|
MRI Elbow w/ + w/o Contrast Bilateral
|
Facility
|
OP
|
$11,703.00
|
|
|
Service Code
|
CPT 73223
|
| Hospital Charge Code |
630825
|
| Min. Negotiated Rate |
$380.12 |
| 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: Aetna Managed Medicare |
$380.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$7,606.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,851.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,617.44
|
| Rate for Payer: Anthem Medicare Advantage |
$380.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,202.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$380.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$380.12
|
| Rate for Payer: Cash Price |
$3,510.90
|
| Rate for Payer: Cash Price |
$3,510.90
|
| Rate for Payer: Cigna Commercial |
$10,766.76
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$380.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,549.00
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$380.12
|
| Rate for Payer: Health EOS Commercial |
$10,415.67
|
| Rate for Payer: HFN Commercial |
$10,766.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,414.05
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$380.12
|
| Rate for Payer: Independent Care Health Plan Medicare |
$380.12
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$380.12
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$380.12
|
| Rate for Payer: Multiplan Commercial |
$9,362.40
|
| Rate for Payer: NAPHCARE Commercial |
$570.18
|
| 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 |
$7,606.95
|
| Rate for Payer: Quartz Medicare Advantage |
$380.12
|
| Rate for Payer: The Alliance Commercial |
$1,520.48
|
| Rate for Payer: United Healthcare Medicare Advantage |
$380.12
|
| Rate for Payer: WEA Trust Commercial |
$6,436.65
|
| Rate for Payer: Wellcare Medicare |
$380.12
|
| Rate for Payer: WPS Commercial |
$8,668.41
|
|
|
MRI Elbow w/ + w/o Contrast Bilateral
|
Facility
|
IP
|
$6,397.00
|
|
|
Service Code
|
CPT 73223 LT,TC
|
| Hospital Charge Code |
1611037
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$3,134.53 |
| Max. Negotiated Rate |
$5,885.24 |
| Rate for Payer: Aetna Commercial |
$5,757.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,501.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,390.41
|
| Rate for Payer: Cash Price |
$1,919.10
|
| Rate for Payer: Cigna Commercial |
$5,885.24
|
| Rate for Payer: Health EOS Commercial |
$5,693.33
|
| Rate for Payer: HFN Commercial |
$5,885.24
|
| Rate for Payer: Multiplan Commercial |
$5,117.60
|
| Rate for Payer: NAPHCARE Commercial |
$3,838.20
|
| Rate for Payer: Preferred Network Access Commercial |
$5,885.24
|
| Rate for Payer: Quartz Beloit One Network |
$3,134.53
|
| Rate for Payer: Quartz Commercial |
$3,838.20
|
| Rate for Payer: WEA Trust Commercial |
$3,518.35
|
| Rate for Payer: WPS Commercial |
$4,738.26
|
|
|
MRI Elbow w/ + w/o Contrast Bilateral
|
Professional
|
Both
|
$6,397.00
|
|
|
Service Code
|
CPT 73223 LT,TC
|
| Hospital Charge Code |
1611037
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,507.24 |
| Max. Negotiated Rate |
$6,077.15 |
| Rate for Payer: Aetna Commercial |
$6,077.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,501.42
|
| Rate for Payer: Cash Price |
$1,919.10
|
| Rate for Payer: Cash Price |
$1,919.10
|
| Rate for Payer: Cash Price |
$1,919.10
|
| Rate for Payer: Cigna Commercial |
$6,077.15
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$3,198.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,838.20
|
| Rate for Payer: Health EOS Commercial |
$5,821.27
|
| Rate for Payer: HFN Commercial |
$6,077.15
|
| 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 |
$5,117.60
|
| Rate for Payer: Preferred Network Access Commercial |
$6,077.15
|
| Rate for Payer: Quartz Beloit One Network |
$2,814.68
|
| Rate for Payer: Quartz Commercial |
$3,646.29
|
| Rate for Payer: The Alliance Commercial |
$3,198.50
|
| Rate for Payer: WEA Trust Commercial |
$3,518.35
|
| Rate for Payer: WPS Commercial |
$4,738.26
|
|
|
MRI Elbow w/ + w/o Contrast Bilateral
|
Facility
|
OP
|
$6,397.00
|
|
|
Service Code
|
CPT 73223 LT,TC
|
| Hospital Charge Code |
1611037
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$380.12 |
| Max. Negotiated Rate |
$5,885.24 |
| Rate for Payer: Aetna Commercial |
$5,757.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,501.42
|
| Rate for Payer: Aetna Managed Medicare |
$380.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,496.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,871.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,726.00
