|
MRI Hip w/ + w/o Contrast Right
|
Facility
|
IP
|
$5,965.00
|
|
|
Service Code
|
CPT 73723 TC,RT
|
| Hospital Charge Code |
3072752
|
|
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 Hip w/ + w/o Contrast Right
|
Facility
|
OP
|
$5,965.00
|
|
|
Service Code
|
CPT 73723 TC,RT
|
| Hospital Charge Code |
3072752
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$380.12 |
| 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 |
$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 |
$3,161.45
|
| 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 |
$1,789.50
|
| 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 |
$380.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,338.01
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$380.12
|
| 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 |
$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 |
$4,772.00
|
| Rate for Payer: NAPHCARE Commercial |
$570.18
|
| 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 |
$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 |
$3,280.75
|
| Rate for Payer: Wellcare Medicare |
$380.12
|
| Rate for Payer: WPS Commercial |
$4,418.28
|
|
|
MRI Hip w/ + w/o Contrast Right
|
Professional
|
Both
|
$6,295.00
|
|
|
Service Code
|
CPT 73723 TC,RT
|
| Hospital Charge Code |
1611139
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,502.58 |
| Max. Negotiated Rate |
$5,980.25 |
| Rate for Payer: Aetna Commercial |
$5,980.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,413.70
|
| Rate for Payer: Cash Price |
$1,888.50
|
| Rate for Payer: Cash Price |
$1,888.50
|
| Rate for Payer: Cash Price |
$1,888.50
|
| Rate for Payer: Cigna Commercial |
$5,980.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$3,147.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,777.00
|
| Rate for Payer: Health EOS Commercial |
$5,728.45
|
| Rate for Payer: HFN Commercial |
$5,980.25
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,502.58
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,502.58
|
| Rate for Payer: Multiplan Commercial |
$5,036.00
|
| Rate for Payer: Preferred Network Access Commercial |
$5,980.25
|
| Rate for Payer: Quartz Beloit One Network |
$2,769.80
|
| Rate for Payer: Quartz Commercial |
$3,588.15
|
| Rate for Payer: The Alliance Commercial |
$3,147.50
|
| Rate for Payer: WEA Trust Commercial |
$3,462.25
|
| Rate for Payer: WPS Commercial |
$4,662.71
|
|
|
MRI Hip w/ + w/o Contrast Right
|
Professional
|
Both
|
$6,080.00
|
|
|
Service Code
|
CPT 73723
|
| Hospital Charge Code |
630985
|
| Min. Negotiated Rate |
$1,502.58 |
| Max. Negotiated Rate |
$5,776.00 |
| Rate for Payer: Aetna Commercial |
$5,776.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,228.80
|
| Rate for Payer: Cash Price |
$1,824.00
|
| Rate for Payer: Cash Price |
$1,824.00
|
| Rate for Payer: Cash Price |
$1,824.00
|
| Rate for Payer: Cigna Commercial |
$5,776.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$3,040.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,648.00
|
| Rate for Payer: Health EOS Commercial |
$5,532.80
|
| Rate for Payer: HFN Commercial |
$5,776.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,502.58
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,502.58
|
| Rate for Payer: Multiplan Commercial |
$4,864.00
|
| Rate for Payer: Preferred Network Access Commercial |
$5,776.00
|
| Rate for Payer: Quartz Beloit One Network |
$2,675.20
|
| Rate for Payer: Quartz Commercial |
$3,465.60
|
| Rate for Payer: The Alliance Commercial |
$3,040.00
|
| Rate for Payer: WEA Trust Commercial |
$3,344.00
|
| Rate for Payer: WPS Commercial |
$4,503.46
|
|
|
MRI Hip w/ + w/o Contrast Right
|
Facility
|
IP
|
$6,080.00
|
|
|
Service Code
|
CPT 73723
|
