|
MRI Chest w/ Contrast
|
Facility
|
IP
|
$7,316.00
|
|
|
Service Code
|
CPT 71551 TC
|
| Hospital Charge Code |
1611027
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$3,728.23 |
| Max. Negotiated Rate |
$6,999.95 |
| Rate for Payer: Aetna Commercial |
$6,847.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,543.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,032.58
|
| Rate for Payer: Cash Price |
$2,194.80
|
| Rate for Payer: Cigna Commercial |
$6,999.95
|
| Rate for Payer: Health EOS Commercial |
$6,771.69
|
| Rate for Payer: HFN Commercial |
$6,999.95
|
| Rate for Payer: Multiplan Commercial |
$6,086.91
|
| Rate for Payer: Preferred Network Access Commercial |
$6,999.95
|
| Rate for Payer: Quartz Beloit One Network |
$3,728.23
|
| Rate for Payer: Quartz Commercial |
$4,565.18
|
| Rate for Payer: WEA Trust Commercial |
$4,184.75
|
| Rate for Payer: WPS Commercial |
$5,635.51
|
|
|
MRI Chest w/ Contrast
|
Professional
|
Both
|
$7,457.00
|
|
|
Service Code
|
CPT 71551
|
| Hospital Charge Code |
629710
|
| Min. Negotiated Rate |
$369.80 |
| Max. Negotiated Rate |
$7,367.52 |
| Rate for Payer: Aetna Commercial |
$7,367.52
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,669.54
|
| Rate for Payer: Aetna Managed Medicare |
$369.80
|
| Rate for Payer: Anthem Medicare Advantage |
$369.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$369.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$369.80
|
| Rate for Payer: Cash Price |
$2,237.10
|
| Rate for Payer: Cash Price |
$2,237.10
|
| Rate for Payer: Cash Price |
$2,237.10
|
| Rate for Payer: Cigna Commercial |
$7,367.52
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$3,877.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$369.80
|
| Rate for Payer: Health EOS Commercial |
$7,057.30
|
| Rate for Payer: HFN Commercial |
$7,367.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,510.48
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,510.48
|
| Rate for Payer: Independent Care Health Plan Medicare |
$369.80
|
| Rate for Payer: Multiplan Commercial |
$6,204.22
|
| Rate for Payer: NAPHCARE Commercial |
$554.70
|
| Rate for Payer: Preferred Network Access Commercial |
$7,367.52
|
| Rate for Payer: Quartz Beloit One Network |
$3,412.32
|
| Rate for Payer: Quartz Commercial |
$4,420.51
|
| Rate for Payer: Quartz Medicare Advantage |
$369.80
|
| Rate for Payer: The Alliance Commercial |
$1,405.25
|
| Rate for Payer: United Healthcare Medicare Advantage |
$369.80
|
| Rate for Payer: WEA Trust Commercial |
$4,265.40
|
| Rate for Payer: WPS Commercial |
$1,849.02
|
|
|
MRI Chest w/ Contrast
|
Facility
|
OP
|
$7,457.00
|
|
|
Service Code
|
CPT 71551
|
| Hospital Charge Code |
629710
|
| Min. Negotiated Rate |
$824.99 |
| Max. Negotiated Rate |
$7,134.86 |
| Rate for Payer: Aetna Commercial |
$6,979.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,669.54
|
| Rate for Payer: Aetna Managed Medicare |
$824.99
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,040.93
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,877.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,722.53
|
| Rate for Payer: Anthem Medicare Advantage |
$824.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,110.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$824.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$824.99
|
| Rate for Payer: Cash Price |
$2,237.10
|
| Rate for Payer: Cash Price |
$2,237.10
|
| Rate for Payer: Cigna Commercial |
$7,134.86
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$824.99
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,339.97
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$824.99
|
| Rate for Payer: Health EOS Commercial |
$6,902.20
|
| Rate for Payer: HFN Commercial |
$7,134.86
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,068.96
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$824.99
|
| Rate for Payer: Independent Care Health Plan Medicare |
$824.99
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$824.99
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$824.99
|
| Rate for Payer: Multiplan Commercial |
$6,204.22
|
| Rate for Payer: NAPHCARE Commercial |
$1,237.49
|
| Rate for Payer: Preferred Network Access Commercial |
$7,134.86
|
| Rate for Payer: Quartz Beloit One Network |
$3,800.09
|
| Rate for Payer: Quartz Commercial |
$5,040.93
|
| Rate for Payer: Quartz Medicare Advantage |
$824.99
|
| Rate for Payer: The Alliance Commercial |
$3,299.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$824.99
|
