|
MRI Elbow w/ Contrast Right
|
Facility
|
IP
|
$5,965.00
|
|
|
Service Code
|
CPT 73222 TC,RT
|
| Hospital Charge Code |
2980043
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$2,922.85 |
| Max. Negotiated Rate |
$5,487.80 |
| Rate for Payer: Aetna Commercial |
$5,368.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,129.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,161.45
|
| Rate for Payer: Cash Price |
$1,789.50
|
| Rate for Payer: Cigna Commercial |
$5,487.80
|
| Rate for Payer: Health EOS Commercial |
$5,308.85
|
| Rate for Payer: HFN Commercial |
$5,487.80
|
| Rate for Payer: Multiplan Commercial |
$4,772.00
|
| Rate for Payer: NAPHCARE Commercial |
$3,579.00
|
| Rate for Payer: Preferred Network Access Commercial |
$5,487.80
|
| Rate for Payer: Quartz Beloit One Network |
$2,922.85
|
| Rate for Payer: Quartz Commercial |
$3,579.00
|
| Rate for Payer: WEA Trust Commercial |
$3,280.75
|
| Rate for Payer: WPS Commercial |
$4,418.28
|
|
|
MRI Elbow w/ Contrast Right
|
Facility
|
OP
|
$5,965.00
|
|
|
Service Code
|
CPT 73222 TC,RT
|
| Hospital Charge Code |
1611047
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$791.40 |
| Max. Negotiated Rate |
$5,487.80 |
| Rate for Payer: Aetna Commercial |
$5,368.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,129.90
|
| Rate for Payer: Aetna Managed Medicare |
$791.40
|
| 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 |
$791.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,161.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$791.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$791.40
|
| Rate for Payer: Cash Price |
$1,789.50
|
| Rate for Payer: Cash Price |
$1,789.50
|
| Rate for Payer: Cash Price |
$1,789.50
|
| Rate for Payer: Cash Price |
$1,789.50
|
| Rate for Payer: Cigna Commercial |
$5,487.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$791.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,338.01
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$791.40
|
| Rate for Payer: Health EOS Commercial |
$5,308.85
|
| Rate for Payer: HFN Commercial |
$5,487.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,944.01
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$791.40
|
| Rate for Payer: Independent Care Health Plan Medicare |
$791.40
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$791.40
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$791.40
|
| Rate for Payer: Multiplan Commercial |
$4,772.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,187.10
|
| Rate for Payer: Preferred Network Access Commercial |
$5,487.80
|
| Rate for Payer: Quartz Beloit One Network |
$2,922.85
|
| Rate for Payer: Quartz Commercial |
$3,877.25
|
| Rate for Payer: Quartz Medicare Advantage |
$791.40
|
| Rate for Payer: The Alliance Commercial |
$3,165.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$791.40
|
| Rate for Payer: United Healthcare PPO |
$3,022.00
|
| Rate for Payer: WEA Trust Commercial |
$3,280.75
|
| Rate for Payer: Wellcare Medicare |
$791.40
|
| Rate for Payer: WPS Commercial |
$4,418.28
|
|
|
MRI Elbow w/o Contrast Bilateral
|
Facility
|
IP
|
$9,122.00
|
|
|
Service Code
|
CPT 73221
|
| Hospital Charge Code |
630843
|
| Min. Negotiated Rate |
$4,469.78 |
| Max. Negotiated Rate |
$8,392.24 |
| Rate for Payer: Aetna Commercial |
$8,209.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,844.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,834.66
|
| Rate for Payer: Cash Price |
$2,736.60
|
| Rate for Payer: Cigna Commercial |
$8,392.24
|
| Rate for Payer: Health EOS Commercial |
$8,118.58
|
| Rate for Payer: HFN Commercial |
$8,392.24
|
| Rate for Payer: Multiplan Commercial |
$7,297.60
|
| Rate for Payer: NAPHCARE Commercial |
$5,473.20
|
| Rate for Payer: Preferred Network Access Commercial |
$8,392.24
|
| Rate for Payer: Quartz Beloit One Network |
$4,469.78