| Hospital Charge Code |
630985
|
| Min. Negotiated Rate |
$2,979.20 |
| Max. Negotiated Rate |
$5,593.60 |
| Rate for Payer: Aetna Commercial |
$5,472.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,228.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,222.40
|
| Rate for Payer: Cash Price |
$1,824.00
|
| Rate for Payer: Cigna Commercial |
$5,593.60
|
| Rate for Payer: Health EOS Commercial |
$5,411.20
|
| Rate for Payer: HFN Commercial |
$5,593.60
|
| Rate for Payer: Multiplan Commercial |
$4,864.00
|
| Rate for Payer: NAPHCARE Commercial |
$3,648.00
|
| Rate for Payer: Preferred Network Access Commercial |
$5,593.60
|
| Rate for Payer: Quartz Beloit One Network |
$2,979.20
|
| Rate for Payer: Quartz Commercial |
$3,648.00
|
| Rate for Payer: WEA Trust Commercial |
$3,344.00
|
| Rate for Payer: WPS Commercial |
$4,503.46
|
|
|
MRI Humerus w/ Contrast Bilateral
|
Facility
|
OP
|
$10,322.00
|
|
|
Service Code
|
CPT 73219
|
| Hospital Charge Code |
631031
|
| Min. Negotiated Rate |
$380.12 |
| Max. Negotiated Rate |
$9,496.24 |
| Rate for Payer: Aetna Commercial |
$9,289.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,876.92
|
| Rate for Payer: Aetna Managed Medicare |
$380.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,709.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,161.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,954.56
|
| Rate for Payer: Anthem Medicare Advantage |
$380.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,470.66
|
| 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 |
$3,096.60
|
| Rate for Payer: Cash Price |
$3,096.60
|
| Rate for Payer: Cigna Commercial |
$9,496.24
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$380.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,776.19
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$380.12
|
| Rate for Payer: Health EOS Commercial |
$9,186.58
|
| Rate for Payer: HFN Commercial |
$9,496.24
|
| 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 |
$8,257.60
|
| Rate for Payer: NAPHCARE Commercial |
$570.18
|
| Rate for Payer: Preferred Network Access Commercial |
$9,496.24
|
| Rate for Payer: Quartz Beloit One Network |
$5,057.78
|
| Rate for Payer: Quartz Commercial |
$6,709.30
|
| 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 |
$5,677.10
|
| Rate for Payer: Wellcare Medicare |
$380.12
|
| Rate for Payer: WPS Commercial |
$7,645.51
|
|
|
MRI Humerus w/ Contrast Bilateral
|
Facility
|
OP
|
$5,063.00
|
|
|
Service Code
|
CPT 73219 TC,LT
|
| Hospital Charge Code |
1611159
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$380.12 |
| Max. Negotiated Rate |
$4,657.96 |
| Rate for Payer: Aetna Commercial |
$4,556.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,354.18
|
| Rate for Payer: Aetna Managed Medicare |
$380.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,496.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,871.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,726.00
|
| Rate for Payer: Anthem Medicare Advantage |
$380.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,683.39
|
| 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 |
$1,518.90
|
| Rate for Payer: Cash Price |
$1,518.90
|
| Rate for Payer: Cash Price |
$1,518.90
|
| Rate for Payer: Cash Price |
$1,518.90
|
| Rate for Payer: Cigna Commercial |
$4,657.96
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$380.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,833.25
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$380.12
|
| Rate for Payer: Health EOS Commercial |
$4,506.07
|
| Rate for Payer: HFN Commercial |
$4,657.96
|
| 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 |
$4,050.40
|
| Rate for Payer: NAPHCARE Commercial |
$570.18
|