|
| Rate for Payer: Anthem Medicare Advantage |
$380.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,390.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$380.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$380.12
|
| Rate for Payer: Cash Price |
$1,919.10
|
| Rate for Payer: Cash Price |
$1,919.10
|
| Rate for Payer: Cash Price |
$1,919.10
|
| Rate for Payer: Cash Price |
$1,919.10
|
| Rate for Payer: Cigna Commercial |
$5,885.24
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$380.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,579.76
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$380.12
|
| Rate for Payer: Health EOS Commercial |
$5,693.33
|
| Rate for Payer: HFN Commercial |
$5,885.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,414.05
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$380.12
|
| Rate for Payer: Independent Care Health Plan Medicare |
$380.12
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$380.12
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$380.12
|
| Rate for Payer: Multiplan Commercial |
$5,117.60
|
| Rate for Payer: NAPHCARE Commercial |
$570.18
|
| Rate for Payer: Preferred Network Access Commercial |
$5,885.24
|
| Rate for Payer: Quartz Beloit One Network |
$3,134.53
|
| Rate for Payer: Quartz Commercial |
$4,158.05
|
| Rate for Payer: Quartz Medicare Advantage |
$380.12
|
| Rate for Payer: The Alliance Commercial |
$1,520.48
|
| Rate for Payer: United Healthcare Medicare Advantage |
$380.12
|
| Rate for Payer: United Healthcare PPO |
$3,022.00
|
| Rate for Payer: WEA Trust Commercial |
$3,518.35
|
| Rate for Payer: Wellcare Medicare |
$380.12
|
| Rate for Payer: WPS Commercial |
$4,738.26
|
|
|
MRI Elbow w/ + w/o Contrast Left
|
Facility
|
OP
|
$5,851.00
|
|
|
Service Code
|
CPT 73223
|
| Hospital Charge Code |
630828
|
| Min. Negotiated Rate |
$380.12 |
| Max. Negotiated Rate |
$5,382.92 |
| Rate for Payer: Aetna Commercial |
$5,265.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,031.86
|
| Rate for Payer: Aetna Managed Medicare |
$380.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,803.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,925.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,808.48
|
| Rate for Payer: Anthem Medicare Advantage |
$380.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,101.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$380.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$380.12
|
| Rate for Payer: Cash Price |
$1,755.30
|
| Rate for Payer: Cash Price |
$1,755.30
|
| Rate for Payer: Cigna Commercial |
$5,382.92
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$380.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,274.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$380.12
|
| Rate for Payer: Health EOS Commercial |
$5,207.39
|
| Rate for Payer: HFN Commercial |
$5,382.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,414.05
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$380.12
|
| Rate for Payer: Independent Care Health Plan Medicare |
$380.12
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$380.12
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$380.12
|
| Rate for Payer: Multiplan Commercial |
$4,680.80
|
| Rate for Payer: NAPHCARE Commercial |
$570.18
|
| Rate for Payer: Preferred Network Access Commercial |
$5,382.92
|
| Rate for Payer: Quartz Beloit One Network |
$2,866.99
|
| Rate for Payer: Quartz Commercial |
$3,803.15
|
| Rate for Payer: Quartz Medicare Advantage |
$380.12
|
| Rate for Payer: The Alliance Commercial |
$1,520.48
|
| Rate for Payer: United Healthcare Medicare Advantage |
$380.12
|
| Rate for Payer: WEA Trust Commercial |
$3,218.05
|
| Rate for Payer: Wellcare Medicare |
$380.12
|
| Rate for Payer: WPS Commercial |
$4,333.84
|
|
|
MRI Elbow w/ + w/o Contrast Left
|
Facility
|
OP
|
$6,397.00
|
|
|
Service Code
|
CPT 73223 LT,TC
|
| Hospital Charge Code |
1611039
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$380.12 |
| Max. Negotiated Rate |
$5,885.24 |
| Rate for Payer: Aetna Commercial |
$5,757.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,501.42
|
| Rate for Payer: Aetna Managed Medicare |
$380.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,496.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,871.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,726.00
|
| Rate for Payer: Anthem Medicare Advantage |
$380.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,390.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$380.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$380.12
