|
MRI Humerus w/ + w/o Contrast Bilateral
|
Facility
|
OP
|
$10,957.00
|
|
|
Service Code
|
CPT 73220
|
| Hospital Charge Code |
631015
|
| Min. Negotiated Rate |
$380.12 |
| Max. Negotiated Rate |
$10,080.44 |
| Rate for Payer: Aetna Commercial |
$9,861.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,423.02
|
| Rate for Payer: Aetna Managed Medicare |
$380.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$7,122.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,478.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,259.36
|
| Rate for Payer: Anthem Medicare Advantage |
$380.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,807.21
|
| 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 |
$3,287.10
|
| Rate for Payer: Cash Price |
$3,287.10
|
| Rate for Payer: Cigna Commercial |
$10,080.44
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$380.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,131.54
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$380.12
|
| Rate for Payer: Health EOS Commercial |
$9,751.73
|
| Rate for Payer: HFN Commercial |
$10,080.44
|
| 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 |
$8,765.60
|
| Rate for Payer: NAPHCARE Commercial |
$570.18
|
| Rate for Payer: Preferred Network Access Commercial |
$10,080.44
|
| Rate for Payer: Quartz Beloit One Network |
$5,368.93
|
| Rate for Payer: Quartz Commercial |
$7,122.05
|
| 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: WEA Trust Commercial |
$6,026.35
|
| Rate for Payer: Wellcare Medicare |
$380.12
|
| Rate for Payer: WPS Commercial |
$8,115.85
|
|
|
MRI Humerus w/ + w/o Contrast Bilateral
|
Facility
|
IP
|
$6,077.00
|
|
|
Service Code
|
CPT 73220 TC,LT
|
| Hospital Charge Code |
1611153
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$2,977.73 |
| Max. Negotiated Rate |
$5,590.84 |
| Rate for Payer: Aetna Commercial |
$5,469.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,226.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,220.81
|
| Rate for Payer: Cash Price |
$1,823.10
|
| Rate for Payer: Cigna Commercial |
$5,590.84
|
| Rate for Payer: Health EOS Commercial |
$5,408.53
|
| Rate for Payer: HFN Commercial |
$5,590.84
|
| Rate for Payer: Multiplan Commercial |
$4,861.60
|
| Rate for Payer: NAPHCARE Commercial |
$3,646.20
|
| Rate for Payer: Preferred Network Access Commercial |
$5,590.84
|
| Rate for Payer: Quartz Beloit One Network |
$2,977.73
|
| Rate for Payer: Quartz Commercial |
$3,646.20
|
| Rate for Payer: WEA Trust Commercial |
$3,342.35
|
| Rate for Payer: WPS Commercial |
$4,501.23
|
|
|
MRI Humerus w/ + w/o Contrast Bilateral
|
Professional
|
Both
|
$6,077.00
|
|
|
Service Code
|
CPT 73220 TC,LT
|
| Hospital Charge Code |
1611153
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,596.12 |
| Max. Negotiated Rate |
$5,773.15 |
| Rate for Payer: Aetna Commercial |
$5,773.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,226.22
|
| Rate for Payer: Cash Price |
$1,823.10
|
| Rate for Payer: Cash Price |
$1,823.10
|
| Rate for Payer: Cash Price |
$1,823.10
|
| Rate for Payer: Cigna Commercial |
$5,773.15
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$3,038.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,646.20
|
| Rate for Payer: Health EOS Commercial |
$5,530.07
|
| Rate for Payer: HFN Commercial |
$5,773.15
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,596.12
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,596.12
|
| Rate for Payer: Multiplan Commercial |
$4,861.60
|
| Rate for Payer: Preferred Network Access Commercial |
$5,773.15
|
| Rate for Payer: Quartz Beloit One Network |
$2,673.88
|
| Rate for Payer: Quartz Commercial |
$3,463.89
|
| Rate for Payer: The Alliance Commercial |
$3,038.50
|
| Rate for Payer: WEA Trust Commercial |
$3,342.35
|
| Rate for Payer: WPS Commercial |