| Rate for Payer: Preferred Network Access Commercial |
$4,657.96
|
| Rate for Payer: Quartz Beloit One Network |
$2,480.87
|
| Rate for Payer: Quartz Commercial |
$3,290.95
|
| 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: United Healthcare PPO |
$3,022.00
|
| Rate for Payer: WEA Trust Commercial |
$2,784.65
|
| Rate for Payer: Wellcare Medicare |
$380.12
|
| Rate for Payer: WPS Commercial |
$3,750.16
|
|
|
MRI Humerus w/ Contrast Bilateral
|
Facility
|
IP
|
$5,063.00
|
|
|
Service Code
|
CPT 73219 TC,LT
|
| Hospital Charge Code |
1611159
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$2,480.87 |
| Max. Negotiated Rate |
$4,657.96 |
| Rate for Payer: Aetna Commercial |
$4,556.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,354.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,683.39
|
| Rate for Payer: Cash Price |
$1,518.90
|
| Rate for Payer: Cigna Commercial |
$4,657.96
|
| Rate for Payer: Health EOS Commercial |
$4,506.07
|
| Rate for Payer: HFN Commercial |
$4,657.96
|
| Rate for Payer: Multiplan Commercial |
$4,050.40
|
| Rate for Payer: NAPHCARE Commercial |
$3,037.80
|
| Rate for Payer: Preferred Network Access Commercial |
$4,657.96
|
| Rate for Payer: Quartz Beloit One Network |
$2,480.87
|
| Rate for Payer: Quartz Commercial |
$3,037.80
|
| Rate for Payer: WEA Trust Commercial |
$2,784.65
|
| Rate for Payer: WPS Commercial |
$3,750.16
|
|
|
MRI Humerus w/ Contrast Bilateral
|
Facility
|
IP
|
$10,322.00
|
|
|
Service Code
|
CPT 73219
|
| Hospital Charge Code |
631031
|
| Min. Negotiated Rate |
$5,057.78 |
| Max. Negotiated Rate |
$9,496.24 |
| Rate for Payer: Aetna Commercial |
$9,289.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,876.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,470.66
|
| Rate for Payer: Cash Price |
$3,096.60
|
| Rate for Payer: Cigna Commercial |
$9,496.24
|
| Rate for Payer: Health EOS Commercial |
$9,186.58
|
| Rate for Payer: HFN Commercial |
$9,496.24
|
| Rate for Payer: Multiplan Commercial |
$8,257.60
|
| Rate for Payer: NAPHCARE Commercial |
$6,193.20
|
| Rate for Payer: Preferred Network Access Commercial |
$9,496.24
|
| Rate for Payer: Quartz Beloit One Network |
$5,057.78
|
| Rate for Payer: Quartz Commercial |
$6,193.20
|
| Rate for Payer: WEA Trust Commercial |
$5,677.10
|
| Rate for Payer: WPS Commercial |
$7,645.51
|
|
|
MRI Humerus w/ Contrast Bilateral
|
Professional
|
Both
|
$10,322.00
|
|
|
Service Code
|
CPT 73219
|
| Hospital Charge Code |
631031
|
| Min. Negotiated Rate |
$1,288.41 |
| Max. Negotiated Rate |
$9,805.90 |
| Rate for Payer: Aetna Commercial |
$9,805.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,876.92
|
| Rate for Payer: Cash Price |
$3,096.60
|
| Rate for Payer: Cash Price |
$3,096.60
|
| Rate for Payer: Cash Price |
$3,096.60
|
| Rate for Payer: Cigna Commercial |
$9,805.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$5,161.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,193.20
|
| Rate for Payer: Health EOS Commercial |
$9,393.02
|
| Rate for Payer: HFN Commercial |
$9,805.90
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,288.41
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,288.41
|
| Rate for Payer: Multiplan Commercial |
$8,257.60
|
| Rate for Payer: Preferred Network Access Commercial |
$9,805.90
|
| Rate for Payer: Quartz Beloit One Network |
$4,541.68
|
| Rate for Payer: Quartz Commercial |
$5,883.54
|
| Rate for Payer: The Alliance Commercial |
$5,161.00
|
| Rate for Payer: WEA Trust Commercial |
$5,677.10
|
| Rate for Payer: WPS Commercial |
$7,645.51
|
|
|
MRI Humerus w/ Contrast Bilateral
|
Professional
|
Both
|
$5,063.00
|
|
|
Service Code
|
CPT 73219 TC,LT
|
| Hospital Charge Code |
1611159