|
| Rate for Payer: Quartz Commercial |
$5,473.20
|
| Rate for Payer: WEA Trust Commercial |
$5,017.10
|
| Rate for Payer: WPS Commercial |
$6,756.67
|
|
|
MRI Elbow w/o Contrast Bilateral
|
Facility
|
OP
|
$9,122.00
|
|
|
Service Code
|
CPT 73221
|
| Hospital Charge Code |
630843
|
| Min. Negotiated Rate |
$242.20 |
| Max. Negotiated Rate |
$8,392.24 |
| Rate for Payer: Aetna Commercial |
$8,209.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,844.92
|
| Rate for Payer: Aetna Managed Medicare |
$242.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,929.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,561.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,378.56
|
| Rate for Payer: Anthem Medicare Advantage |
$242.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,834.66
|
| 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 |
$2,736.60
|
| Rate for Payer: Cash Price |
$2,736.60
|
| Rate for Payer: Cigna Commercial |
$8,392.24
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$242.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,104.67
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$242.20
|
| Rate for Payer: Health EOS Commercial |
$8,118.58
|
| Rate for Payer: HFN Commercial |
$8,392.24
|
| 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 |
$7,297.60
|
| Rate for Payer: NAPHCARE Commercial |
$363.30
|
| Rate for Payer: Preferred Network Access Commercial |
$8,392.24
|
| Rate for Payer: Quartz Beloit One Network |
$4,469.78
|
| Rate for Payer: Quartz Commercial |
$5,929.30
|
| 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 |
$5,017.10
|
| Rate for Payer: Wellcare Medicare |
$242.20
|
| Rate for Payer: WPS Commercial |
$6,756.67
|
|
|
MRI Elbow w/o Contrast Bilateral
|
Facility
|
OP
|
$5,533.00
|
|
|
Service Code
|
CPT 73221 TC,LT
|
| Hospital Charge Code |
1611049
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$242.20 |
| Max. Negotiated Rate |
$5,090.36 |
| Rate for Payer: Aetna Commercial |
$4,979.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,758.38
|
| 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 |
$2,932.49
|
| 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 |
$1,659.90
|
| Rate for Payer: Cash Price |
$1,659.90
|
| Rate for Payer: Cash Price |
$1,659.90
|
| Rate for Payer: Cash Price |
$1,659.90
|
| Rate for Payer: Cigna Commercial |
$5,090.36
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$242.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,096.27
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$242.20
|
| Rate for Payer: Health EOS Commercial |
$4,924.37
|
| Rate for Payer: HFN Commercial |
$5,090.36
|
| 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 |
$4,426.40
|
| Rate for Payer: NAPHCARE Commercial |
$363.30
|
| Rate for Payer: Preferred Network Access Commercial |
$5,090.36
|
| Rate for Payer: Quartz Beloit One Network |
$2,711.17
|
| Rate for Payer: Quartz Commercial |
$3,596.45
|
| Rate for Payer: Quartz Medicare Advantage |
$242.20
|
| Rate for Payer: The Alliance Commercial |
$968.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$242.20
|
| Rate for Payer: United Healthcare PPO |
$3,022.00
|
| Rate for Payer: WEA Trust Commercial |
$3,043.15
|
| Rate for Payer: Wellcare Medicare |
$242.20
|
| Rate for Payer: WPS Commercial |
$4,098.29
|
|
|
MRI Elbow w/o Contrast Bilateral
|
Professional
|
Both
|
$9,122.00
|
|
|
Service Code
|
CPT 73221
|
| Hospital Charge Code |
630843
|
| Min. Negotiated Rate |
$764.42 |
| Max. Negotiated Rate |
$8,665.90 |
| Rate for Payer: Aetna Commercial |
$8,665.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,844.92
|
| Rate for Payer: Cash Price |
$2,736.60
|
| Rate for Payer: Cash Price |
$2,736.60
|
| Rate for Payer: Cash Price |
$2,736.60
|
| Rate for Payer: Cigna Commercial |