$4,501.23
|
|
|
MRI Humerus w/ + w/o Contrast Left
|
Professional
|
Both
|
$5,479.00
|
|
|
Service Code
|
CPT 73220
|
| Hospital Charge Code |
631021
|
| Min. Negotiated Rate |
$1,596.12 |
| Max. Negotiated Rate |
$5,205.05 |
| Rate for Payer: Aetna Commercial |
$5,205.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,711.94
|
| Rate for Payer: Cash Price |
$1,643.70
|
| Rate for Payer: Cash Price |
$1,643.70
|
| Rate for Payer: Cash Price |
$1,643.70
|
| Rate for Payer: Cigna Commercial |
$5,205.05
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,739.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,287.40
|
| Rate for Payer: Health EOS Commercial |
$4,985.89
|
| Rate for Payer: HFN Commercial |
$5,205.05
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,596.12
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,596.12
|
| Rate for Payer: Multiplan Commercial |
$4,383.20
|
| Rate for Payer: Preferred Network Access Commercial |
$5,205.05
|
| Rate for Payer: Quartz Beloit One Network |
$2,410.76
|
| Rate for Payer: Quartz Commercial |
$3,123.03
|
| Rate for Payer: The Alliance Commercial |
$2,739.50
|
| Rate for Payer: WEA Trust Commercial |
$3,013.45
|
| Rate for Payer: WPS Commercial |
$4,058.30
|
|
|
MRI Humerus w/ + w/o Contrast Left
|
Facility
|
OP
|
$5,479.00
|
|
|
Service Code
|
CPT 73220
|
| Hospital Charge Code |
631021
|
| Min. Negotiated Rate |
$380.12 |
| Max. Negotiated Rate |
$5,040.68 |
| Rate for Payer: Aetna Commercial |
$4,931.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,711.94
|
| Rate for Payer: Aetna Managed Medicare |
$380.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,561.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,739.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,629.92
|
| Rate for Payer: Anthem Medicare Advantage |
$380.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,903.87
|
| 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 |
$1,643.70
|
| Rate for Payer: Cash Price |
$1,643.70
|
| Rate for Payer: Cigna Commercial |
$5,040.68
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$380.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,066.05
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$380.12
|
| Rate for Payer: Health EOS Commercial |
$4,876.31
|
| Rate for Payer: HFN Commercial |
$5,040.68
|
| 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 |
$4,383.20
|
| Rate for Payer: NAPHCARE Commercial |
$570.18
|
| Rate for Payer: Preferred Network Access Commercial |
$5,040.68
|
| Rate for Payer: Quartz Beloit One Network |
$2,684.71
|
| Rate for Payer: Quartz Commercial |
$3,561.35
|
| 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 |
$3,013.45
|
| Rate for Payer: Wellcare Medicare |
$380.12
|
| Rate for Payer: WPS Commercial |
$4,058.30
|
|
|
MRI Humerus w/ + w/o Contrast Left
|
Facility
|
OP
|
$6,636.00
|
|
|
Service Code
|
CPT 73220 TC,LT
|
| Hospital Charge Code |
1611155
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$380.12 |
| Max. Negotiated Rate |
$6,105.12 |
| Rate for Payer: Aetna Commercial |
$5,972.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,706.96
|
| 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 |
$3,517.08
|
| 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 |
$1,990.80
|
| Rate for Payer: Cash Price |
$1,990.80
|
| Rate for Payer: Cash Price |
$1,990.80
|
| Rate for Payer: Cash Price |
$1,990.80
|
| Rate for Payer: Cigna Commercial |
$6,105.12
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$380.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,713.51
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$380.12
|
| Rate for Payer: Health EOS Commercial |
$5,906.04
|
| Rate for Payer: HFN Commercial |
$6,105.12
|
| 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 |
$5,308.80
|