|
| Rate for Payer: Cash Price |
$1,919.10
|
| Rate for Payer: Cash Price |
$1,919.10
|
| Rate for Payer: Cash Price |
$1,919.10
|
| Rate for Payer: Cash Price |
$1,919.10
|
| Rate for Payer: Cigna Commercial |
$5,885.24
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$380.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,579.76
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$380.12
|
| Rate for Payer: Health EOS Commercial |
$5,693.33
|
| Rate for Payer: HFN Commercial |
$5,885.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,414.05
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$380.12
|
| Rate for Payer: Independent Care Health Plan Medicare |
$380.12
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$380.12
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$380.12
|
| Rate for Payer: Multiplan Commercial |
$5,117.60
|
| Rate for Payer: NAPHCARE Commercial |
$570.18
|
| Rate for Payer: Preferred Network Access Commercial |
$5,885.24
|
| Rate for Payer: Quartz Beloit One Network |
$3,134.53
|
| Rate for Payer: Quartz Commercial |
$4,158.05
|
| Rate for Payer: Quartz Medicare Advantage |
$380.12
|
| Rate for Payer: The Alliance Commercial |
$1,520.48
|
| Rate for Payer: United Healthcare Medicare Advantage |
$380.12
|
| Rate for Payer: United Healthcare PPO |
$3,022.00
|
| Rate for Payer: WEA Trust Commercial |
$3,518.35
|
| Rate for Payer: Wellcare Medicare |
$380.12
|
| Rate for Payer: WPS Commercial |
$4,738.26
|
|
|
MRI Elbow w/ + w/o Contrast Left
|
Facility
|
IP
|
$6,397.00
|
|
|
Service Code
|
CPT 73223 LT,TC
|
| Hospital Charge Code |
1611039
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$3,134.53 |
| Max. Negotiated Rate |
$5,885.24 |
| Rate for Payer: Aetna Commercial |
$5,757.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,501.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,390.41
|
| Rate for Payer: Cash Price |
$1,919.10
|
| Rate for Payer: Cigna Commercial |
$5,885.24
|
| Rate for Payer: Health EOS Commercial |
$5,693.33
|
| Rate for Payer: HFN Commercial |
$5,885.24
|
| Rate for Payer: Multiplan Commercial |
$5,117.60
|
| Rate for Payer: NAPHCARE Commercial |
$3,838.20
|
| Rate for Payer: Preferred Network Access Commercial |
$5,885.24
|
| Rate for Payer: Quartz Beloit One Network |
$3,134.53
|
| Rate for Payer: Quartz Commercial |
$3,838.20
|
| Rate for Payer: WEA Trust Commercial |
$3,518.35
|
| Rate for Payer: WPS Commercial |
$4,738.26
|
|
|
MRI Elbow w/ + w/o Contrast Left
|
Professional
|
Both
|
$5,851.00
|
|
|
Service Code
|
CPT 73223
|
| Hospital Charge Code |
630828
|
| Min. Negotiated Rate |
$1,507.24 |
| Max. Negotiated Rate |
$5,558.45 |
| Rate for Payer: Aetna Commercial |
$5,558.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,031.86
|
| Rate for Payer: Cash Price |
$1,755.30
|
| Rate for Payer: Cash Price |
$1,755.30
|
| Rate for Payer: Cash Price |
$1,755.30
|
| Rate for Payer: Cigna Commercial |
$5,558.45
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,925.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,510.60
|
| Rate for Payer: Health EOS Commercial |
$5,324.41
|
| Rate for Payer: HFN Commercial |
$5,558.45
|
| 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 |
$4,680.80
|
| Rate for Payer: Preferred Network Access Commercial |
$5,558.45
|
| Rate for Payer: Quartz Beloit One Network |
$2,574.44
|
| Rate for Payer: Quartz Commercial |
$3,335.07
|
| Rate for Payer: The Alliance Commercial |
$2,925.50
|
| Rate for Payer: WEA Trust Commercial |
$3,218.05
|
| Rate for Payer: WPS Commercial |
$4,333.84
|
|
|
MRI Elbow w/ + w/o Contrast Left
|
Facility
|
IP
|
$5,851.00
|
|
|
Service Code
|
CPT 73223
|
| Hospital Charge Code |
630828
|
| Min. Negotiated Rate |
$2,866.99 |
| Max. Negotiated Rate |
$5,382.92 |
| Rate for Payer: Aetna Commercial |
$5,265.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,031.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,101.03
|
| Rate for Payer: Cash Price |
$1,755.30
|
| Rate for Payer: Cigna Commercial |
$5,382.92
|
| Rate for Payer: Health EOS Commercial |
$5,207.39
|
| Rate for Payer: HFN Commercial |
$5,382.92
|
| Rate for Payer: Multiplan Commercial |
$4,680.80
|
| Rate for Payer: NAPHCARE Commercial |
$3,510.60
|
| Rate for Payer: Preferred Network Access Commercial |
$5,382.92
|
| Rate for Payer: Quartz Beloit One Network |
$2,866.99
|
| Rate for Payer: Quartz Commercial |
$3,510.60
|
| Rate for Payer: WEA Trust Commercial |
$3,218.05
|
| Rate for Payer: WPS Commercial |
$4,333.84
|
|
