate for Payer: Quartz Commercial |
$4,508.92
|
| Rate for Payer: Quartz Medicare Advantage |
$4,162.08
|
| Rate for Payer: The Alliance Commercial |
$846.56
|
| Rate for Payer: United Healthcare PPO |
$3,142.88
|
| Rate for Payer: WEA Trust Commercial |
$3,815.24
|
| Rate for Payer: WPS Commercial |
$1,481.48
|
|
|
MRI Spine Thoracic w/ + w/o Contrast
|
Facility
|
IP
|
$6,670.00
|
|
|
Service Code
|
CPT 72157 TC
|
| Hospital Charge Code |
3072644
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$3,399.03 |
| Max. Negotiated Rate |
$6,381.86 |
| Rate for Payer: Aetna Commercial |
$6,243.12
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,965.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,676.50
|
| Rate for Payer: Cash Price |
$2,001.00
|
| Rate for Payer: Cigna Commercial |
$6,381.86
|
| Rate for Payer: Health EOS Commercial |
$6,173.75
|
| Rate for Payer: HFN Commercial |
$6,381.86
|
| Rate for Payer: Multiplan Commercial |
$5,549.44
|
| Rate for Payer: Preferred Network Access Commercial |
$6,381.86
|
| Rate for Payer: Quartz Beloit One Network |
$3,399.03
|
| Rate for Payer: Quartz Commercial |
$4,162.08
|
| Rate for Payer: WEA Trust Commercial |
$3,815.24
|
| Rate for Payer: WPS Commercial |
$5,137.90
|
|
|
MRI Spine Thoracic w/ + w/o Contrast
|
Facility
|
IP
|
$6,670.00
|
|
|
Service Code
|
CPT 72157 TC
|
| Hospital Charge Code |
1611317
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$3,399.03 |
| Max. Negotiated Rate |
$6,381.86 |
| Rate for Payer: Aetna Commercial |
$6,243.12
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,965.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,676.50
|
| Rate for Payer: Cash Price |
$2,001.00
|
| Rate for Payer: Cigna Commercial |
$6,381.86
|
| Rate for Payer: Health EOS Commercial |
$6,173.75
|
| Rate for Payer: HFN Commercial |
$6,381.86
|
| Rate for Payer: Multiplan Commercial |
$5,549.44
|
| Rate for Payer: Preferred Network Access Commercial |
$6,381.86
|
| Rate for Payer: Quartz Beloit One Network |
$3,399.03
|
| Rate for Payer: Quartz Commercial |
$4,162.08
|
| Rate for Payer: WEA Trust Commercial |
$3,815.24
|
| Rate for Payer: WPS Commercial |
$5,137.90
|
|
|
MRI Spine Thoracic w/ + w/o Contrast
|
Facility
|
IP
|
$6,235.00
|
|
|
Service Code
|
CPT 72157
|
| Hospital Charge Code |
631293
|
| Min. Negotiated Rate |
$3,177.36 |
| Max. Negotiated Rate |
$5,965.65 |
| Rate for Payer: Aetna Commercial |
$5,835.96
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,576.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,436.73
|
| Rate for Payer: Cash Price |
$1,870.50
|
| Rate for Payer: Cigna Commercial |
$5,965.65
|
| Rate for Payer: Health EOS Commercial |
$5,771.12
|
| Rate for Payer: HFN Commercial |
$5,965.65
|
| Rate for Payer: Multiplan Commercial |
$5,187.52
|
| Rate for Payer: Preferred Network Access Commercial |
$5,965.65
|
| Rate for Payer: Quartz Beloit One Network |
$3,177.36
|
| Rate for Payer: Quartz Commercial |
$3,890.64
|
| Rate for Payer: WEA Trust Commercial |
$3,566.42
|
| Rate for Payer: WPS Commercial |
$4,802.82
|
|
|
MRI Spine Thoracic w/ + w/o Contrast
|
Facility
|
OP
|
$6,235.00
|
|
|
Service Code
|
CPT 72157
|
| Hospital Charge Code |
631293
|
| Min. Negotiated Rate |
$367.15 |
| Max. Negotiated Rate |
$5,965.65 |
| Rate for Payer: Aetna Commercial |
$5,835.96
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,576.58
|
| Rate for Payer: Aetna Managed Medicare |
$367.15
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,214.86
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,242.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,112.51
|
| Rate for Payer: Anthem Medicare Advantage |
$367.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,436.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$367.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$367.15
|
| Rate for Payer: Cash Price |
$1,870.50
|
| Rate for Payer: Cash Price |
$1,870.50
|
| Rate for Payer: Cigna Commercial |
$5,965.65
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$367.15
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,628.77