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,288.41 |
| Max. Negotiated Rate |
$4,809.85 |
| Rate for Payer: Aetna Commercial |
$4,809.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,354.18
|
| Rate for Payer: Cash Price |
$1,518.90
|
| Rate for Payer: Cash Price |
$1,518.90
|
| Rate for Payer: Cash Price |
$1,518.90
|
| Rate for Payer: Cigna Commercial |
$4,809.85
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,531.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,037.80
|
| Rate for Payer: Health EOS Commercial |
$4,607.33
|
| Rate for Payer: HFN Commercial |
$4,809.85
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,288.41
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,288.41
|
| Rate for Payer: Multiplan Commercial |
$4,050.40
|
| Rate for Payer: Preferred Network Access Commercial |
$4,809.85
|
| Rate for Payer: Quartz Beloit One Network |
$2,227.72
|
| Rate for Payer: Quartz Commercial |
$2,885.91
|
| Rate for Payer: The Alliance Commercial |
$2,531.50
|
| Rate for Payer: WEA Trust Commercial |
$2,784.65
|
| Rate for Payer: WPS Commercial |
$3,750.16
|
|
|
MRI Humerus w/ Contrast Left
|
Facility
|
OP
|
$5,063.00
|
|
|
Service Code
|
CPT 73219 TC,LT
|
| Hospital Charge Code |
1611161
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$380.12 |
| Max. Negotiated Rate |
$4,657.96 |
| Rate for Payer: Aetna Commercial |
$4,556.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,354.18
|
| Rate for Payer: Aetna Managed Medicare |
$380.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,496.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,871.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,726.00
|
| Rate for Payer: Anthem Medicare Advantage |
$380.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,683.39
|
| 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 |
$1,518.90
|
| Rate for Payer: Cash Price |
$1,518.90
|
| Rate for Payer: Cash Price |
$1,518.90
|
| Rate for Payer: Cash Price |
$1,518.90
|
| Rate for Payer: Cigna Commercial |
$4,657.96
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$380.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,833.25
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$380.12
|
| Rate for Payer: Health EOS Commercial |
$4,506.07
|
| Rate for Payer: HFN Commercial |
$4,657.96
|
| 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 |
$4,050.40
|
| Rate for Payer: NAPHCARE Commercial |
$570.18
|
| Rate for Payer: Preferred Network Access Commercial |
$4,657.96
|
| Rate for Payer: Quartz Beloit One Network |
$2,480.87
|
| Rate for Payer: Quartz Commercial |
$3,290.95
|
| 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: United Healthcare PPO |
$3,022.00
|
| Rate for Payer: WEA Trust Commercial |
$2,784.65
|
| Rate for Payer: Wellcare Medicare |
$380.12
|
| Rate for Payer: WPS Commercial |
$3,750.16
|
|
|
MRI Humerus w/ Contrast Left
|
Facility
|
OP
|
$5,162.00
|
|
|
Service Code
|
CPT 73219
|
| Hospital Charge Code |
631033
|
| Min. Negotiated Rate |
$380.12 |
| Max. Negotiated Rate |
$4,749.04 |
| Rate for Payer: Aetna Commercial |
$4,645.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,439.32
|
| Rate for Payer: Aetna Managed Medicare |
$380.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,355.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,581.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,477.76
|
| Rate for Payer: Anthem Medicare Advantage |
$380.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,735.86
|
| 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 |
$1,548.60
|
| Rate for Payer: Cash Price |
$1,548.60
|
| Rate for Payer: Cigna Commercial |
$4,749.04
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$380.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,888.66