|
MRI Elbow w/ + w/o Contrast Left
|
Professional
|
Both
|
$6,397.00
|
|
|
Service Code
|
CPT 73223 LT,TC
|
| Hospital Charge Code |
1611039
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,507.24 |
| Max. Negotiated Rate |
$6,077.15 |
| Rate for Payer: Aetna Commercial |
$6,077.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,501.42
|
| Rate for Payer: Cash Price |
$1,919.10
|
| Rate for Payer: Cash Price |
$1,919.10
|
| Rate for Payer: Cash Price |
$1,919.10
|
| Rate for Payer: Cigna Commercial |
$6,077.15
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$3,198.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,838.20
|
| Rate for Payer: Health EOS Commercial |
$5,821.27
|
| Rate for Payer: HFN Commercial |
$6,077.15
|
| 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 |
$5,117.60
|
| Rate for Payer: Preferred Network Access Commercial |
$6,077.15
|
| Rate for Payer: Quartz Beloit One Network |
$2,814.68
|
| Rate for Payer: Quartz Commercial |
$3,646.29
|
| Rate for Payer: The Alliance Commercial |
$3,198.50
|
| Rate for Payer: WEA Trust Commercial |
$3,518.35
|
| Rate for Payer: WPS Commercial |
$4,738.26
|
|
|
MRI Elbow w/ + w/o Contrast Right
|
Facility
|
IP
|
$5,851.00
|
|
|
Service Code
|
CPT 73223
|
| Hospital Charge Code |
630831
|
| Min. Negotiated Rate |
$2,866.99 |
| Max. Negotiated Rate |
$5,382.92 |
| Rate for Payer: Aetna Commercial |
$5,265.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,031.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,101.03
|
| Rate for Payer: Cash Price |
$1,755.30
|
| Rate for Payer: Cigna Commercial |
$5,382.92
|
| Rate for Payer: Health EOS Commercial |
$5,207.39
|
| Rate for Payer: HFN Commercial |
$5,382.92
|
| Rate for Payer: Multiplan Commercial |
$4,680.80
|
| Rate for Payer: NAPHCARE Commercial |
$3,510.60
|
| Rate for Payer: Preferred Network Access Commercial |
$5,382.92
|
| Rate for Payer: Quartz Beloit One Network |
$2,866.99
|
| Rate for Payer: Quartz Commercial |
$3,510.60
|
| Rate for Payer: WEA Trust Commercial |
$3,218.05
|
| Rate for Payer: WPS Commercial |
$4,333.84
|
|
|
MRI Elbow w/ + w/o Contrast Right
|
Facility
|
OP
|
$6,397.00
|
|
|
Service Code
|
CPT 73223 RT,TC
|
| Hospital Charge Code |
1611041
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$380.12 |
| Max. Negotiated Rate |
$5,885.24 |
| Rate for Payer: Aetna Commercial |
$5,757.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,501.42
|
| Rate for Payer: Aetna Managed Medicare |
$380.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,496.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,871.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,726.00
|
| Rate for Payer: Anthem Medicare Advantage |
$380.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,390.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$380.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$380.12
|
| Rate for Payer: Cash Price |
$1,919.10
|
| Rate for Payer: Cash Price |
$1,919.10
|
| Rate for Payer: Cash Price |
$1,919.10
|
| Rate for Payer: Cash Price |
$1,919.10
|
| Rate for Payer: Cigna Commercial |
$5,885.24
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$380.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,579.76
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$380.12
|
| Rate for Payer: Health EOS Commercial |
$5,693.33
|
| Rate for Payer: HFN Commercial |
$5,885.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,414.05
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$380.12
|
| Rate for Payer: Independent Care Health Plan Medicare |
$380.12
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$380.12
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$380.12
|
| Rate for Payer: Multiplan Commercial |
$5,117.60
|
| Rate for Payer: NAPHCARE Commercial |
$570.18
|
| Rate for Payer: Preferred Network Access Commercial |
$5,885.24
|
| Rate for Payer: Quartz Beloit One Network |
$3,134.53
|
| Rate for Payer: Quartz Commercial |
$4,158.05
|
| Rate for Payer: Quartz Medicare Advantage |
$380.12
|
| Rate for Payer: The Alliance Commercial |
$1,520.48
|
| Rate for Payer: United Healthcare Medicare Advantage |
$380.12
|
| Rate for Payer: United Healthcare PPO |
$3,022.00
|
| Rate for Payer: WEA Trust Commercial |
$3,518.35
|
| Rate for Payer: Wellcare Medicare |
$380.12
|
| Rate for Payer: WPS Commercial |
$4,738.26
|
|
|
MRI Elbow w/ + w/o Contrast Right
|
Professional
|
Both
|
$6,397.00
|
|
|
Service Code
|
CPT 73223 TC,RT
|
| Hospital Charge Code |
2980047
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,507.24 |