| Rate for Payer: WEA Trust Commercial |
$4,265.40
|
| Rate for Payer: Wellcare Medicare |
$824.99
|
| Rate for Payer: WPS Commercial |
$5,744.13
|
|
|
MRI Chest w/ Contrast
|
Facility
|
OP
|
$7,316.00
|
|
|
Service Code
|
CPT 71551 TC
|
| Hospital Charge Code |
1611027
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,160.68 |
| Max. Negotiated Rate |
$6,999.95 |
| Rate for Payer: Aetna Commercial |
$6,847.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,543.43
|
| Rate for Payer: Aetna Managed Medicare |
$2,130.42
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,635.84
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,985.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,835.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,032.58
|
| Rate for Payer: Cash Price |
$2,194.80
|
| Rate for Payer: Cash Price |
$2,194.80
|
| Rate for Payer: Cash Price |
$2,194.80
|
| Rate for Payer: Cash Price |
$2,194.80
|
| Rate for Payer: Cigna Commercial |
$6,999.95
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,257.91
|
| Rate for Payer: Health EOS Commercial |
$6,771.69
|
| Rate for Payer: HFN Commercial |
$6,999.95
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,706.48
|
| Rate for Payer: Multiplan Commercial |
$6,086.91
|
| Rate for Payer: NAPHCARE Commercial |
$4,565.18
|
| Rate for Payer: Preferred Network Access Commercial |
$6,999.95
|
| Rate for Payer: Quartz Beloit One Network |
$3,728.23
|
| Rate for Payer: Quartz Commercial |
$4,945.62
|
| Rate for Payer: Quartz Medicare Advantage |
$4,565.18
|
| Rate for Payer: The Alliance Commercial |
$1,160.68
|
| Rate for Payer: United Healthcare PPO |
$3,142.88
|
| Rate for Payer: WEA Trust Commercial |
$4,184.75
|
| Rate for Payer: WPS Commercial |
$2,031.19
|
|
|
MRI Chest w/o Contrast
|
Facility
|
IP
|
$6,652.00
|
|
|
Service Code
|
CPT 71550 TC
|
| Hospital Charge Code |
1611029
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$3,389.86 |
| Max. Negotiated Rate |
$6,364.63 |
| Rate for Payer: Aetna Commercial |
$6,226.27
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,949.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,666.58
|
| Rate for Payer: Cash Price |
$1,995.60
|
| Rate for Payer: Cigna Commercial |
$6,364.63
|
| Rate for Payer: Health EOS Commercial |
$6,157.09
|
| Rate for Payer: HFN Commercial |
$6,364.63
|
| Rate for Payer: Multiplan Commercial |
$5,534.46
|
| Rate for Payer: Preferred Network Access Commercial |
$6,364.63
|
| Rate for Payer: Quartz Beloit One Network |
$3,389.86
|
| Rate for Payer: Quartz Commercial |
$4,150.85
|
| Rate for Payer: WEA Trust Commercial |
$3,804.94
|
| Rate for Payer: WPS Commercial |
$5,124.04
|
|
|
MRI Chest w/o Contrast
|
Facility
|
IP
|
$6,780.00
|
|
|
Service Code
|
CPT 71550
|
| Hospital Charge Code |
629712
|
| Min. Negotiated Rate |
$3,455.09 |
| Max. Negotiated Rate |
$6,487.10 |
| Rate for Payer: Aetna Commercial |
$6,346.08
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,064.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,737.14
|
| Rate for Payer: Cash Price |
$2,034.00
|
| Rate for Payer: Cigna Commercial |
$6,487.10
|
| Rate for Payer: Health EOS Commercial |
$6,275.57
|
| Rate for Payer: HFN Commercial |
$6,487.10
|
| Rate for Payer: Multiplan Commercial |
$5,640.96
|
| Rate for Payer: Preferred Network Access Commercial |
$6,487.10
|
| Rate for Payer: Quartz Beloit One Network |
$3,455.09
|
| Rate for Payer: Quartz Commercial |
$4,230.72
|
| Rate for Payer: WEA Trust Commercial |
$3,878.16
|
| Rate for Payer: WPS Commercial |
$5,222.63
|
|
|
MRI Chest w/o Contrast
|
Facility
|
OP
|
$6,780.00
|
|
|
Service Code
|
CPT 71550
|
| Hospital Charge Code |
629712
|
| Min. Negotiated Rate |
$251.10 |
| Max. Negotiated Rate |
$6,487.10 |
| Rate for Payer: Aetna Commercial |
$6,346.08
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,064.03
|
| Rate for Payer: Aetna Managed Medicare |
$251.10
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,583.28
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,525.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,384.58
|
| Rate for Payer: Anthem Medicare Advantage |
$251.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,737.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$251.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$251.10
|
| Rate for Payer: Cash Price |
$2,034.00
|
| Rate for Payer: Cash Price |
$2,034.00
|
| Rate for Payer: Cigna Commercial |
$6,487.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$251.10
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,945.96