$8,665.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$4,561.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,473.20
|
| Rate for Payer: Health EOS Commercial |
$8,301.02
|
| Rate for Payer: HFN Commercial |
$8,665.90
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$764.42
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$764.42
|
| Rate for Payer: Multiplan Commercial |
$7,297.60
|
| Rate for Payer: Preferred Network Access Commercial |
$8,665.90
|
| Rate for Payer: Quartz Beloit One Network |
$4,013.68
|
| Rate for Payer: Quartz Commercial |
$5,199.54
|
| Rate for Payer: The Alliance Commercial |
$4,561.00
|
| Rate for Payer: WEA Trust Commercial |
$5,017.10
|
| Rate for Payer: WPS Commercial |
$6,756.67
|
|
|
MRI Elbow w/o Contrast Bilateral
|
Professional
|
Both
|
$5,533.00
|
|
|
Service Code
|
CPT 73221 TC,LT
|
| Hospital Charge Code |
1611049
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$764.42 |
| Max. Negotiated Rate |
$5,256.35 |
| Rate for Payer: Aetna Commercial |
$5,256.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,758.38
|
| Rate for Payer: Cash Price |
$1,659.90
|
| Rate for Payer: Cash Price |
$1,659.90
|
| Rate for Payer: Cash Price |
$1,659.90
|
| Rate for Payer: Cigna Commercial |
$5,256.35
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,766.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,319.80
|
| Rate for Payer: Health EOS Commercial |
$5,035.03
|
| Rate for Payer: HFN Commercial |
$5,256.35
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$764.42
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$764.42
|
| Rate for Payer: Multiplan Commercial |
$4,426.40
|
| Rate for Payer: Preferred Network Access Commercial |
$5,256.35
|
| Rate for Payer: Quartz Beloit One Network |
$2,434.52
|
| Rate for Payer: Quartz Commercial |
$3,153.81
|
| Rate for Payer: The Alliance Commercial |
$2,766.50
|
| Rate for Payer: WEA Trust Commercial |
$3,043.15
|
| Rate for Payer: WPS Commercial |
$4,098.29
|
|
|
MRI Elbow w/o Contrast Bilateral
|
Facility
|
IP
|
$5,533.00
|
|
|
Service Code
|
CPT 73221 TC,LT
|
| Hospital Charge Code |
1611049
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$2,711.17 |
| Max. Negotiated Rate |
$5,090.36 |
| Rate for Payer: Aetna Commercial |
$4,979.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,758.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,932.49
|
| Rate for Payer: Cash Price |
$1,659.90
|
| Rate for Payer: Cigna Commercial |
$5,090.36
|
| Rate for Payer: Health EOS Commercial |
$4,924.37
|
| Rate for Payer: HFN Commercial |
$5,090.36
|
| Rate for Payer: Multiplan Commercial |
$4,426.40
|
| Rate for Payer: NAPHCARE Commercial |
$3,319.80
|
| Rate for Payer: Preferred Network Access Commercial |
$5,090.36
|
| Rate for Payer: Quartz Beloit One Network |
$2,711.17
|
| Rate for Payer: Quartz Commercial |
$3,319.80
|
| Rate for Payer: WEA Trust Commercial |
$3,043.15
|
| Rate for Payer: WPS Commercial |
$4,098.29
|
|
|
MRI Elbow w/o Contrast Left
|
Professional
|
Both
|
$5,085.00
|
|
|
Service Code
|
CPT 73221 TC,LT
|
| Hospital Charge Code |
1611051
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$764.42 |
| Max. Negotiated Rate |
$4,830.75 |
| Rate for Payer: Aetna Commercial |
$4,830.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,373.10
|
| 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 |
$4,830.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,542.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,051.00
|
| Rate for Payer: Health EOS Commercial |
$4,627.35
|
| Rate for Payer: HFN Commercial |
$4,830.75
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$764.42
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$764.42
|
| Rate for Payer: Multiplan Commercial |
$4,068.00
|
| Rate for Payer: Preferred Network Access Commercial |
$4,830.75
|
| Rate for Payer: Quartz Beloit One Network |
$2,237.40
|