| Max. Negotiated Rate |
$6,077.15 |
| Rate for Payer: Aetna Commercial |
$6,077.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,501.42
|
| Rate for Payer: Cash Price |
$1,919.10
|
| Rate for Payer: Cash Price |
$1,919.10
|
| Rate for Payer: Cash Price |
$1,919.10
|
| Rate for Payer: Cigna Commercial |
$6,077.15
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$3,198.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,838.20
|
| Rate for Payer: Health EOS Commercial |
$5,821.27
|
| Rate for Payer: HFN Commercial |
$6,077.15
|
| 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 |
$5,117.60
|
| Rate for Payer: Preferred Network Access Commercial |
$6,077.15
|
| Rate for Payer: Quartz Beloit One Network |
$2,814.68
|
| Rate for Payer: Quartz Commercial |
$3,646.29
|
| Rate for Payer: The Alliance Commercial |
$3,198.50
|
| Rate for Payer: WEA Trust Commercial |
$3,518.35
|
| Rate for Payer: WPS Commercial |
$4,738.26
|
|
|
MRI Elbow w/ + w/o Contrast Right
|
Facility
|
OP
|
$6,397.00
|
|
|
Service Code
|
CPT 73223 TC,RT
|
| Hospital Charge Code |
2980047
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$380.12 |
| Max. Negotiated Rate |
$5,885.24 |
| Rate for Payer: Aetna Commercial |
$5,757.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,501.42
|
| Rate for Payer: Aetna Managed Medicare |
$380.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,496.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,871.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,726.00
|
| Rate for Payer: Anthem Medicare Advantage |
$380.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,390.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$380.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$380.12
|
| Rate for Payer: Cash Price |
$1,919.10
|
| Rate for Payer: Cash Price |
$1,919.10
|
| Rate for Payer: Cash Price |
$1,919.10
|
| Rate for Payer: Cash Price |
$1,919.10
|
| Rate for Payer: Cigna Commercial |
$5,885.24
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$380.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,579.76
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$380.12
|
| Rate for Payer: Health EOS Commercial |
$5,693.33
|
| Rate for Payer: HFN Commercial |
$5,885.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,414.05
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$380.12
|
| Rate for Payer: Independent Care Health Plan Medicare |
$380.12
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$380.12
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$380.12
|
| Rate for Payer: Multiplan Commercial |
$5,117.60
|
| Rate for Payer: NAPHCARE Commercial |
$570.18
|
| Rate for Payer: Preferred Network Access Commercial |
$5,885.24
|
| Rate for Payer: Quartz Beloit One Network |
$3,134.53
|
| Rate for Payer: Quartz Commercial |
$4,158.05
|
| Rate for Payer: Quartz Medicare Advantage |
$380.12
|
| Rate for Payer: The Alliance Commercial |
$1,520.48
|
| Rate for Payer: United Healthcare Medicare Advantage |
$380.12
|
| Rate for Payer: United Healthcare PPO |
$3,022.00
|
| Rate for Payer: WEA Trust Commercial |
$3,518.35
|
| Rate for Payer: Wellcare Medicare |
$380.12
|
| Rate for Payer: WPS Commercial |
$4,738.26
|
|
|
MRI Elbow w/ + w/o Contrast Right
|
Facility
|
IP
|
$6,397.00
|
|
|
Service Code
|
CPT 73223 RT,TC
|
| Hospital Charge Code |
1611041
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$3,134.53 |
| Max. Negotiated Rate |
$5,885.24 |
| Rate for Payer: Aetna Commercial |
$5,757.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,501.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,390.41
|
| Rate for Payer: Cash Price |
$1,919.10
|
| Rate for Payer: Cigna Commercial |
$5,885.24
|
| Rate for Payer: Health EOS Commercial |
$5,693.33
|
| Rate for Payer: HFN Commercial |
$5,885.24
|
| Rate for Payer: Multiplan Commercial |
$5,117.60
|
| Rate for Payer: NAPHCARE Commercial |
$3,838.20
|
| Rate for Payer: Preferred Network Access Commercial |
$5,885.24
|
| Rate for Payer: Quartz Beloit One Network |
$3,134.53
|
| Rate for Payer: Quartz Commercial |
$3,838.20
|
| Rate for Payer: WEA Trust Commercial |
$3,518.35
|
| Rate for Payer: WPS Commercial |
$4,738.26
|
|
|
MRI Elbow w/ + w/o Contrast Right
|
Professional
|
Both
|
$5,851.00
|
|
|
Service Code
|
CPT 73223
|
| Hospital Charge Code |
630831
|
| Min. Negotiated Rate |
$1,507.24 |
| Max. Negotiated Rate |
$5,558.45 |
| Rate for Payer: Aetna Commercial |
$5,558.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,031.86
|
| Rate for Payer: Cash Price |
$1,755.30
|