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$367.15
|
| Rate for Payer: Health EOS Commercial |
$5,771.12
|
| Rate for Payer: HFN Commercial |
$5,965.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,365.80
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$367.15
|
| Rate for Payer: Independent Care Health Plan Medicare |
$367.15
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$367.15
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$367.15
|
| Rate for Payer: Multiplan Commercial |
$5,187.52
|
| Rate for Payer: NAPHCARE Commercial |
$550.73
|
| Rate for Payer: Preferred Network Access Commercial |
$5,965.65
|
| Rate for Payer: Quartz Beloit One Network |
$3,177.36
|
| Rate for Payer: Quartz Commercial |
$4,214.86
|
| Rate for Payer: Quartz Medicare Advantage |
$367.15
|
| Rate for Payer: The Alliance Commercial |
$1,468.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$367.15
|
| Rate for Payer: WEA Trust Commercial |
$3,566.42
|
| Rate for Payer: Wellcare Medicare |
$367.15
|
| Rate for Payer: WPS Commercial |
$4,802.82
|
|
|
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 |
$3,389.86 |
| Max. Negotiated Rate |
$6,364.63 |
| Rate for Payer: Aetna Commercial |
$6,226.27
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,949.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,666.58
|
| Rate for Payer: Cash Price |
$1,995.60
|
| Rate for Payer: Cigna Commercial |
$6,364.63
|
| Rate for Payer: Health EOS Commercial |
$6,157.09
|
| Rate for Payer: HFN Commercial |
$6,364.63
|
| Rate for Payer: Multiplan Commercial |
$5,534.46
|
| Rate for Payer: Preferred Network Access Commercial |
$6,364.63
|
| Rate for Payer: Quartz Beloit One Network |
$3,389.86
|
| Rate for Payer: Quartz Commercial |
$4,150.85
|
| Rate for Payer: WEA Trust Commercial |
$3,804.94
|
| Rate for Payer: WPS Commercial |
$5,124.04
|
|
|
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 |
$264.88 |
| Max. Negotiated Rate |
$6,572.18 |
| Rate for Payer: Aetna Commercial |
$6,572.18
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,949.55
|
| Rate for Payer: Aetna Managed Medicare |
$264.88
|
| Rate for Payer: Anthem Medicare Advantage |
$264.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$264.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$264.88
|
| 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 |
$6,572.18
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$3,459.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$264.88
|
| Rate for Payer: Health EOS Commercial |
$6,295.45
|
| Rate for Payer: HFN Commercial |
$6,572.18
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,118.18
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,118.18
|
| Rate for Payer: Independent Care Health Plan Medicare |
$264.88
|
| Rate for Payer: Multiplan Commercial |
$5,534.46
|
| Rate for Payer: NAPHCARE Commercial |
$397.32
|
| Rate for Payer: Preferred Network Access Commercial |
$6,572.18
|
| Rate for Payer: Quartz Beloit One Network |
$3,043.96
|
| Rate for Payer: Quartz Commercial |
$3,943.31
|
| Rate for Payer: Quartz Medicare Advantage |
$264.88
|
| Rate for Payer: The Alliance Commercial |
$1,006.53
|
| Rate for Payer: United Healthcare Medicare Advantage |
$264.88
|
| Rate for Payer: WEA Trust Commercial |
$3,804.94
|
| Rate for Payer: WPS Commercial |
$1,324.39
|
|
|
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 |
$1,059.51 |
| Max. Negotiated Rate |
$6,364.63 |
| Rate for Payer: Aetna Commercial |
$6,226.27
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,949.55
|
| Rate for Payer: Aetna Managed Medicare |
$1,937.06
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,635.84
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,985.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,835.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,666.58
|
| 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 |
$6,364.63
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,871.46
|
| Rate for Payer: Health EOS Commercial |
$6,157.09
|
| Rate for Payer: HFN Commercial |
$6,364.63
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,188.56