| Rate for Payer: Quartz Commercial |
$2,898.45
|
| Rate for Payer: The Alliance Commercial |
$2,542.50
|
| Rate for Payer: WEA Trust Commercial |
$2,796.75
|
| Rate for Payer: WPS Commercial |
$3,766.46
|
|
|
MRI Elbow w/o Contrast Left
|
Facility
|
IP
|
$5,085.00
|
|
|
Service Code
|
CPT 73221 TC,LT
|
| Hospital Charge Code |
1611051
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$2,491.65 |
| Max. Negotiated Rate |
$4,678.20 |
| Rate for Payer: Aetna Commercial |
$4,576.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,373.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,695.05
|
| Rate for Payer: Cash Price |
$1,525.50
|
| Rate for Payer: Cigna Commercial |
$4,678.20
|
| Rate for Payer: Health EOS Commercial |
$4,525.65
|
| Rate for Payer: HFN Commercial |
$4,678.20
|
| Rate for Payer: Multiplan Commercial |
$4,068.00
|
| Rate for Payer: NAPHCARE Commercial |
$3,051.00
|
| Rate for Payer: Preferred Network Access Commercial |
$4,678.20
|
| Rate for Payer: Quartz Beloit One Network |
$2,491.65
|
| Rate for Payer: Quartz Commercial |
$3,051.00
|
| Rate for Payer: WEA Trust Commercial |
$2,796.75
|
| Rate for Payer: WPS Commercial |
$3,766.46
|
|
|
MRI Elbow w/o Contrast Left
|
Facility
|
IP
|
$4,561.00
|
|
|
Service Code
|
CPT 73221
|
| Hospital Charge Code |
630845
|
| Min. Negotiated Rate |
$2,234.89 |
| Max. Negotiated Rate |
$4,196.12 |
| Rate for Payer: Aetna Commercial |
$4,104.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,922.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,417.33
|
| Rate for Payer: Cash Price |
$1,368.30
|
| Rate for Payer: Cigna Commercial |
$4,196.12
|
| Rate for Payer: Health EOS Commercial |
$4,059.29
|
| Rate for Payer: HFN Commercial |
$4,196.12
|
| Rate for Payer: Multiplan Commercial |
$3,648.80
|
| Rate for Payer: NAPHCARE Commercial |
$2,736.60
|
| Rate for Payer: Preferred Network Access Commercial |
$4,196.12
|
| Rate for Payer: Quartz Beloit One Network |
$2,234.89
|
| Rate for Payer: Quartz Commercial |
$2,736.60
|
| Rate for Payer: WEA Trust Commercial |
$2,508.55
|
| Rate for Payer: WPS Commercial |
$3,378.33
|
|
|
MRI Elbow w/o Contrast Left
|
Facility
|
OP
|
$4,561.00
|
|
|
Service Code
|
CPT 73221
|
| Hospital Charge Code |
630845
|
| Min. Negotiated Rate |
$242.20 |
| Max. Negotiated Rate |
$4,196.12 |
| Rate for Payer: Aetna Commercial |
$4,104.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,922.46
|
| Rate for Payer: Aetna Managed Medicare |
$242.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,964.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,280.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,189.28
|
| Rate for Payer: Anthem Medicare Advantage |
$242.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,417.33
|
| 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 |
$1,368.30
|
| Rate for Payer: Cash Price |
$1,368.30
|
| Rate for Payer: Cigna Commercial |
$4,196.12
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$242.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,552.34
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$242.20
|
| Rate for Payer: Health EOS Commercial |
$4,059.29
|
| Rate for Payer: HFN Commercial |
$4,196.12
|
| 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 |
$3,648.80
|
| Rate for Payer: NAPHCARE Commercial |
$363.30
|
| Rate for Payer: Preferred Network Access Commercial |
$4,196.12
|
| Rate for Payer: Quartz Beloit One Network |
$2,234.89
|
| Rate for Payer: Quartz Commercial |
$2,964.65
|
| 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 |
$2,508.55
|
| Rate for Payer: Wellcare Medicare |
$242.20
|
| Rate for Payer: WPS Commercial |
$3,378.33
|
|
|
MRI Elbow w/o Contrast Left
|
Facility
|
OP
|
$5,085.00
|
|
|
Service Code
|
CPT 73221 TC,LT
|
| Hospital Charge Code |
1611051
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$242.20 |