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$380.12
|
| Rate for Payer: Health EOS Commercial |
$4,594.18
|
| Rate for Payer: HFN Commercial |
$4,749.04
|
| 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 |
$4,129.60
|
| Rate for Payer: NAPHCARE Commercial |
$570.18
|
| Rate for Payer: Preferred Network Access Commercial |
$4,749.04
|
| Rate for Payer: Quartz Beloit One Network |
$2,529.38
|
| Rate for Payer: Quartz Commercial |
$3,355.30
|
| 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 |
$2,839.10
|
| Rate for Payer: Wellcare Medicare |
$380.12
|
| Rate for Payer: WPS Commercial |
$3,823.49
|
|
|
MRI Humerus w/ Contrast Left
|
Facility
|
IP
|
$5,162.00
|
|
|
Service Code
|
CPT 73219
|
| Hospital Charge Code |
631033
|
| Min. Negotiated Rate |
$2,529.38 |
| Max. Negotiated Rate |
$4,749.04 |
| Rate for Payer: Aetna Commercial |
$4,645.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,439.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,735.86
|
| Rate for Payer: Cash Price |
$1,548.60
|
| Rate for Payer: Cigna Commercial |
$4,749.04
|
| Rate for Payer: Health EOS Commercial |
$4,594.18
|
| Rate for Payer: HFN Commercial |
$4,749.04
|
| Rate for Payer: Multiplan Commercial |
$4,129.60
|
| Rate for Payer: NAPHCARE Commercial |
$3,097.20
|
| Rate for Payer: Preferred Network Access Commercial |
$4,749.04
|
| Rate for Payer: Quartz Beloit One Network |
$2,529.38
|
| Rate for Payer: Quartz Commercial |
$3,097.20
|
| Rate for Payer: WEA Trust Commercial |
$2,839.10
|
| Rate for Payer: WPS Commercial |
$3,823.49
|
|
|
MRI Humerus w/ Contrast Left
|
Professional
|
Both
|
$5,063.00
|
|
|
Service Code
|
CPT 73219 TC,LT
|
| Hospital Charge Code |
1611161
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,288.41 |
| Max. Negotiated Rate |
$4,809.85 |
| Rate for Payer: Aetna Commercial |
$4,809.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,354.18
|
| Rate for Payer: Cash Price |
$1,518.90
|
| Rate for Payer: Cash Price |
$1,518.90
|
| Rate for Payer: Cash Price |
$1,518.90
|
| Rate for Payer: Cigna Commercial |
$4,809.85
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,531.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,037.80
|
| Rate for Payer: Health EOS Commercial |
$4,607.33
|
| Rate for Payer: HFN Commercial |
$4,809.85
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,288.41
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,288.41
|
| Rate for Payer: Multiplan Commercial |
$4,050.40
|
| Rate for Payer: Preferred Network Access Commercial |
$4,809.85
|
| Rate for Payer: Quartz Beloit One Network |
$2,227.72
|
| Rate for Payer: Quartz Commercial |
$2,885.91
|
| Rate for Payer: The Alliance Commercial |
$2,531.50
|
| Rate for Payer: WEA Trust Commercial |
$2,784.65
|
| Rate for Payer: WPS Commercial |
$3,750.16
|
|
|
MRI Humerus w/ Contrast Left
|
Facility
|
IP
|
$5,063.00
|
|
|
Service Code
|
CPT 73219 TC,LT
|
| Hospital Charge Code |
1611161
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$2,480.87 |
| Max. Negotiated Rate |
$4,657.96 |
| Rate for Payer: Aetna Commercial |
$4,556.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,354.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,683.39
|
| Rate for Payer: Cash Price |
$1,518.90
|
| Rate for Payer: Cigna Commercial |
$4,657.96
|
| Rate for Payer: Health EOS Commercial |
$4,506.07
|
| Rate for Payer: HFN Commercial |
$4,657.96
|
| Rate for Payer: Multiplan Commercial |
$4,050.40
|
| Rate for Payer: NAPHCARE Commercial |
$3,037.80
|
| Rate for Payer: Preferred Network Access Commercial |
$4,657.96
|
| Rate for Payer: Quartz Beloit One Network |
$2,480.87
|
| Rate for Payer: Quartz Commercial |
$3,037.80
|
| Rate for Payer: WEA Trust Commercial |