| Rate for Payer: NAPHCARE Commercial |
$570.18
|
| Rate for Payer: Preferred Network Access Commercial |
$6,105.12
|
| Rate for Payer: Quartz Beloit One Network |
$3,251.64
|
| Rate for Payer: Quartz Commercial |
$4,313.40
|
| 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 |
$3,649.80
|
| Rate for Payer: Wellcare Medicare |
$380.12
|
| Rate for Payer: WPS Commercial |
$4,915.29
|
|
|
MRI Humerus w/ + w/o Contrast Left
|
Facility
|
IP
|
$6,636.00
|
|
|
Service Code
|
CPT 73220 TC,LT
|
| Hospital Charge Code |
1611155
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$3,251.64 |
| Max. Negotiated Rate |
$6,105.12 |
| Rate for Payer: Aetna Commercial |
$5,972.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,706.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,517.08
|
| Rate for Payer: Cash Price |
$1,990.80
|
| Rate for Payer: Cigna Commercial |
$6,105.12
|
| Rate for Payer: Health EOS Commercial |
$5,906.04
|
| Rate for Payer: HFN Commercial |
$6,105.12
|
| Rate for Payer: Multiplan Commercial |
$5,308.80
|
| Rate for Payer: NAPHCARE Commercial |
$3,981.60
|
| Rate for Payer: Preferred Network Access Commercial |
$6,105.12
|
| Rate for Payer: Quartz Beloit One Network |
$3,251.64
|
| Rate for Payer: Quartz Commercial |
$3,981.60
|
| Rate for Payer: WEA Trust Commercial |
$3,649.80
|
| Rate for Payer: WPS Commercial |
$4,915.29
|
|
|
MRI Humerus w/ + w/o Contrast Left
|
Professional
|
Both
|
$6,636.00
|
|
|
Service Code
|
CPT 73220 TC,LT
|
| Hospital Charge Code |
1611155
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,596.12 |
| Max. Negotiated Rate |
$6,304.20 |
| Rate for Payer: Aetna Commercial |
$6,304.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,706.96
|
| Rate for Payer: Cash Price |
$1,990.80
|
| Rate for Payer: Cash Price |
$1,990.80
|
| Rate for Payer: Cash Price |
$1,990.80
|
| Rate for Payer: Cigna Commercial |
$6,304.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$3,318.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,981.60
|
| Rate for Payer: Health EOS Commercial |
$6,038.76
|
| Rate for Payer: HFN Commercial |
$6,304.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,596.12
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,596.12
|
| Rate for Payer: Multiplan Commercial |
$5,308.80
|
| Rate for Payer: Preferred Network Access Commercial |
$6,304.20
|
| Rate for Payer: Quartz Beloit One Network |
$2,919.84
|
| Rate for Payer: Quartz Commercial |
$3,782.52
|
| Rate for Payer: The Alliance Commercial |
$3,318.00
|
| Rate for Payer: WEA Trust Commercial |
$3,649.80
|
| Rate for Payer: WPS Commercial |
$4,915.29
|
|
|
MRI Humerus w/ + w/o Contrast Left
|
Facility
|
IP
|
$5,479.00
|
|
|
Service Code
|
CPT 73220
|
| Hospital Charge Code |
631021
|
| Min. Negotiated Rate |
$2,684.71 |
| Max. Negotiated Rate |
$5,040.68 |
| Rate for Payer: Aetna Commercial |
$4,931.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,711.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,903.87
|
| Rate for Payer: Cash Price |
$1,643.70
|
| Rate for Payer: Cigna Commercial |
$5,040.68
|
| Rate for Payer: Health EOS Commercial |
$4,876.31
|
| Rate for Payer: HFN Commercial |
$5,040.68
|
| Rate for Payer: Multiplan Commercial |
$4,383.20
|
| Rate for Payer: NAPHCARE Commercial |
$3,287.40
|
| Rate for Payer: Preferred Network Access Commercial |
$5,040.68
|
| Rate for Payer: Quartz Beloit One Network |
$2,684.71
|
| Rate for Payer: Quartz Commercial |
$3,287.40
|
| Rate for Payer: WEA Trust Commercial |
$3,013.45
|
| Rate for Payer: WPS Commercial |
$4,058.30
|
|
|
MRI Humerus w/ + w/o Contrast Right
|
Professional
|
Both
|
$6,077.00
|
|
|
Service Code
|
CPT 73220 TC,RT
|
| Hospital Charge Code |
1611157
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,596.12 |
| Max. Negotiated Rate |
$5,773.15 |
| Rate for Payer: Aetna Commercial |