| Max. Negotiated Rate |
$4,678.20 |
| Rate for Payer: Aetna Commercial |
$4,576.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,373.10
|
| 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 |
$2,695.05
|
| 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 |
$1,525.50
|
| 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 |
$4,678.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$242.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,845.57
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$242.20
|
| Rate for Payer: Health EOS Commercial |
$4,525.65
|
| Rate for Payer: HFN Commercial |
$4,678.20
|
| 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 |
$4,068.00
|
| Rate for Payer: NAPHCARE Commercial |
$363.30
|
| Rate for Payer: Preferred Network Access Commercial |
$4,678.20
|
| Rate for Payer: Quartz Beloit One Network |
$2,491.65
|
| Rate for Payer: Quartz Commercial |
$3,305.25
|
| 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 |
$2,796.75
|
| Rate for Payer: Wellcare Medicare |
$242.20
|
| Rate for Payer: WPS Commercial |
$3,766.46
|
|
|
MRI Elbow w/o Contrast Left
|
Professional
|
Both
|
$4,561.00
|
|
|
Service Code
|
CPT 73221
|
| Hospital Charge Code |
630845
|
| Min. Negotiated Rate |
$764.42 |
| Max. Negotiated Rate |
$4,332.95 |
| Rate for Payer: Aetna Commercial |
$4,332.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,922.46
|
| Rate for Payer: Cash Price |
$1,368.30
|
| Rate for Payer: Cash Price |
$1,368.30
|
| Rate for Payer: Cash Price |
$1,368.30
|
| Rate for Payer: Cigna Commercial |
$4,332.95
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,280.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,736.60
|
| Rate for Payer: Health EOS Commercial |
$4,150.51
|
| Rate for Payer: HFN Commercial |
$4,332.95
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$764.42
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$764.42
|
| Rate for Payer: Multiplan Commercial |
$3,648.80
|
| Rate for Payer: Preferred Network Access Commercial |
$4,332.95
|
| Rate for Payer: Quartz Beloit One Network |
$2,006.84
|
| Rate for Payer: Quartz Commercial |
$2,599.77
|
| Rate for Payer: The Alliance Commercial |
$2,280.50
|
| Rate for Payer: WEA Trust Commercial |
$2,508.55
|
| Rate for Payer: WPS Commercial |
$3,378.33
|
|
|
MRI Elbow w/o Contrast Right
|
Facility
|
OP
|
$5,085.00
|
|
|
Service Code
|
CPT 73221 TC,RT
|
| Hospital Charge Code |
1611053
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$242.20 |
| Max. Negotiated Rate |
$4,678.20 |
| Rate for Payer: Aetna Commercial |
$4,576.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,373.10
|
| 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 |
$2,695.05
|
| 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 |
$1,525.50
|
| 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 |
$4,678.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$242.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,845.57
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$242.20
|
| Rate for Payer: Health EOS Commercial |
$4,525.65
|
| Rate for Payer: HFN Commercial |
$4,678.20
|
| 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 |
$4,068.00
|
| Rate for Payer: NAPHCARE Commercial |
$363.30
|
| Rate for Payer: Preferred Network Access Commercial |
$4,678.20
|
| Rate for Payer: Quartz Beloit One Network |
$2,491.65
|
| Rate for Payer: Quartz Commercial |
$3,305.25
|
| 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 |
$2,796.75
|
| Rate for Payer: Wellcare Medicare |
$242.20
|
| Rate for Payer: WPS Commercial |
$3,766.46
|
|
|
MRI Elbow w/o Contrast Right
|
Facility
|
IP
|
$5,085.00
|
|
|
Service Code
|
CPT 73221 TC,RT
|
| Hospital Charge Code |
1611053
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$2,491.65 |
| Max. Negotiated Rate |
$4,678.20 |
| Rate for Payer: Aetna Commercial |