$2,784.65
|
| Rate for Payer: WPS Commercial |
$3,750.16
|
|
|
MRI Humerus w/ Contrast Left
|
Professional
|
Both
|
$5,162.00
|
|
|
Service Code
|
CPT 73219
|
| Hospital Charge Code |
631033
|
| Min. Negotiated Rate |
$1,288.41 |
| Max. Negotiated Rate |
$4,903.90 |
| Rate for Payer: Aetna Commercial |
$4,903.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,439.32
|
| Rate for Payer: Cash Price |
$1,548.60
|
| Rate for Payer: Cash Price |
$1,548.60
|
| Rate for Payer: Cash Price |
$1,548.60
|
| Rate for Payer: Cigna Commercial |
$4,903.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,581.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,097.20
|
| Rate for Payer: Health EOS Commercial |
$4,697.42
|
| Rate for Payer: HFN Commercial |
$4,903.90
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,288.41
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,288.41
|
| Rate for Payer: Multiplan Commercial |
$4,129.60
|
| Rate for Payer: Preferred Network Access Commercial |
$4,903.90
|
| Rate for Payer: Quartz Beloit One Network |
$2,271.28
|
| Rate for Payer: Quartz Commercial |
$2,942.34
|
| Rate for Payer: The Alliance Commercial |
$2,581.00
|
| Rate for Payer: WEA Trust Commercial |
$2,839.10
|
| Rate for Payer: WPS Commercial |
$3,823.49
|
|
|
MRI Humerus w/ Contrast Right
|
Facility
|
IP
|
$5,162.00
|
|
|
Service Code
|
CPT 73219
|
| Hospital Charge Code |
631036
|
| Min. Negotiated Rate |
$2,529.38 |
| Max. Negotiated Rate |
$4,749.04 |
| Rate for Payer: Aetna Commercial |
$4,645.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,439.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,735.86
|
| Rate for Payer: Cash Price |
$1,548.60
|
| Rate for Payer: Cigna Commercial |
$4,749.04
|
| Rate for Payer: Health EOS Commercial |
$4,594.18
|
| Rate for Payer: HFN Commercial |
$4,749.04
|
| Rate for Payer: Multiplan Commercial |
$4,129.60
|
| Rate for Payer: NAPHCARE Commercial |
$3,097.20
|
| Rate for Payer: Preferred Network Access Commercial |
$4,749.04
|
| Rate for Payer: Quartz Beloit One Network |
$2,529.38
|
| Rate for Payer: Quartz Commercial |
$3,097.20
|
| Rate for Payer: WEA Trust Commercial |
$2,839.10
|
| Rate for Payer: WPS Commercial |
$3,823.49
|
|
|
MRI Humerus w/ Contrast Right
|
Professional
|
Both
|
$5,063.00
|
|
|
Service Code
|
CPT 73219 TC,RT
|
| Hospital Charge Code |
1611163
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,288.41 |
| Max. Negotiated Rate |
$4,809.85 |
| Rate for Payer: Aetna Commercial |
$4,809.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,354.18
|
| Rate for Payer: Cash Price |
$1,518.90
|
| Rate for Payer: Cash Price |
$1,518.90
|
| Rate for Payer: Cash Price |
$1,518.90
|
| Rate for Payer: Cigna Commercial |
$4,809.85
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,531.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,037.80
|
| Rate for Payer: Health EOS Commercial |
$4,607.33
|
| Rate for Payer: HFN Commercial |
$4,809.85
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,288.41
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,288.41
|
| Rate for Payer: Multiplan Commercial |
$4,050.40
|
| Rate for Payer: Preferred Network Access Commercial |
$4,809.85
|
| Rate for Payer: Quartz Beloit One Network |
$2,227.72
|
| Rate for Payer: Quartz Commercial |
$2,885.91
|
| Rate for Payer: The Alliance Commercial |
$2,531.50
|
| Rate for Payer: WEA Trust Commercial |
$2,784.65
|
| Rate for Payer: WPS Commercial |
$3,750.16
|
|
|
MRI Humerus w/ Contrast Right
|
Facility
|
OP
|
$5,063.00
|
|
|
Service Code
|
CPT 73219 TC,RT
|
| Hospital Charge Code |
1611163
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$380.12 |
| Max. Negotiated Rate |
$4,657.96 |