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$251.10
|
| Rate for Payer: Health EOS Commercial |
$6,275.57
|
| Rate for Payer: HFN Commercial |
$6,487.10
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$934.08
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$251.10
|
| Rate for Payer: Independent Care Health Plan Medicare |
$251.10
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$251.10
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$251.10
|
| Rate for Payer: Multiplan Commercial |
$5,640.96
|
| Rate for Payer: NAPHCARE Commercial |
$376.65
|
| Rate for Payer: Preferred Network Access Commercial |
$6,487.10
|
| Rate for Payer: Quartz Beloit One Network |
$3,455.09
|
| Rate for Payer: Quartz Commercial |
$4,583.28
|
| Rate for Payer: Quartz Medicare Advantage |
$251.10
|
| Rate for Payer: The Alliance Commercial |
$1,004.39
|
| Rate for Payer: United Healthcare Medicare Advantage |
$251.10
|
| Rate for Payer: WEA Trust Commercial |
$3,878.16
|
| Rate for Payer: Wellcare Medicare |
$251.10
|
| Rate for Payer: WPS Commercial |
$5,222.63
|
|
|
MRI Chest w/o Contrast
|
Facility
|
OP
|
$6,652.00
|
|
|
Service Code
|
CPT 71550 TC
|
| Hospital Charge Code |
1611029
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,059.51 |
| Max. Negotiated Rate |
$6,364.63 |
| Rate for Payer: Aetna Commercial |
$6,226.27
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,949.55
|
| Rate for Payer: Aetna Managed Medicare |
$1,937.06
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,635.84
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,985.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,835.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,666.58
|
| Rate for Payer: Cash Price |
$1,995.60
|
| Rate for Payer: Cash Price |
$1,995.60
|
| Rate for Payer: Cash Price |
$1,995.60
|
| Rate for Payer: Cash Price |
$1,995.60
|
| Rate for Payer: Cigna Commercial |
$6,364.63
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,871.46
|
| Rate for Payer: Health EOS Commercial |
$6,157.09
|
| Rate for Payer: HFN Commercial |
$6,364.63
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,188.56
|
| Rate for Payer: Multiplan Commercial |
$5,534.46
|
| Rate for Payer: NAPHCARE Commercial |
$4,150.85
|
| Rate for Payer: Preferred Network Access Commercial |
$6,364.63
|
| Rate for Payer: Quartz Beloit One Network |
$3,389.86
|
| Rate for Payer: Quartz Commercial |
$4,496.75
|
| Rate for Payer: Quartz Medicare Advantage |
$4,150.85
|
| Rate for Payer: The Alliance Commercial |
$1,059.51
|
| Rate for Payer: United Healthcare PPO |
$3,142.88
|
| Rate for Payer: WEA Trust Commercial |
$3,804.94
|
| Rate for Payer: WPS Commercial |
$1,854.14
|
|
|
MRI Chest w/o Contrast
|
Professional
|
Both
|
$6,652.00
|
|
|
Service Code
|
CPT 71550 TC
|
| Hospital Charge Code |
1611029
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$264.88 |
| Max. Negotiated Rate |
$6,572.18 |
| Rate for Payer: Aetna Commercial |
$6,572.18
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,949.55
|
| Rate for Payer: Aetna Managed Medicare |
$264.88
|
| Rate for Payer: Anthem Medicare Advantage |
$264.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$264.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$264.88
|
| Rate for Payer: Cash Price |
$1,995.60
|
| Rate for Payer: Cash Price |
$1,995.60
|
| Rate for Payer: Cash Price |
$1,995.60
|
| Rate for Payer: Cigna Commercial |
$6,572.18
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$3,459.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$264.88
|
| Rate for Payer: Health EOS Commercial |
$6,295.45
|
| Rate for Payer: HFN Commercial |
$6,572.18
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,118.18
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,118.18
|
| Rate for Payer: Independent Care Health Plan Medicare |
$264.88
|
| Rate for Payer: Multiplan Commercial |
$5,534.46
|
| Rate for Payer: NAPHCARE Commercial |
$397.32
|
| Rate for Payer: Preferred Network Access Commercial |
$6,572.18
|
| Rate for Payer: Quartz Beloit One Network |
$3,043.96
|
| Rate for Payer: Quartz Commercial |
$3,943.31
|
| Rate for Payer: Quartz Medicare Advantage |
$264.88
|
| Rate for Payer: The Alliance Commercial |
$1,006.53
|
| Rate for Payer: United Healthcare Medicare Advantage |
$264.88
|
| Rate for Payer: WEA Trust Commercial |
$3,804.94
|
| Rate for Payer: WPS Commercial |
$1,324.39
|
|
|
MRI Chest w/o Contrast
|
Professional
|
Both
|
$6,780.00
|
|
|
Service Code
|
CPT 71550
|
| Hospital Charge Code |