$5,773.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,226.22
|
| Rate for Payer: Cash Price |
$1,823.10
|
| Rate for Payer: Cash Price |
$1,823.10
|
| Rate for Payer: Cash Price |
$1,823.10
|
| Rate for Payer: Cigna Commercial |
$5,773.15
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$3,038.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,646.20
|
| Rate for Payer: Health EOS Commercial |
$5,530.07
|
| Rate for Payer: HFN Commercial |
$5,773.15
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,596.12
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,596.12
|
| Rate for Payer: Multiplan Commercial |
$4,861.60
|
| Rate for Payer: Preferred Network Access Commercial |
$5,773.15
|
| Rate for Payer: Quartz Beloit One Network |
$2,673.88
|
| Rate for Payer: Quartz Commercial |
$3,463.89
|
| Rate for Payer: The Alliance Commercial |
$3,038.50
|
| Rate for Payer: WEA Trust Commercial |
$3,342.35
|
| Rate for Payer: WPS Commercial |
$4,501.23
|
|
|
MRI Humerus w/ + w/o Contrast Right
|
Professional
|
Both
|
$6,077.00
|
|
|
Service Code
|
CPT 73220 TC,RT
|
| Hospital Charge Code |
2980037
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,596.12 |
| Max. Negotiated Rate |
$5,773.15 |
| Rate for Payer: Aetna Commercial |
$5,773.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,226.22
|
| Rate for Payer: Cash Price |
$1,823.10
|
| Rate for Payer: Cash Price |
$1,823.10
|
| Rate for Payer: Cash Price |
$1,823.10
|
| Rate for Payer: Cigna Commercial |
$5,773.15
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$3,038.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,646.20
|
| Rate for Payer: Health EOS Commercial |
$5,530.07
|
| Rate for Payer: HFN Commercial |
$5,773.15
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,596.12
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,596.12
|
| Rate for Payer: Multiplan Commercial |
$4,861.60
|
| Rate for Payer: Preferred Network Access Commercial |
$5,773.15
|
| Rate for Payer: Quartz Beloit One Network |
$2,673.88
|
| Rate for Payer: Quartz Commercial |
$3,463.89
|
| Rate for Payer: The Alliance Commercial |
$3,038.50
|
| Rate for Payer: WEA Trust Commercial |
$3,342.35
|
| Rate for Payer: WPS Commercial |
$4,501.23
|
|
|
MRI Humerus w/ + w/o Contrast Right
|
Facility
|
IP
|
$6,077.00
|
|
|
Service Code
|
CPT 73220 TC,RT
|
| Hospital Charge Code |
1611157
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$2,977.73 |
| Max. Negotiated Rate |
$5,590.84 |
| Rate for Payer: Aetna Commercial |
$5,469.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,226.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,220.81
|
| Rate for Payer: Cash Price |
$1,823.10
|
| Rate for Payer: Cigna Commercial |
$5,590.84
|
| Rate for Payer: Health EOS Commercial |
$5,408.53
|
| Rate for Payer: HFN Commercial |
$5,590.84
|
| Rate for Payer: Multiplan Commercial |
$4,861.60
|
| Rate for Payer: NAPHCARE Commercial |
$3,646.20
|
| Rate for Payer: Preferred Network Access Commercial |
$5,590.84
|
| Rate for Payer: Quartz Beloit One Network |
$2,977.73
|
| Rate for Payer: Quartz Commercial |
$3,646.20
|
| Rate for Payer: WEA Trust Commercial |
$3,342.35
|
| Rate for Payer: WPS Commercial |
$4,501.23
|
|
|
MRI Humerus w/ + w/o Contrast Right
|
Facility
|
IP
|
$6,077.00
|
|
|
Service Code
|
CPT 73220 TC,RT
|
| Hospital Charge Code |
2980037
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$2,977.73 |
| Max. Negotiated Rate |
$5,590.84 |
| Rate for Payer: Aetna Commercial |
$5,469.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,226.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,220.81
|
| Rate for Payer: Cash Price |
$1,823.10
|
| Rate for Payer: Cigna Commercial |
$5,590.84
|
| Rate for Payer: Health EOS Commercial |
$5,408.53
|
| Rate for Payer: HFN Commercial |
$5,590.84
|