| Rate for Payer: Cash Price |
$1,755.30
|
| Rate for Payer: Cash Price |
$1,755.30
|
| Rate for Payer: Cigna Commercial |
$5,558.45
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,925.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,510.60
|
| Rate for Payer: Health EOS Commercial |
$5,324.41
|
| Rate for Payer: HFN Commercial |
$5,558.45
|
| 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 |
$4,680.80
|
| Rate for Payer: Preferred Network Access Commercial |
$5,558.45
|
| Rate for Payer: Quartz Beloit One Network |
$2,574.44
|
| Rate for Payer: Quartz Commercial |
$3,335.07
|
| Rate for Payer: The Alliance Commercial |
$2,925.50
|
| Rate for Payer: WEA Trust Commercial |
$3,218.05
|
| Rate for Payer: WPS Commercial |
$4,333.84
|
|
|
MRI Elbow w/ + w/o Contrast Right
|
Facility
|
OP
|
$5,851.00
|
|
|
Service Code
|
CPT 73223
|
| Hospital Charge Code |
630831
|
| Min. Negotiated Rate |
$380.12 |
| Max. Negotiated Rate |
$5,382.92 |
| Rate for Payer: Aetna Commercial |
$5,265.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,031.86
|
| Rate for Payer: Aetna Managed Medicare |
$380.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,803.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,925.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,808.48
|
| Rate for Payer: Anthem Medicare Advantage |
$380.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,101.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$380.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$380.12
|
| Rate for Payer: Cash Price |
$1,755.30
|
| Rate for Payer: Cash Price |
$1,755.30
|
| Rate for Payer: Cigna Commercial |
$5,382.92
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$380.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,274.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$380.12
|
| Rate for Payer: Health EOS Commercial |
$5,207.39
|
| Rate for Payer: HFN Commercial |
$5,382.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,414.05
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$380.12
|
| Rate for Payer: Independent Care Health Plan Medicare |
$380.12
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$380.12
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$380.12
|
| Rate for Payer: Multiplan Commercial |
$4,680.80
|
| Rate for Payer: NAPHCARE Commercial |
$570.18
|
| Rate for Payer: Preferred Network Access Commercial |
$5,382.92
|
| Rate for Payer: Quartz Beloit One Network |
$2,866.99
|
| Rate for Payer: Quartz Commercial |
$3,803.15
|
| Rate for Payer: Quartz Medicare Advantage |
$380.12
|
| Rate for Payer: The Alliance Commercial |
$1,520.48
|
| Rate for Payer: United Healthcare Medicare Advantage |
$380.12
|
| Rate for Payer: WEA Trust Commercial |
$3,218.05
|
| Rate for Payer: Wellcare Medicare |
$380.12
|
| Rate for Payer: WPS Commercial |
$4,333.84
|
|
|
MRI Elbow w/ + w/o Contrast Right
|
Facility
|
IP
|
$6,397.00
|
|
|
Service Code
|
CPT 73223 TC,RT
|
| Hospital Charge Code |
2980047
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$3,134.53 |
| Max. Negotiated Rate |
$5,885.24 |
| Rate for Payer: Aetna Commercial |
$5,757.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,501.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,390.41
|
| Rate for Payer: Cash Price |
$1,919.10
|
| Rate for Payer: Cigna Commercial |
$5,885.24
|
| Rate for Payer: Health EOS Commercial |
$5,693.33
|
| Rate for Payer: HFN Commercial |
$5,885.24
|
| Rate for Payer: Multiplan Commercial |
$5,117.60
|
| Rate for Payer: NAPHCARE Commercial |
$3,838.20
|
| Rate for Payer: Preferred Network Access Commercial |
$5,885.24
|
| Rate for Payer: Quartz Beloit One Network |
$3,134.53
|
| Rate for Payer: Quartz Commercial |
$3,838.20
|
| Rate for Payer: WEA Trust Commercial |
$3,518.35
|
| Rate for Payer: WPS Commercial |
$4,738.26
|
|
|
MRI Elbow w/ + w/o Contrast Right
|
Professional
|
Both
|
$6,397.00
|
|
|
Service Code
|
CPT 73223 RT,TC
|
| Hospital Charge Code |
1611041
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,507.24 |
| Max. Negotiated Rate |
$6,077.15 |
| Rate for Payer: Aetna Commercial |
$6,077.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,501.42
|
| Rate for Payer: Cash Price |
$1,919.10
|
| Rate for Payer: Cash Price |
$1,919.10
|
| Rate for Payer: Cash Price |
$1,919.10
|
| Rate for Payer: Cigna Commercial |
$6,077.15
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$3,198.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,838.20
|
| Rate for Payer: Health EOS Commercial |
$5,821.27
|
| Rate for Payer: HFN Commercial |
$6,077.15
|