629712
|
| Min. Negotiated Rate |
$331.59 |
| Max. Negotiated Rate |
$6,698.64 |
| Rate for Payer: Aetna Commercial |
$6,698.64
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,064.03
|
| Rate for Payer: Aetna Managed Medicare |
$331.59
|
| Rate for Payer: Anthem Medicare Advantage |
$331.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$331.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$331.59
|
| Rate for Payer: Cash Price |
$2,034.00
|
| Rate for Payer: Cash Price |
$2,034.00
|
| Rate for Payer: Cash Price |
$2,034.00
|
| Rate for Payer: Cigna Commercial |
$6,698.64
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$3,525.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$331.59
|
| Rate for Payer: Health EOS Commercial |
$6,416.59
|
| Rate for Payer: HFN Commercial |
$6,698.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,371.42
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,371.42
|
| Rate for Payer: Independent Care Health Plan Medicare |
$331.59
|
| Rate for Payer: Multiplan Commercial |
$5,640.96
|
| Rate for Payer: NAPHCARE Commercial |
$497.39
|
| Rate for Payer: Preferred Network Access Commercial |
$6,698.64
|
| Rate for Payer: Quartz Beloit One Network |
$3,102.53
|
| Rate for Payer: Quartz Commercial |
$4,019.18
|
| Rate for Payer: Quartz Medicare Advantage |
$331.59
|
| Rate for Payer: The Alliance Commercial |
$1,260.06
|
| Rate for Payer: United Healthcare Medicare Advantage |
$331.59
|
| Rate for Payer: WEA Trust Commercial |
$3,878.16
|
| Rate for Payer: WPS Commercial |
$1,657.97
|
|
|
MRI Chest w/ + w/o Contrast
|
Facility
|
OP
|
$8,950.00
|
|
|
Service Code
|
CPT 71552 TC
|
| Hospital Charge Code |
1611025
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,439.32 |
| Max. Negotiated Rate |
$8,563.36 |
| Rate for Payer: Aetna Commercial |
$8,377.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,004.88
|
| Rate for Payer: Aetna Managed Medicare |
$2,606.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,635.84
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,985.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,835.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,933.24
|
| Rate for Payer: Cash Price |
$2,685.00
|
| Rate for Payer: Cash Price |
$2,685.00
|
| Rate for Payer: Cash Price |
$2,685.00
|
| Rate for Payer: Cash Price |
$2,685.00
|
| Rate for Payer: Cigna Commercial |
$8,563.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,208.90
|
| Rate for Payer: Health EOS Commercial |
$8,284.12
|
| Rate for Payer: HFN Commercial |
$8,563.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,981.00
|
| Rate for Payer: Multiplan Commercial |
$7,446.40
|
| Rate for Payer: NAPHCARE Commercial |
$5,584.80
|
| Rate for Payer: Preferred Network Access Commercial |
$8,563.36
|
| Rate for Payer: Quartz Beloit One Network |
$4,560.92
|
| Rate for Payer: Quartz Commercial |
$6,050.20
|
| Rate for Payer: Quartz Medicare Advantage |
$5,584.80
|
| Rate for Payer: The Alliance Commercial |
$1,439.32
|
| Rate for Payer: United Healthcare PPO |
$3,142.88
|
| Rate for Payer: WEA Trust Commercial |
$5,119.40
|
| Rate for Payer: WPS Commercial |
$2,518.81
|
|
|
MRI Chest w/ + w/o Contrast
|
Facility
|
OP
|
$9,122.00
|
|
|
Service Code
|
CPT 71552
|
| Hospital Charge Code |
629708
|
| Min. Negotiated Rate |
$367.15 |
| Max. Negotiated Rate |
$8,727.93 |
| Rate for Payer: Aetna Commercial |
$8,538.19
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,158.72
|
| Rate for Payer: Aetna Managed Medicare |
$367.15
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,166.47
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,743.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,553.70
|
| Rate for Payer: Anthem Medicare Advantage |
$367.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,028.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$367.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$367.15
|
| Rate for Payer: Cash Price |
$2,736.60
|
| Rate for Payer: Cash Price |
$2,736.60
|
| Rate for Payer: Cigna Commercial |
$8,727.93
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$367.15
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,309.00
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$367.15
|
| Rate for Payer: Health EOS Commercial |
$8,443.32
|
| Rate for Payer: HFN Commercial |
$8,727.93
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,365.80
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$367.15
|
| Rate for Payer: Independent Care Health Plan Medicare |
$367.15