$4,576.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,373.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,695.05
|
| Rate for Payer: Cash Price |
$1,525.50
|
| Rate for Payer: Cigna Commercial |
$4,678.20
|
| Rate for Payer: Health EOS Commercial |
$4,525.65
|
| Rate for Payer: HFN Commercial |
$4,678.20
|
| Rate for Payer: Multiplan Commercial |
$4,068.00
|
| Rate for Payer: NAPHCARE Commercial |
$3,051.00
|
| Rate for Payer: Preferred Network Access Commercial |
$4,678.20
|
| Rate for Payer: Quartz Beloit One Network |
$2,491.65
|
| Rate for Payer: Quartz Commercial |
$3,051.00
|
| Rate for Payer: WEA Trust Commercial |
$2,796.75
|
| Rate for Payer: WPS Commercial |
$3,766.46
|
|
|
MRI Elbow w/o Contrast Right
|
Professional
|
Both
|
$5,085.00
|
|
|
Service Code
|
CPT 73221 TC,RT
|
| Hospital Charge Code |
1611053
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$764.42 |
| Max. Negotiated Rate |
$4,830.75 |
| Rate for Payer: Aetna Commercial |
$4,830.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,373.10
|
| 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 |
$4,830.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,542.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,051.00
|
| Rate for Payer: Health EOS Commercial |
$4,627.35
|
| Rate for Payer: HFN Commercial |
$4,830.75
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$764.42
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$764.42
|
| Rate for Payer: Multiplan Commercial |
$4,068.00
|
| Rate for Payer: Preferred Network Access Commercial |
$4,830.75
|
| Rate for Payer: Quartz Beloit One Network |
$2,237.40
|
| Rate for Payer: Quartz Commercial |
$2,898.45
|
| Rate for Payer: The Alliance Commercial |
$2,542.50
|
| Rate for Payer: WEA Trust Commercial |
$2,796.75
|
| Rate for Payer: WPS Commercial |
$3,766.46
|
|
|
MRI Elbow w/o Contrast Right
|
Facility
|
OP
|
$4,561.00
|
|
|
Service Code
|
CPT 73221
|
| Hospital Charge Code |
630849
|
| Min. Negotiated Rate |
$242.20 |
| Max. Negotiated Rate |
$4,196.12 |
| Rate for Payer: Aetna Commercial |
$4,104.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,922.46
|
| Rate for Payer: Aetna Managed Medicare |
$242.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,964.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,280.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,189.28
|
| Rate for Payer: Anthem Medicare Advantage |
$242.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,417.33
|
| 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 |
$1,368.30
|
| Rate for Payer: Cash Price |
$1,368.30
|
| Rate for Payer: Cigna Commercial |
$4,196.12
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$242.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,552.34
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$242.20
|
| Rate for Payer: Health EOS Commercial |
$4,059.29
|
| Rate for Payer: HFN Commercial |
$4,196.12
|
| 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 |
$3,648.80
|
| Rate for Payer: NAPHCARE Commercial |
$363.30
|
| Rate for Payer: Preferred Network Access Commercial |
$4,196.12
|
| Rate for Payer: Quartz Beloit One Network |
$2,234.89
|
| Rate for Payer: Quartz Commercial |
$2,964.65
|
| 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 |
$2,508.55
|
| Rate for Payer: Wellcare Medicare |
$242.20
|
| Rate for Payer: WPS Commercial |
$3,378.33
|
|
|
MRI Elbow w/o Contrast Right
|
Professional
|
Both
|
$4,561.00
|
|
|
Service Code
|
CPT 73221
|
| Hospital Charge Code |
630849
|
| Min. Negotiated Rate |
$764.42 |
| Max. Negotiated Rate |
$4,332.95 |
| Rate for Payer: Aetna Commercial |
$4,332.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,922.46
|
| Rate for Payer: Cash Price |
$1,368.30
|
| Rate for Payer: Cash Price |
$1,368.30
|
| Rate for Payer: Cash Price |
$1,368.30
|
| Rate for Payer: Cigna Commercial |