|
| Rate for Payer: Multiplan Commercial |
$5,534.46
|
| Rate for Payer: NAPHCARE Commercial |
$4,150.85
|
| Rate for Payer: Preferred Network Access Commercial |
$6,364.63
|
| Rate for Payer: Quartz Beloit One Network |
$3,389.86
|
| Rate for Payer: Quartz Commercial |
$4,496.75
|
| Rate for Payer: Quartz Medicare Advantage |
$4,150.85
|
| Rate for Payer: The Alliance Commercial |
$1,059.51
|
| Rate for Payer: United Healthcare PPO |
$3,142.88
|
| Rate for Payer: WEA Trust Commercial |
$3,804.94
|
| Rate for Payer: WPS Commercial |
$1,854.14
|
|
|
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 |
$4,560.92 |
| Max. Negotiated Rate |
$8,563.36 |
| Rate for Payer: Aetna Commercial |
$8,377.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,004.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,933.24
|
| Rate for Payer: Cash Price |
$2,685.00
|
| Rate for Payer: Cigna Commercial |
$8,563.36
|
| Rate for Payer: Health EOS Commercial |
$8,284.12
|
| Rate for Payer: HFN Commercial |
$8,563.36
|
| Rate for Payer: Multiplan Commercial |
$7,446.40
|
| Rate for Payer: Preferred Network Access Commercial |
$8,563.36
|
| Rate for Payer: Quartz Beloit One Network |
$4,560.92
|
| Rate for Payer: Quartz Commercial |
$5,584.80
|
| Rate for Payer: WEA Trust Commercial |
$5,119.40
|
| Rate for Payer: WPS Commercial |
$6,894.19
|
|
|
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 |
$1,439.32 |
| Max. Negotiated Rate |
$8,563.36 |
| Rate for Payer: Aetna Commercial |
$8,377.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,004.88
|
| Rate for Payer: Aetna Managed Medicare |
$2,606.24
|
| 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 |
$4,933.24
|
| 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 |
$8,563.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,208.90
|
| Rate for Payer: Health EOS Commercial |
$8,284.12
|
| Rate for Payer: HFN Commercial |
$8,563.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,981.00
|
| Rate for Payer: Multiplan Commercial |
$7,446.40
|
| Rate for Payer: NAPHCARE Commercial |
$5,584.80
|
| Rate for Payer: Preferred Network Access Commercial |
$8,563.36
|
| Rate for Payer: Quartz Beloit One Network |
$4,560.92
|
| Rate for Payer: Quartz Commercial |
$6,050.20
|
| Rate for Payer: Quartz Medicare Advantage |
$5,584.80
|
| Rate for Payer: The Alliance Commercial |
$1,439.32
|
| Rate for Payer: United Healthcare PPO |
$3,142.88
|
| Rate for Payer: WEA Trust Commercial |
$5,119.40
|
| Rate for Payer: WPS Commercial |
$2,518.81
|
|
|
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 |
$359.83 |
| Max. Negotiated Rate |
$8,842.60 |
| Rate for Payer: Aetna Commercial |
$8,842.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,004.88
|
| Rate for Payer: Aetna Managed Medicare |
$359.83
|
| Rate for Payer: Anthem Medicare Advantage |
$359.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$359.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$359.83
|
| 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 |
$8,842.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$4,654.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$359.83
|
| Rate for Payer: Health EOS Commercial |
$8,470.28
|
| Rate for Payer: HFN Commercial |
$8,842.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,525.57
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,525.57
|
| Rate for Payer: Independent Care Health Plan Medicare |
$359.83
|
| Rate for Payer: Multiplan Commercial |
$7,446.40
|
| Rate for Payer: NAPHCARE Commercial |
$539.74
|
| Rate for Payer: Preferred Network Access Commercial |
$8,842.60
|
| Rate for Payer: Quartz Beloit One Network |
$4,095.52
|
| Rate for Payer: Quartz Commercial |
$5,305.56
|
| Rate for Payer: Quartz Medicare Advantage |
$359.83
|
| Rate for Payer: The Alliance Commercial |
$1,367.35
|
| Rate for Payer: United Healthcare Medicare Advantage |
$359.83
|
| Rate for Payer: WEA Trust Commercial |
$5,119.40
|
| Rate for Payer: WPS Commercial |
$1,799.15
|
|
|
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 |
$2,402.25 |
| Max. Negotiated Rate |
$4,510.36 |