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$367.15
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$367.15
|
| Rate for Payer: Multiplan Commercial |
$7,589.50
|
| Rate for Payer: NAPHCARE Commercial |
$550.73
|
| Rate for Payer: Preferred Network Access Commercial |
$8,727.93
|
| Rate for Payer: Quartz Beloit One Network |
$4,648.57
|
| Rate for Payer: Quartz Commercial |
$6,166.47
|
| Rate for Payer: Quartz Medicare Advantage |
$367.15
|
| Rate for Payer: The Alliance Commercial |
$1,468.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$367.15
|
| Rate for Payer: WEA Trust Commercial |
$5,217.78
|
| Rate for Payer: Wellcare Medicare |
$367.15
|
| Rate for Payer: WPS Commercial |
$7,026.68
|
|
|
MRI Chest w/ + w/o Contrast
|
Professional
|
Both
|
$8,950.00
|
|
|
Service Code
|
CPT 71552 TC
|
| Hospital Charge Code |
1611025
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$359.83 |
| Max. Negotiated Rate |
$8,842.60 |
| Rate for Payer: Aetna Commercial |
$8,842.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,004.88
|
| Rate for Payer: Aetna Managed Medicare |
$359.83
|
| Rate for Payer: Anthem Medicare Advantage |
$359.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$359.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$359.83
|
| Rate for Payer: Cash Price |
$2,685.00
|
| Rate for Payer: Cash Price |
$2,685.00
|
| Rate for Payer: Cash Price |
$2,685.00
|
| Rate for Payer: Cigna Commercial |
$8,842.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$4,654.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$359.83
|
| Rate for Payer: Health EOS Commercial |
$8,470.28
|
| Rate for Payer: HFN Commercial |
$8,842.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,525.57
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,525.57
|
| Rate for Payer: Independent Care Health Plan Medicare |
$359.83
|
| Rate for Payer: Multiplan Commercial |
$7,446.40
|
| Rate for Payer: NAPHCARE Commercial |
$539.74
|
| Rate for Payer: Preferred Network Access Commercial |
$8,842.60
|
| Rate for Payer: Quartz Beloit One Network |
$4,095.52
|
| Rate for Payer: Quartz Commercial |
$5,305.56
|
| Rate for Payer: Quartz Medicare Advantage |
$359.83
|
| Rate for Payer: The Alliance Commercial |
$1,367.35
|
| Rate for Payer: United Healthcare Medicare Advantage |
$359.83
|
| Rate for Payer: WEA Trust Commercial |
$5,119.40
|
| Rate for Payer: WPS Commercial |
$1,799.15
|
|
|
MRI Chest w/ + w/o Contrast
|
Professional
|
Both
|
$9,122.00
|
|
|
Service Code
|
CPT 71552
|
| Hospital Charge Code |
629708
|
| Min. Negotiated Rate |
$463.60 |
| Max. Negotiated Rate |
$9,012.54 |
| Rate for Payer: Aetna Commercial |
$9,012.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,158.72
|
| Rate for Payer: Aetna Managed Medicare |
$463.60
|
| Rate for Payer: Anthem Medicare Advantage |
$463.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$463.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$463.60
|
| 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 |
$9,012.54
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$4,743.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$463.60
|
| Rate for Payer: Health EOS Commercial |
$8,633.06
|
| Rate for Payer: HFN Commercial |
$9,012.54
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,916.63
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,916.63
|
| Rate for Payer: Independent Care Health Plan Medicare |
$463.60
|
| Rate for Payer: Multiplan Commercial |
$7,589.50
|
| Rate for Payer: NAPHCARE Commercial |
$695.40
|
| Rate for Payer: Preferred Network Access Commercial |
$9,012.54
|
| Rate for Payer: Quartz Beloit One Network |
$4,174.23
|
| Rate for Payer: Quartz Commercial |
$5,407.52
|
| Rate for Payer: Quartz Medicare Advantage |
$463.60
|
| Rate for Payer: The Alliance Commercial |
$1,761.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$463.60
|
| Rate for Payer: WEA Trust Commercial |
$5,217.78
|
| Rate for Payer: WPS Commercial |
$2,318.00
|
|
|
MRI Chest w/ + w/o Contrast
|
Facility
|
IP
|
$9,122.00
|
|
|
Service Code
|
CPT 71552
|
| Hospital Charge Code |
629708
|
| Min. Negotiated Rate |
$4,648.57 |
| Max. Negotiated Rate |
$8,727.93 |
| Rate for Payer: Aetna Commercial |
$8,538.19
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,158.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,028.05
|
| Rate for Payer: Cash Price |
$2,736.60
|
| Rate for Payer: Cigna Commercial |
$8,727.93
|
| Rate for Payer: Health EOS Commercial |
$8,443.32
|
| Rate for Payer: HFN Commercial |