| Rate for Payer: Multiplan Commercial |
$4,861.60
|
| Rate for Payer: NAPHCARE Commercial |
$3,646.20
|
| Rate for Payer: Preferred Network Access Commercial |
$5,590.84
|
| Rate for Payer: Quartz Beloit One Network |
$2,977.73
|
| Rate for Payer: Quartz Commercial |
$3,646.20
|
| Rate for Payer: WEA Trust Commercial |
$3,342.35
|
| Rate for Payer: WPS Commercial |
$4,501.23
|
|
|
MRI Humerus w/ + w/o Contrast Right
|
Facility
|
OP
|
$5,479.00
|
|
|
Service Code
|
CPT 73220
|
| Hospital Charge Code |
631027
|
| Min. Negotiated Rate |
$380.12 |
| Max. Negotiated Rate |
$5,040.68 |
| Rate for Payer: Aetna Commercial |
$4,931.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,711.94
|
| Rate for Payer: Aetna Managed Medicare |
$380.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,561.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,739.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,629.92
|
| Rate for Payer: Anthem Medicare Advantage |
$380.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,903.87
|
| 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 |
$1,643.70
|
| Rate for Payer: Cash Price |
$1,643.70
|
| Rate for Payer: Cigna Commercial |
$5,040.68
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$380.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,066.05
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$380.12
|
| Rate for Payer: Health EOS Commercial |
$4,876.31
|
| Rate for Payer: HFN Commercial |
$5,040.68
|
| 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 |
$4,383.20
|
| Rate for Payer: NAPHCARE Commercial |
$570.18
|
| Rate for Payer: Preferred Network Access Commercial |
$5,040.68
|
| Rate for Payer: Quartz Beloit One Network |
$2,684.71
|
| Rate for Payer: Quartz Commercial |
$3,561.35
|
| 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 |
$3,013.45
|
| Rate for Payer: Wellcare Medicare |
$380.12
|
| Rate for Payer: WPS Commercial |
$4,058.30
|
|
|
MRI Humerus w/ + w/o Contrast Right
|
Professional
|
Both
|
$5,479.00
|
|
|
Service Code
|
CPT 73220
|
| Hospital Charge Code |
631027
|
| Min. Negotiated Rate |
$1,596.12 |
| Max. Negotiated Rate |
$5,205.05 |
| Rate for Payer: Aetna Commercial |
$5,205.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,711.94
|
| Rate for Payer: Cash Price |
$1,643.70
|
| Rate for Payer: Cash Price |
$1,643.70
|
| Rate for Payer: Cash Price |
$1,643.70
|
| Rate for Payer: Cigna Commercial |
$5,205.05
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,739.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,287.40
|
| Rate for Payer: Health EOS Commercial |
$4,985.89
|
| Rate for Payer: HFN Commercial |
$5,205.05
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,596.12
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,596.12
|
| Rate for Payer: Multiplan Commercial |
$4,383.20
|
| Rate for Payer: Preferred Network Access Commercial |
$5,205.05
|
| Rate for Payer: Quartz Beloit One Network |
$2,410.76
|
| Rate for Payer: Quartz Commercial |
$3,123.03
|
| Rate for Payer: The Alliance Commercial |
$2,739.50
|
| Rate for Payer: WEA Trust Commercial |
$3,013.45
|
| Rate for Payer: WPS Commercial |
$4,058.30
|
|
|
MRI Humerus w/ + w/o Contrast Right
|
Facility
|
OP
|
$6,077.00
|
|
|
Service Code
|
CPT 73220 TC,RT
|
| Hospital Charge Code |
2980037
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$380.12 |
| Max. Negotiated Rate |
$5,590.84 |
| Rate for Payer: Aetna Commercial |
$5,469.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,226.22
|
| 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 |
$3,220.81
|
| 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 |
$1,823.10
|
| Rate for Payer: Cash Price |
$1,823.10
|
| Rate for Payer: Cash Price |
$1,823.10
|
| Rate for Payer: Cash Price |
$1,823.10
|
| Rate for Payer: Cigna Commercial |
$5,590.84