| Rate for Payer: Aetna Commercial |
$4,412.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,216.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,598.36
|
| Rate for Payer: Cash Price |
$1,414.20
|
| Rate for Payer: Cigna Commercial |
$4,510.36
|
| Rate for Payer: Health EOS Commercial |
$4,363.28
|
| Rate for Payer: HFN Commercial |
$4,510.36
|
| Rate for Payer: Multiplan Commercial |
$3,922.05
|
| Rate for Payer: Preferred Network Access Commercial |
$4,510.36
|
| Rate for Payer: Quartz Beloit One Network |
$2,402.25
|
| Rate for Payer: Quartz Commercial |
$2,941.54
|
| Rate for Payer: WEA Trust Commercial |
$2,696.41
|
| Rate for Payer: WPS Commercial |
$3,631.19
|
|
|
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 |
$1,049.15 |
| Max. Negotiated Rate |
$4,657.43 |
| Rate for Payer: Aetna Commercial |
$4,657.43
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,216.20
|
| 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 |
$4,657.43
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,451.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,941.54
|
| Rate for Payer: Health EOS Commercial |
$4,461.33
|
| Rate for Payer: HFN Commercial |
$4,657.43
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,049.15
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,049.15
|
| Rate for Payer: Multiplan Commercial |
$3,922.05
|
| Rate for Payer: Preferred Network Access Commercial |
$4,657.43
|
| Rate for Payer: Quartz Beloit One Network |
$2,157.13
|
| Rate for Payer: Quartz Commercial |
$2,794.46
|
| Rate for Payer: The Alliance Commercial |
$2,451.28
|
| Rate for Payer: WEA Trust Commercial |
$2,696.41
|
| Rate for Payer: WPS Commercial |
$3,631.19
|
|
|
MRI Tibia/Fibula w/ Contrast Bilateral
|
Facility
|
IP
|
$9,612.00
|
|
|
Service Code
|
CPT 73719
|
| Hospital Charge Code |
631315
|
| Min. Negotiated Rate |
$4,898.28 |
| Max. Negotiated Rate |
$9,196.76 |
| Rate for Payer: Aetna Commercial |
$8,996.83
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,596.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,298.13
|
| Rate for Payer: Cash Price |
$2,883.60
|
| Rate for Payer: Cigna Commercial |
$9,196.76
|
| Rate for Payer: Health EOS Commercial |
$8,896.87
|
| Rate for Payer: HFN Commercial |
$9,196.76
|
| Rate for Payer: Multiplan Commercial |
$7,997.18
|
| Rate for Payer: Preferred Network Access Commercial |
$9,196.76
|
| Rate for Payer: Quartz Beloit One Network |
$4,898.28
|
| Rate for Payer: Quartz Commercial |
$5,997.89
|
| Rate for Payer: WEA Trust Commercial |
$5,498.06
|
| Rate for Payer: WPS Commercial |
$7,404.12
|
|
|
MRI Tibia/Fibula w/ Contrast Bilateral
|
Facility
|
OP
|
$9,612.00
|
|
|
Service Code
|
CPT 73719
|
| Hospital Charge Code |
631315
|
| Min. Negotiated Rate |
$367.15 |
| Max. Negotiated Rate |
$9,196.76 |
| Rate for Payer: Aetna Commercial |
$8,996.83
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,596.97
|
| Rate for Payer: Aetna Managed Medicare |
$367.15
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,497.71
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,998.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,798.31
|
| Rate for Payer: Anthem Medicare Advantage |
$367.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,298.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$367.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$367.15
|
| Rate for Payer: Cash Price |
$2,883.60
|
| Rate for Payer: Cash Price |
$2,883.60
|
| Rate for Payer: Cigna Commercial |
$9,196.76
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$367.15
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,594.18
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$367.15
|
| Rate for Payer: Health EOS Commercial |
$8,896.87
|
| Rate for Payer: HFN Commercial |
$9,196.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,365.80
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$367.15
|
| Rate for Payer: Independent Care Health Plan Medicare |
$367.15
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$367.15
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$367.15
|
| Rate for Payer: Multiplan Commercial |