$4,332.95
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,280.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,736.60
|
| Rate for Payer: Health EOS Commercial |
$4,150.51
|
| Rate for Payer: HFN Commercial |
$4,332.95
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$764.42
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$764.42
|
| Rate for Payer: Multiplan Commercial |
$3,648.80
|
| Rate for Payer: Preferred Network Access Commercial |
$4,332.95
|
| Rate for Payer: Quartz Beloit One Network |
$2,006.84
|
| Rate for Payer: Quartz Commercial |
$2,599.77
|
| Rate for Payer: The Alliance Commercial |
$2,280.50
|
| Rate for Payer: WEA Trust Commercial |
$2,508.55
|
| Rate for Payer: WPS Commercial |
$3,378.33
|
|
|
MRI Elbow w/o Contrast Right
|
Facility
|
IP
|
$4,561.00
|
|
|
Service Code
|
CPT 73221
|
| Hospital Charge Code |
630849
|
| Min. Negotiated Rate |
$2,234.89 |
| Max. Negotiated Rate |
$4,196.12 |
| Rate for Payer: Aetna Commercial |
$4,104.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,922.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,417.33
|
| Rate for Payer: Cash Price |
$1,368.30
|
| Rate for Payer: Cigna Commercial |
$4,196.12
|
| Rate for Payer: Health EOS Commercial |
$4,059.29
|
| Rate for Payer: HFN Commercial |
$4,196.12
|
| Rate for Payer: Multiplan Commercial |
$3,648.80
|
| Rate for Payer: NAPHCARE Commercial |
$2,736.60
|
| Rate for Payer: Preferred Network Access Commercial |
$4,196.12
|
| Rate for Payer: Quartz Beloit One Network |
$2,234.89
|
| Rate for Payer: Quartz Commercial |
$2,736.60
|
| Rate for Payer: WEA Trust Commercial |
$2,508.55
|
| Rate for Payer: WPS Commercial |
$3,378.33
|
|
|
MRI Elbow w/o Contrast Right
|
Facility
|
IP
|
$5,533.00
|
|
|
Service Code
|
CPT 73221 TC,RT
|
| Hospital Charge Code |
2980039
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$2,711.17 |
| Max. Negotiated Rate |
$5,090.36 |
| Rate for Payer: Aetna Commercial |
$4,979.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,758.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,932.49
|
| Rate for Payer: Cash Price |
$1,659.90
|
| Rate for Payer: Cigna Commercial |
$5,090.36
|
| Rate for Payer: Health EOS Commercial |
$4,924.37
|
| Rate for Payer: HFN Commercial |
$5,090.36
|
| Rate for Payer: Multiplan Commercial |
$4,426.40
|
| Rate for Payer: NAPHCARE Commercial |
$3,319.80
|
| Rate for Payer: Preferred Network Access Commercial |
$5,090.36
|
| Rate for Payer: Quartz Beloit One Network |
$2,711.17
|
| Rate for Payer: Quartz Commercial |
$3,319.80
|
| Rate for Payer: WEA Trust Commercial |
$3,043.15
|
| Rate for Payer: WPS Commercial |
$4,098.29
|
|
|
MRI Elbow w/o Contrast Right
|
Professional
|
Both
|
$5,533.00
|
|
|
Service Code
|
CPT 73221 TC,RT
|
| Hospital Charge Code |
2980039
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$764.42 |
| Max. Negotiated Rate |
$5,256.35 |
| Rate for Payer: Aetna Commercial |
$5,256.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,758.38
|
| Rate for Payer: Cash Price |
$1,659.90
|
| Rate for Payer: Cash Price |
$1,659.90
|
| Rate for Payer: Cash Price |
$1,659.90
|
| Rate for Payer: Cigna Commercial |
$5,256.35
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,766.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,319.80
|
| Rate for Payer: Health EOS Commercial |
$5,035.03
|
| Rate for Payer: HFN Commercial |
$5,256.35
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$764.42
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$764.42
|
| Rate for Payer: Multiplan Commercial |
$4,426.40
|
| Rate for Payer: Preferred Network Access Commercial |
$5,256.35
|
| Rate for Payer: Quartz Beloit One Network |
$2,434.52
|
| Rate for Payer: Quartz Commercial |
$3,153.81
|
| Rate for Payer: The Alliance Commercial |
$2,766.50
|
| Rate for Payer: WEA Trust Commercial |