$8,727.93
|
| Rate for Payer: Multiplan Commercial |
$7,589.50
|
| Rate for Payer: Preferred Network Access Commercial |
$8,727.93
|
| Rate for Payer: Quartz Beloit One Network |
$4,648.57
|
| Rate for Payer: Quartz Commercial |
$5,692.13
|
| Rate for Payer: WEA Trust Commercial |
$5,217.78
|
| Rate for Payer: WPS Commercial |
$7,026.68
|
|
|
MRI Chest w/ + w/o Contrast
|
Facility
|
IP
|
$8,950.00
|
|
|
Service Code
|
CPT 71552 TC
|
| Hospital Charge Code |
1611025
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$4,560.92 |
| Max. Negotiated Rate |
$8,563.36 |
| Rate for Payer: Aetna Commercial |
$8,377.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,004.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,933.24
|
| Rate for Payer: Cash Price |
$2,685.00
|
| Rate for Payer: Cigna Commercial |
$8,563.36
|
| Rate for Payer: Health EOS Commercial |
$8,284.12
|
| Rate for Payer: HFN Commercial |
$8,563.36
|
| Rate for Payer: Multiplan Commercial |
$7,446.40
|
| Rate for Payer: Preferred Network Access Commercial |
$8,563.36
|
| Rate for Payer: Quartz Beloit One Network |
$4,560.92
|
| Rate for Payer: Quartz Commercial |
$5,584.80
|
| Rate for Payer: WEA Trust Commercial |
$5,119.40
|
| Rate for Payer: WPS Commercial |
$6,894.19
|
|
|
MRI Elbow w/ Contrast Bilateral
|
Facility
|
IP
|
$9,376.00
|
|
|
Service Code
|
CPT 73222
|
| Hospital Charge Code |
630835
|
| Min. Negotiated Rate |
$4,778.01 |
| Max. Negotiated Rate |
$8,970.96 |
| Rate for Payer: Aetna Commercial |
$8,775.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,385.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,168.05
|
| Rate for Payer: Cash Price |
$2,812.80
|
| Rate for Payer: Cigna Commercial |
$8,970.96
|
| Rate for Payer: Health EOS Commercial |
$8,678.43
|
| Rate for Payer: HFN Commercial |
$8,970.96
|
| Rate for Payer: Multiplan Commercial |
$7,800.83
|
| Rate for Payer: Preferred Network Access Commercial |
$8,970.96
|
| Rate for Payer: Quartz Beloit One Network |
$4,778.01
|
| Rate for Payer: Quartz Commercial |
$5,850.62
|
| Rate for Payer: WEA Trust Commercial |
$5,363.07
|
| Rate for Payer: WPS Commercial |
$7,222.33
|
|
|
MRI Elbow w/ Contrast Bilateral
|
Professional
|
Both
|
$5,965.00
|
|
|
Service Code
|
CPT 73222 TC,LT
|
| Hospital Charge Code |
1611043
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,268.77 |
| Max. Negotiated Rate |
$5,893.42 |
| Rate for Payer: Aetna Commercial |
$5,893.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,335.10
|
| 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 |
$5,893.42
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$3,101.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,722.16
|
| Rate for Payer: Health EOS Commercial |
$5,645.28
|
| Rate for Payer: HFN Commercial |
$5,893.42
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,268.77
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,268.77
|
| Rate for Payer: Multiplan Commercial |
$4,962.88
|
| Rate for Payer: Preferred Network Access Commercial |
$5,893.42
|
| Rate for Payer: Quartz Beloit One Network |
$2,729.58
|
| Rate for Payer: Quartz Commercial |
$3,536.05
|
| Rate for Payer: The Alliance Commercial |
$3,101.80
|
| Rate for Payer: WEA Trust Commercial |
$3,411.98
|
| Rate for Payer: WPS Commercial |
$4,594.84
|
|
|
MRI Elbow w/ Contrast Bilateral
|
Facility
|
OP
|
$9,376.00
|
|
|
Service Code
|
CPT 73222
|
| Hospital Charge Code |
630835
|
| Min. Negotiated Rate |
$824.99 |
| Max. Negotiated Rate |
$8,970.96 |
| Rate for Payer: Aetna Commercial |
$8,775.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,385.89
|
| Rate for Payer: Aetna Managed Medicare |
$824.99
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,338.18
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,875.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,680.50
|
| Rate for Payer: Anthem Medicare Advantage |
$824.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,168.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$824.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$824.99
|
| Rate for Payer: Cash Price |
$2,812.80
|
| Rate for Payer: Cash Price |
$2,812.80
|
| Rate for Payer: Cigna Commercial |
$8,970.96
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$824.99
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,456.83
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$824.99
|
| Rate for Payer: Health EOS Commercial |
$8,678.43
|
| Rate for Payer: HFN Commercial |
$8,970.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,068.96