| 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 |
$5,117.60
|
| Rate for Payer: Preferred Network Access Commercial |
$6,077.15
|
| Rate for Payer: Quartz Beloit One Network |
$2,814.68
|
| Rate for Payer: Quartz Commercial |
$3,646.29
|
| Rate for Payer: The Alliance Commercial |
$3,198.50
|
| Rate for Payer: WEA Trust Commercial |
$3,518.35
|
| Rate for Payer: WPS Commercial |
$4,738.26
|
|
|
MRI Face Neck Orbit w/ Contrast
|
Facility
|
IP
|
$6,951.00
|
|
|
Service Code
|
CPT 70542
|
| Hospital Charge Code |
630857
|
| Min. Negotiated Rate |
$3,405.99 |
| Max. Negotiated Rate |
$6,394.92 |
| Rate for Payer: Aetna Commercial |
$6,255.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,977.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,684.03
|
| Rate for Payer: Cash Price |
$2,085.30
|
| Rate for Payer: Cigna Commercial |
$6,394.92
|
| Rate for Payer: Health EOS Commercial |
$6,186.39
|
| Rate for Payer: HFN Commercial |
$6,394.92
|
| Rate for Payer: Multiplan Commercial |
$5,560.80
|
| Rate for Payer: NAPHCARE Commercial |
$4,170.60
|
| Rate for Payer: Preferred Network Access Commercial |
$6,394.92
|
| Rate for Payer: Quartz Beloit One Network |
$3,405.99
|
| Rate for Payer: Quartz Commercial |
$4,170.60
|
| Rate for Payer: WEA Trust Commercial |
$3,823.05
|
| Rate for Payer: WPS Commercial |
$5,148.61
|
|
|
MRI Face Neck Orbit w/ Contrast
|
Facility
|
IP
|
$6,820.00
|
|
|
Service Code
|
CPT 70542 TC
|
| Hospital Charge Code |
1611057
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$3,341.80 |
| Max. Negotiated Rate |
$6,274.40 |
| Rate for Payer: Aetna Commercial |
$6,138.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,865.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,614.60
|
| Rate for Payer: Cash Price |
$2,046.00
|
| Rate for Payer: Cigna Commercial |
$6,274.40
|
| Rate for Payer: Health EOS Commercial |
$6,069.80
|
| Rate for Payer: HFN Commercial |
$6,274.40
|
| Rate for Payer: Multiplan Commercial |
$5,456.00
|
| Rate for Payer: NAPHCARE Commercial |
$4,092.00
|
| Rate for Payer: Preferred Network Access Commercial |
$6,274.40
|
| Rate for Payer: Quartz Beloit One Network |
$3,341.80
|
| Rate for Payer: Quartz Commercial |
$4,092.00
|
| Rate for Payer: WEA Trust Commercial |
$3,751.00
|
| Rate for Payer: WPS Commercial |
$5,051.57
|
|
|
MRI Face Neck Orbit w/ Contrast
|
Professional
|
Both
|
$6,820.00
|
|
|
Service Code
|
CPT 70542 TC
|
| Hospital Charge Code |
1611057
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$760.72 |
| Max. Negotiated Rate |
$6,479.00 |
| Rate for Payer: Aetna Commercial |
$6,479.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,865.20
|
| Rate for Payer: Cash Price |
$2,046.00
|
| Rate for Payer: Cash Price |
$2,046.00
|
| Rate for Payer: Cash Price |
$2,046.00
|
| Rate for Payer: Cigna Commercial |
$6,479.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$3,410.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,092.00
|
| Rate for Payer: Health EOS Commercial |
$6,206.20
|
| Rate for Payer: HFN Commercial |
$6,479.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$760.72
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$760.72
|
| Rate for Payer: Multiplan Commercial |
$5,456.00
|
| Rate for Payer: Preferred Network Access Commercial |
$6,479.00
|
| Rate for Payer: Quartz Beloit One Network |
$3,000.80
|
| Rate for Payer: Quartz Commercial |
$3,887.40
|
| Rate for Payer: The Alliance Commercial |
$3,410.00
|
| Rate for Payer: WEA Trust Commercial |
$3,751.00
|
| Rate for Payer: WPS Commercial |
$5,051.57
|
|
|
MRI Face Neck Orbit w/ Contrast
|
Professional
|
Both
|
$6,951.00
|
|
|
Service Code
|
CPT 70542
|
| Hospital Charge Code |
630857
|
| Min. Negotiated Rate |
$1,032.00 |
| Max. Negotiated Rate |
$6,603.45 |
| Rate for Payer: Aetna Commercial |
$6,603.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,977.86
|
| Rate for Payer: Cash Price |
$2,085.30
|
| Rate for Payer: Cash Price |
$2,085.30
|
| Rate for Payer: Cash Price |
$2,085.30
|
| Rate for Payer: Cigna Commercial |
$6,603.45
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$3,475.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,170.60
|
| Rate for Payer: Health EOS Commercial |
$6,325.41
|
| Rate for Payer: HFN Commercial |
$6,603.45
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,032.00
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,032.00
|
| Rate for Payer: Multiplan Commercial |
$5,560.80
|
| Rate for Payer: Preferred Network Access Commercial |
$6,603.45
|
| Rate for Payer: Quartz Beloit One Network |
$3,058.44