| Rate for Payer: Aetna Commercial |
$4,556.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,354.18
|
| Rate for Payer: Aetna Managed Medicare |
$380.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,496.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,871.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,726.00
|
| Rate for Payer: Anthem Medicare Advantage |
$380.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,683.39
|
| 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 |
$1,518.90
|
| Rate for Payer: Cash Price |
$1,518.90
|
| Rate for Payer: Cash Price |
$1,518.90
|
| Rate for Payer: Cash Price |
$1,518.90
|
| Rate for Payer: Cigna Commercial |
$4,657.96
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$380.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,833.25
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$380.12
|
| Rate for Payer: Health EOS Commercial |
$4,506.07
|
| Rate for Payer: HFN Commercial |
$4,657.96
|
| 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 |
$4,050.40
|
| Rate for Payer: NAPHCARE Commercial |
$570.18
|
| Rate for Payer: Preferred Network Access Commercial |
$4,657.96
|
| Rate for Payer: Quartz Beloit One Network |
$2,480.87
|
| Rate for Payer: Quartz Commercial |
$3,290.95
|
| 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: United Healthcare PPO |
$3,022.00
|
| Rate for Payer: WEA Trust Commercial |
$2,784.65
|
| Rate for Payer: Wellcare Medicare |
$380.12
|
| Rate for Payer: WPS Commercial |
$3,750.16
|
|
|
MRI Humerus w/ Contrast Right
|
Professional
|
Both
|
$5,063.00
|
|
|
Service Code
|
CPT 73219 TC,RT
|
| Hospital Charge Code |
2980033
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,288.41 |
| Max. Negotiated Rate |
$4,809.85 |
| Rate for Payer: Aetna Commercial |
$4,809.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,354.18
|
| Rate for Payer: Cash Price |
$1,518.90
|
| Rate for Payer: Cash Price |
$1,518.90
|
| Rate for Payer: Cash Price |
$1,518.90
|
| Rate for Payer: Cigna Commercial |
$4,809.85
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,531.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,037.80
|
| Rate for Payer: Health EOS Commercial |
$4,607.33
|
| Rate for Payer: HFN Commercial |
$4,809.85
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,288.41
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,288.41
|
| Rate for Payer: Multiplan Commercial |
$4,050.40
|
| Rate for Payer: Preferred Network Access Commercial |
$4,809.85
|
| Rate for Payer: Quartz Beloit One Network |
$2,227.72
|
| Rate for Payer: Quartz Commercial |
$2,885.91
|
| Rate for Payer: The Alliance Commercial |
$2,531.50
|
| Rate for Payer: WEA Trust Commercial |
$2,784.65
|
| Rate for Payer: WPS Commercial |
$3,750.16
|
|
|
MRI Humerus w/ Contrast Right
|
Facility
|
OP
|
$5,162.00
|
|
|
Service Code
|
CPT 73219
|
| Hospital Charge Code |
631036
|
| Min. Negotiated Rate |
$380.12 |
| Max. Negotiated Rate |
$4,749.04 |
| Rate for Payer: Aetna Commercial |
$4,645.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,439.32
|
| Rate for Payer: Aetna Managed Medicare |
$380.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,355.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,581.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,477.76
|
| Rate for Payer: Anthem Medicare Advantage |
$380.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,735.86
|
| 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 |
$1,548.60
|
| Rate for Payer: Cash Price |
$1,548.60
|
| Rate for Payer: Cigna Commercial |
$4,749.04
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$380.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,888.66
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$380.12