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$824.99
|
| Rate for Payer: Independent Care Health Plan Medicare |
$824.99
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$824.99
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$824.99
|
| Rate for Payer: Multiplan Commercial |
$7,800.83
|
| Rate for Payer: NAPHCARE Commercial |
$1,237.49
|
| Rate for Payer: Preferred Network Access Commercial |
$8,970.96
|
| Rate for Payer: Quartz Beloit One Network |
$4,778.01
|
| Rate for Payer: Quartz Commercial |
$6,338.18
|
| Rate for Payer: Quartz Medicare Advantage |
$824.99
|
| Rate for Payer: The Alliance Commercial |
$3,299.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$824.99
|
| Rate for Payer: WEA Trust Commercial |
$5,363.07
|
| Rate for Payer: Wellcare Medicare |
$824.99
|
| Rate for Payer: WPS Commercial |
$7,222.33
|
|
|
MRI Elbow w/ Contrast Bilateral
|
Professional
|
Both
|
$9,376.00
|
|
|
Service Code
|
CPT 73222
|
| Hospital Charge Code |
630835
|
| Min. Negotiated Rate |
$311.30 |
| Max. Negotiated Rate |
$9,263.49 |
| Rate for Payer: Aetna Commercial |
$9,263.49
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,385.89
|
| Rate for Payer: Aetna Managed Medicare |
$311.30
|
| Rate for Payer: Anthem Medicare Advantage |
$311.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$311.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$311.30
|
| Rate for Payer: Cash Price |
$2,812.80
|
| Rate for Payer: Cash Price |
$2,812.80
|
| Rate for Payer: Cash Price |
$2,812.80
|
| Rate for Payer: Cigna Commercial |
$9,263.49
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$4,875.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$311.30
|
| Rate for Payer: Health EOS Commercial |
$8,873.45
|
| Rate for Payer: HFN Commercial |
$9,263.49
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,268.77
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,268.77
|
| Rate for Payer: Independent Care Health Plan Medicare |
$311.30
|
| Rate for Payer: Multiplan Commercial |
$7,800.83
|
| Rate for Payer: NAPHCARE Commercial |
$466.95
|
| Rate for Payer: Preferred Network Access Commercial |
$9,263.49
|
| Rate for Payer: Quartz Beloit One Network |
$4,290.46
|
| Rate for Payer: Quartz Commercial |
$5,558.09
|
| Rate for Payer: Quartz Medicare Advantage |
$311.30
|
| Rate for Payer: The Alliance Commercial |
$1,182.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$311.30
|
| Rate for Payer: WEA Trust Commercial |
$5,363.07
|
| Rate for Payer: WPS Commercial |
$1,556.52
|
|
|
MRI Elbow w/ Contrast Bilateral
|
Facility
|
OP
|
$5,965.00
|
|
|
Service Code
|
CPT 73222 TC,LT
|
| Hospital Charge Code |
1611043
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,737.01 |
| Max. Negotiated Rate |
$5,707.31 |
| Rate for Payer: Aetna Commercial |
$5,583.24
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,335.10
|
| Rate for Payer: Aetna Managed Medicare |
$1,737.01
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,635.84
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,985.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,835.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,287.91
|
| 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 |
$5,707.31
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,471.63
|
| Rate for Payer: Health EOS Commercial |
$5,521.20
|
| Rate for Payer: HFN Commercial |
$5,707.31
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,652.70
|
| Rate for Payer: Multiplan Commercial |
$4,962.88
|
| Rate for Payer: NAPHCARE Commercial |
$3,722.16
|
| Rate for Payer: Preferred Network Access Commercial |
$5,707.31
|
| Rate for Payer: Quartz Beloit One Network |
$3,039.76
|
| Rate for Payer: Quartz Commercial |
$4,032.34
|
| Rate for Payer: Quartz Medicare Advantage |
$3,722.16
|
| Rate for Payer: The Alliance Commercial |
$3,101.80
|
| Rate for Payer: United Healthcare PPO |
$3,142.88
|
| Rate for Payer: WEA Trust Commercial |
$3,411.98
|
| Rate for Payer: WPS Commercial |
$4,594.84
|
|
|
MRI Elbow w/ Contrast Bilateral
|
Facility
|
IP
|
$5,965.00
|
|
|
Service Code
|
CPT 73222 TC,LT
|
| Hospital Charge Code |
1611043
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$3,039.76 |
| Max. Negotiated Rate |
$5,707.31 |
| Rate for Payer: Aetna Commercial |
$5,583.24
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,335.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,287.91
|
| Rate for Payer: Cash Price |
$1,789.50
|
| Rate for Payer: Cigna Commercial |
$5,707.31
|
| Rate for Payer: Health EOS Commercial |