|
| Rate for Payer: Quartz Commercial |
$3,962.07
|
| Rate for Payer: The Alliance Commercial |
$3,475.50
|
| Rate for Payer: WEA Trust Commercial |
$3,823.05
|
| Rate for Payer: WPS Commercial |
$5,148.61
|
|
|
MRI Face Neck Orbit w/ Contrast
|
Facility
|
OP
|
$6,951.00
|
|
|
Service Code
|
CPT 70542
|
| Hospital Charge Code |
630857
|
| Min. Negotiated Rate |
$380.12 |
| Max. Negotiated Rate |
$6,394.92 |
| Rate for Payer: Aetna Commercial |
$6,255.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,977.86
|
| Rate for Payer: Aetna Managed Medicare |
$380.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,518.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,475.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,336.48
|
| Rate for Payer: Anthem Medicare Advantage |
$380.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,684.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$380.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$380.12
|
| Rate for Payer: Cash Price |
$2,085.30
|
| Rate for Payer: Cash Price |
$2,085.30
|
| Rate for Payer: Cigna Commercial |
$6,394.92
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$380.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,889.78
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$380.12
|
| Rate for Payer: Health EOS Commercial |
$6,186.39
|
| Rate for Payer: HFN Commercial |
$6,394.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,414.05
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$380.12
|
| Rate for Payer: Independent Care Health Plan Medicare |
$380.12
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$380.12
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$380.12
|
| Rate for Payer: Multiplan Commercial |
$5,560.80
|
| Rate for Payer: NAPHCARE Commercial |
$570.18
|
| Rate for Payer: Preferred Network Access Commercial |
$6,394.92
|
| Rate for Payer: Quartz Beloit One Network |
$3,405.99
|
| Rate for Payer: Quartz Commercial |
$4,518.15
|
| Rate for Payer: Quartz Medicare Advantage |
$380.12
|
| Rate for Payer: The Alliance Commercial |
$1,520.48
|
| Rate for Payer: United Healthcare Medicare Advantage |
$380.12
|
| Rate for Payer: WEA Trust Commercial |
$3,823.05
|
| Rate for Payer: Wellcare Medicare |
$380.12
|
| Rate for Payer: WPS Commercial |
$5,148.61
|
|
|
MRI Face Neck Orbit w/ Contrast
|
Facility
|
OP
|
$6,820.00
|
|
|
Service Code
|
CPT 70542 TC
|
| Hospital Charge Code |
1611057
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$380.12 |
| Max. Negotiated Rate |
$6,274.40 |
| Rate for Payer: Aetna Commercial |
$6,138.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,865.20
|
| Rate for Payer: Aetna Managed Medicare |
$380.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,496.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,871.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,726.00
|
| Rate for Payer: Anthem Medicare Advantage |
$380.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,614.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$380.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$380.12
|
| Rate for Payer: Cash Price |
$2,046.00
|
| Rate for Payer: Cash Price |
$2,046.00
|
| Rate for Payer: Cash Price |
$2,046.00
|
| Rate for Payer: Cash Price |
$2,046.00
|
| Rate for Payer: Cigna Commercial |
$6,274.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$380.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,816.47
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$380.12
|
| Rate for Payer: Health EOS Commercial |
$6,069.80
|
| Rate for Payer: HFN Commercial |
$6,274.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,414.05
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$380.12
|
| Rate for Payer: Independent Care Health Plan Medicare |
$380.12
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$380.12
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$380.12
|
| Rate for Payer: Multiplan Commercial |
$5,456.00
|
| Rate for Payer: NAPHCARE Commercial |
$570.18
|
| Rate for Payer: Preferred Network Access Commercial |
$6,274.40
|
| Rate for Payer: Quartz Beloit One Network |
$3,341.80
|
| Rate for Payer: Quartz Commercial |
$4,433.00
|
| Rate for Payer: Quartz Medicare Advantage |
$380.12
|
| Rate for Payer: The Alliance Commercial |
$1,520.48
|
| Rate for Payer: United Healthcare Medicare Advantage |
$380.12
|
| Rate for Payer: United Healthcare PPO |
$3,022.00
|
| Rate for Payer: WEA Trust Commercial |
$3,751.00
|
| Rate for Payer: Wellcare Medicare |
$380.12
|
| Rate for Payer: WPS Commercial |
$5,051.57
|
|