$3,043.15
|
| Rate for Payer: WPS Commercial |
$4,098.29
|
|
|
MRI Elbow w/o Contrast Right
|
Facility
|
OP
|
$5,533.00
|
|
|
Service Code
|
CPT 73221 TC,RT
|
| Hospital Charge Code |
2980039
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$242.20 |
| Max. Negotiated Rate |
$5,090.36 |
| Rate for Payer: Aetna Commercial |
$4,979.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,758.38
|
| 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 |
$2,932.49
|
| 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 |
$1,659.90
|
| Rate for Payer: Cash Price |
$1,659.90
|
| Rate for Payer: Cash Price |
$1,659.90
|
| Rate for Payer: Cash Price |
$1,659.90
|
| Rate for Payer: Cigna Commercial |
$5,090.36
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$242.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,096.27
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$242.20
|
| Rate for Payer: Health EOS Commercial |
$4,924.37
|
| Rate for Payer: HFN Commercial |
$5,090.36
|
| 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 |
$4,426.40
|
| Rate for Payer: NAPHCARE Commercial |
$363.30
|
| Rate for Payer: Preferred Network Access Commercial |
$5,090.36
|
| Rate for Payer: Quartz Beloit One Network |
$2,711.17
|
| Rate for Payer: Quartz Commercial |
$3,596.45
|
| Rate for Payer: Quartz Medicare Advantage |
$242.20
|
| Rate for Payer: The Alliance Commercial |
$968.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$242.20
|
| Rate for Payer: United Healthcare PPO |
$3,022.00
|
| Rate for Payer: WEA Trust Commercial |
$3,043.15
|
| Rate for Payer: Wellcare Medicare |
$242.20
|
| Rate for Payer: WPS Commercial |
$4,098.29
|
|
|
MRI Elbow w/ + w/o Contrast Bilateral
|
Professional
|
Both
|
$11,703.00
|
|
|
Service Code
|
CPT 73223
|
| Hospital Charge Code |
630825
|
| Min. Negotiated Rate |
$1,507.24 |
| Max. Negotiated Rate |
$11,117.85 |
| Rate for Payer: Aetna Commercial |
$11,117.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,064.58
|
| Rate for Payer: Cash Price |
$3,510.90
|
| Rate for Payer: Cash Price |
$3,510.90
|
| Rate for Payer: Cash Price |
$3,510.90
|
| Rate for Payer: Cigna Commercial |
$11,117.85
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$5,851.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$7,021.80
|
| Rate for Payer: Health EOS Commercial |
$10,649.73
|
| Rate for Payer: HFN Commercial |
$11,117.85
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,507.24
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,507.24
|
| Rate for Payer: Multiplan Commercial |
$9,362.40
|
| Rate for Payer: Preferred Network Access Commercial |
$11,117.85
|
| Rate for Payer: Quartz Beloit One Network |
$5,149.32
|
| Rate for Payer: Quartz Commercial |
$6,670.71
|
| Rate for Payer: The Alliance Commercial |
$5,851.50
|
| Rate for Payer: WEA Trust Commercial |
$6,436.65
|
| Rate for Payer: WPS Commercial |
$8,668.41
|
|
|
MRI Elbow w/ + w/o Contrast Bilateral
|
Facility
|
IP
|
$11,703.00
|
|
|
Service Code
|
CPT 73223
|
| Hospital Charge Code |
630825
|
| Min. Negotiated Rate |
$5,734.47 |
| Max. Negotiated Rate |
$10,766.76 |
| Rate for Payer: Aetna Commercial |
$10,532.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,064.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,202.59
|
| Rate for Payer: Cash Price |
$3,510.90
|
| Rate for Payer: Cigna Commercial |
$10,766.76
|
| Rate for Payer: Health EOS Commercial |
$10,415.67
|
| Rate for Payer: HFN Commercial |
$10,766.76
|
| Rate for Payer: Multiplan Commercial |
$9,362.40
|
| Rate for Payer: NAPHCARE Commercial |
$7,021.80
|
| Rate for Payer: Preferred Network Access Commercial |
$10,766.76
|
| Rate for Payer: Quartz Beloit One Network |
$5,734.47
|
| Rate for Payer: Quartz Commercial |
$7,021.80
|
| Rate for Payer: WEA Trust Commercial |
$6,436.65
|
| Rate for Payer: WPS Commercial |
$8,668.41
|
|