$5,521.20
|
| Rate for Payer: HFN Commercial |
$5,707.31
|
| Rate for Payer: Multiplan Commercial |
$4,962.88
|
| Rate for Payer: Preferred Network Access Commercial |
$5,707.31
|
| Rate for Payer: Quartz Beloit One Network |
$3,039.76
|
| Rate for Payer: Quartz Commercial |
$3,722.16
|
| Rate for Payer: WEA Trust Commercial |
$3,411.98
|
| Rate for Payer: WPS Commercial |
$4,594.84
|
|
|
MRI Elbow w/ Contrast Left
|
Professional
|
Both
|
$5,965.00
|
|
|
Service Code
|
CPT 73222 LT,TC
|
| Hospital Charge Code |
1611045
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,268.77 |
| Max. Negotiated Rate |
$5,893.42 |
| Rate for Payer: Aetna Commercial |
$5,893.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,335.10
|
| 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 |
$5,893.42
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$3,101.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,722.16
|
| Rate for Payer: Health EOS Commercial |
$5,645.28
|
| Rate for Payer: HFN Commercial |
$5,893.42
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,268.77
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,268.77
|
| Rate for Payer: Multiplan Commercial |
$4,962.88
|
| Rate for Payer: Preferred Network Access Commercial |
$5,893.42
|
| Rate for Payer: Quartz Beloit One Network |
$2,729.58
|
| Rate for Payer: Quartz Commercial |
$3,536.05
|
| Rate for Payer: The Alliance Commercial |
$3,101.80
|
| Rate for Payer: WEA Trust Commercial |
$3,411.98
|
| Rate for Payer: WPS Commercial |
$4,594.84
|
|
|
MRI Elbow w/ Contrast Left
|
Facility
|
IP
|
$5,965.00
|
|
|
Service Code
|
CPT 73222 LT,TC
|
| Hospital Charge Code |
1611045
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$3,039.76 |
| Max. Negotiated Rate |
$5,707.31 |
| Rate for Payer: Aetna Commercial |
$5,583.24
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,335.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,287.91
|
| Rate for Payer: Cash Price |
$1,789.50
|
| Rate for Payer: Cigna Commercial |
$5,707.31
|
| Rate for Payer: Health EOS Commercial |
$5,521.20
|
| Rate for Payer: HFN Commercial |
$5,707.31
|
| Rate for Payer: Multiplan Commercial |
$4,962.88
|
| Rate for Payer: Preferred Network Access Commercial |
$5,707.31
|
| Rate for Payer: Quartz Beloit One Network |
$3,039.76
|
| Rate for Payer: Quartz Commercial |
$3,722.16
|
| Rate for Payer: WEA Trust Commercial |
$3,411.98
|
| Rate for Payer: WPS Commercial |
$4,594.84
|
|
|
MRI Elbow w/ Contrast Left
|
Facility
|
OP
|
$4,687.00
|
|
|
Service Code
|
CPT 73222
|
| Hospital Charge Code |
630839
|
| Min. Negotiated Rate |
$824.99 |
| Max. Negotiated Rate |
$4,484.52 |
| Rate for Payer: Aetna Commercial |
$4,387.03
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,192.05
|
| Rate for Payer: Aetna Managed Medicare |
$824.99
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,168.41
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,437.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,339.75
|
| Rate for Payer: Anthem Medicare Advantage |
$824.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,583.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$824.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$824.99
|
| Rate for Payer: Cash Price |
$1,406.10
|
| Rate for Payer: Cash Price |
$1,406.10
|
| Rate for Payer: Cigna Commercial |
$4,484.52
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$824.99
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,727.83
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$824.99
|
| Rate for Payer: Health EOS Commercial |
$4,338.29
|
| Rate for Payer: HFN Commercial |
$4,484.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,068.96
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$824.99
|
| Rate for Payer: Independent Care Health Plan Medicare |
$824.99
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$824.99
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$824.99
|
| Rate for Payer: Multiplan Commercial |
$3,899.58
|
| Rate for Payer: NAPHCARE Commercial |
$1,237.49
|
| Rate for Payer: Preferred Network Access Commercial |
$4,484.52
|
| Rate for Payer: Quartz Beloit One Network |
$2,388.50
|
| Rate for Payer: Quartz Commercial |
$3,168.41
|
| Rate for Payer: Quartz Medicare Advantage |
$824.99
|
| Rate for Payer: The Alliance Commercial |
$3,299.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$824.99
|
| Rate for Payer: WEA Trust Commercial |
$2,680.96
|
| Rate for Payer: Wellcare Medicare |
$824.99
|
| Rate for Payer: WPS Commercial |
$3,610.40
|
|