|
| Rate for Payer: Health EOS Commercial |
$4,594.18
|
| Rate for Payer: HFN Commercial |
$4,749.04
|
| 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 |
$4,129.60
|
| Rate for Payer: NAPHCARE Commercial |
$570.18
|
| Rate for Payer: Preferred Network Access Commercial |
$4,749.04
|
| Rate for Payer: Quartz Beloit One Network |
$2,529.38
|
| Rate for Payer: Quartz Commercial |
$3,355.30
|
| 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 |
$2,839.10
|
| Rate for Payer: Wellcare Medicare |
$380.12
|
| Rate for Payer: WPS Commercial |
$3,823.49
|
|
|
MRI Humerus w/ Contrast Right
|
Facility
|
IP
|
$5,063.00
|
|
|
Service Code
|
CPT 73219 TC,RT
|
| Hospital Charge Code |
2980033
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$2,480.87 |
| Max. Negotiated Rate |
$4,657.96 |
| Rate for Payer: Aetna Commercial |
$4,556.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,354.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,683.39
|
| Rate for Payer: Cash Price |
$1,518.90
|
| Rate for Payer: Cigna Commercial |
$4,657.96
|
| Rate for Payer: Health EOS Commercial |
$4,506.07
|
| Rate for Payer: HFN Commercial |
$4,657.96
|
| Rate for Payer: Multiplan Commercial |
$4,050.40
|
| Rate for Payer: NAPHCARE Commercial |
$3,037.80
|
| Rate for Payer: Preferred Network Access Commercial |
$4,657.96
|
| Rate for Payer: Quartz Beloit One Network |
$2,480.87
|
| Rate for Payer: Quartz Commercial |
$3,037.80
|
| Rate for Payer: WEA Trust Commercial |
$2,784.65
|
| Rate for Payer: WPS Commercial |
$3,750.16
|
|
|
MRI Humerus w/ Contrast Right
|
Professional
|
Both
|
$5,162.00
|
|
|
Service Code
|
CPT 73219
|
| Hospital Charge Code |
631036
|
| Min. Negotiated Rate |
$1,288.41 |
| Max. Negotiated Rate |
$4,903.90 |
| Rate for Payer: Aetna Commercial |
$4,903.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,439.32
|
| Rate for Payer: Cash Price |
$1,548.60
|
| Rate for Payer: Cash Price |
$1,548.60
|
| Rate for Payer: Cash Price |
$1,548.60
|
| Rate for Payer: Cigna Commercial |
$4,903.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,581.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,097.20
|
| Rate for Payer: Health EOS Commercial |
$4,697.42
|
| Rate for Payer: HFN Commercial |
$4,903.90
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,288.41
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,288.41
|
| Rate for Payer: Multiplan Commercial |
$4,129.60
|
| Rate for Payer: Preferred Network Access Commercial |
$4,903.90
|
| Rate for Payer: Quartz Beloit One Network |
$2,271.28
|
| Rate for Payer: Quartz Commercial |
$2,942.34
|
| Rate for Payer: The Alliance Commercial |
$2,581.00
|
| Rate for Payer: WEA Trust Commercial |
$2,839.10
|
| Rate for Payer: WPS Commercial |
$3,823.49
|
|
|
MRI Humerus w/ Contrast Right
|
Facility
|
IP
|
$5,063.00
|
|
|
Service Code
|
CPT 73219 TC,RT
|
| Hospital Charge Code |
1611163
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$2,480.87 |
| Max. Negotiated Rate |
$4,657.96 |
| Rate for Payer: Aetna Commercial |
$4,556.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,354.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,683.39
|
| Rate for Payer: Cash Price |
$1,518.90
|
| Rate for Payer: Cigna Commercial |
$4,657.96
|
| Rate for Payer: Health EOS Commercial |
$4,506.07
|
| Rate for Payer: HFN Commercial |
$4,657.96
|
| Rate for Payer: Multiplan Commercial |
$4,050.40
|
| Rate for Payer: NAPHCARE Commercial |
$3,037.80
|
| Rate for Payer: Preferred Network Access Commercial |
$4,657.96
|
| Rate for Payer: Quartz Beloit One Network |
$2,480.87
|
| Rate for Payer: Quartz Commercial |
$3,037.80
|
| Rate for Payer: WEA Trust Commercial |
$2,784.65
|
| Rate for Payer: WPS Commercial |
$3,750.16
|
|