$7,997.18
|
| Rate for Payer: NAPHCARE Commercial |
$550.73
|
| Rate for Payer: Preferred Network Access Commercial |
$9,196.76
|
| Rate for Payer: Quartz Beloit One Network |
$4,898.28
|
| Rate for Payer: Quartz Commercial |
$6,497.71
|
| Rate for Payer: Quartz Medicare Advantage |
$367.15
|
| Rate for Payer: The Alliance Commercial |
$1,468.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$367.15
|
| Rate for Payer: WEA Trust Commercial |
$5,498.06
|
| Rate for Payer: Wellcare Medicare |
$367.15
|
| Rate for Payer: WPS Commercial |
$7,404.12
|
|
|
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 |
$1,372.72 |
| Max. Negotiated Rate |
$4,510.36 |
| Rate for Payer: Aetna Commercial |
$4,412.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,216.20
|
| Rate for Payer: Aetna Managed Medicare |
$1,372.72
|
| 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 |
$2,598.36
|
| 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 |
$4,510.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,743.55
|
| Rate for Payer: Health EOS Commercial |
$4,363.28
|
| Rate for Payer: HFN Commercial |
$4,510.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,676.92
|
| Rate for Payer: Multiplan Commercial |
$3,922.05
|
| Rate for Payer: NAPHCARE Commercial |
$2,941.54
|
| Rate for Payer: Preferred Network Access Commercial |
$4,510.36
|
| Rate for Payer: Quartz Beloit One Network |
$2,402.25
|
| Rate for Payer: Quartz Commercial |
$3,186.66
|
| Rate for Payer: Quartz Medicare Advantage |
$2,941.54
|
| Rate for Payer: The Alliance Commercial |
$2,451.28
|
| Rate for Payer: United Healthcare PPO |
$3,142.88
|
| Rate for Payer: WEA Trust Commercial |
$2,696.41
|
| Rate for Payer: WPS Commercial |
$3,631.19
|
|
|
MRI Tibia/Fibula w/ Contrast Bilateral
|
Professional
|
Both
|
$9,612.00
|
|
|
Service Code
|
CPT 73719
|
| Hospital Charge Code |
631315
|
| Min. Negotiated Rate |
$260.05 |
| Max. Negotiated Rate |
$9,496.66 |
| Rate for Payer: Aetna Commercial |
$9,496.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,596.97
|
| Rate for Payer: Aetna Managed Medicare |
$260.05
|
| Rate for Payer: Anthem Medicare Advantage |
$260.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$260.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$260.05
|
| 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 |
$9,496.66
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$4,998.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$260.05
|
| Rate for Payer: Health EOS Commercial |
$9,096.80
|
| Rate for Payer: HFN Commercial |
$9,496.66
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,049.15
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,049.15
|
| Rate for Payer: Independent Care Health Plan Medicare |
$260.05
|
| Rate for Payer: Multiplan Commercial |
$7,997.18
|
| Rate for Payer: NAPHCARE Commercial |
$390.08
|
| Rate for Payer: Preferred Network Access Commercial |
$9,496.66
|
| Rate for Payer: Quartz Beloit One Network |
$4,398.45
|
| Rate for Payer: Quartz Commercial |
$5,697.99
|
| Rate for Payer: Quartz Medicare Advantage |
$260.05
|
| Rate for Payer: The Alliance Commercial |
$988.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$260.05
|
| Rate for Payer: WEA Trust Commercial |
$5,498.06
|
| Rate for Payer: WPS Commercial |
$1,300.26
|
|
|
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 |
$2,402.25 |
| Max. Negotiated Rate |
$4,510.36 |
| Rate for Payer: Aetna Commercial |
$4,412.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,216.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,598.36
|
| Rate for Payer: Cash Price |
$1,414.20
|
| Rate for Payer: Cigna Commercial |
$4,510.36
|
| Rate for Payer: Health EOS Commercial |
$4,363.28
|
| Rate for Payer: HFN Commercial |
$4,510.36
|
| Rate for Payer: Multiplan Commercial |
$3,922.05
|
| Rate for Payer: Preferred Network Access Commercial |
$4,510.36
|
| Rate for Payer: Quartz Beloit One Network |
$2,402.25
|
| Rate for Payer: Quartz Commercial |
$2,941.54
|
| Rate for Payer: WEA Trust Commercial |
$2,696.41
|
| Rate for Payer: WPS Commercial |
$3,631.19
|
|