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$380.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,400.69
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$380.12
|
| Rate for Payer: Health EOS Commercial |
$5,408.53
|
| Rate for Payer: HFN Commercial |
$5,590.84
|
| 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 |
$4,861.60
|
| Rate for Payer: NAPHCARE Commercial |
$570.18
|
| Rate for Payer: Preferred Network Access Commercial |
$5,590.84
|
| Rate for Payer: Quartz Beloit One Network |
$2,977.73
|
| Rate for Payer: Quartz Commercial |
$3,950.05
|
| 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 |
$3,342.35
|
| Rate for Payer: Wellcare Medicare |
$380.12
|
| Rate for Payer: WPS Commercial |
$4,501.23
|
|
|
MRI Humerus w/ + w/o Contrast Right
|
Facility
|
OP
|
$6,077.00
|
|
|
Service Code
|
CPT 73220 TC,RT
|
| Hospital Charge Code |
1611157
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$380.12 |
| Max. Negotiated Rate |
$5,590.84 |
| Rate for Payer: Aetna Commercial |
$5,469.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,226.22
|
| 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 |
$3,220.81
|
| 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 |
$1,823.10
|
| Rate for Payer: Cash Price |
$1,823.10
|
| Rate for Payer: Cash Price |
$1,823.10
|
| Rate for Payer: Cash Price |
$1,823.10
|
| Rate for Payer: Cigna Commercial |
$5,590.84
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$380.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,400.69
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$380.12
|
| Rate for Payer: Health EOS Commercial |
$5,408.53
|
| Rate for Payer: HFN Commercial |
$5,590.84
|
| 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 |
$4,861.60
|
| Rate for Payer: NAPHCARE Commercial |
$570.18
|
| Rate for Payer: Preferred Network Access Commercial |
$5,590.84
|
| Rate for Payer: Quartz Beloit One Network |
$2,977.73
|
| Rate for Payer: Quartz Commercial |
$3,950.05
|
| 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 |
$3,342.35
|
| Rate for Payer: Wellcare Medicare |
$380.12
|
| Rate for Payer: WPS Commercial |
$4,501.23
|
|
|
MRI Humerus w/ + w/o Contrast Right
|
Facility
|
IP
|
$5,479.00
|
|
|
Service Code
|
CPT 73220
|
| Hospital Charge Code |
631027
|
| Min. Negotiated Rate |
$2,684.71 |
| Max. Negotiated Rate |
$5,040.68 |
| Rate for Payer: Aetna Commercial |
$4,931.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,711.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,903.87
|
| Rate for Payer: Cash Price |
$1,643.70
|
| Rate for Payer: Cigna Commercial |
$5,040.68
|
| Rate for Payer: Health EOS Commercial |
$4,876.31
|
| Rate for Payer: HFN Commercial |
$5,040.68
|
| Rate for Payer: Multiplan Commercial |
$4,383.20
|
| Rate for Payer: NAPHCARE Commercial |
$3,287.40
|
| Rate for Payer: Preferred Network Access Commercial |
$5,040.68
|
| Rate for Payer: Quartz Beloit One Network |
$2,684.71
|
| Rate for Payer: Quartz Commercial |
$3,287.40
|
| Rate for Payer: WEA Trust Commercial |
$3,013.45
|
| Rate for Payer: WPS Commercial |
$4,058.30
|
|
|
MRI IAC w + w/o Contrast
|
Professional
|
Both
|
$6,115.00
|
|
|
Service Code
|
CPT 70553 TC
|
| Hospital Charge Code |
5382962
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$829.20 |
| Max. Negotiated Rate |
$5,809.25 |
| Rate for Payer: Aetna Commercial |
$5,809.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,258.90
|
| Rate for Payer: Cash Price |
$1,834.50
|
| Rate for Payer: Cash Price |
$1,834.50
|
| Rate for Payer: Cash Price |
$1,834.50
|
| Rate for Payer: Cigna Commercial |
$5,809.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$3,057.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,669.00
|
| Rate for Payer: Health EOS Commercial |
$5,564.65
|
| Rate for Payer: HFN Commercial |
$5,809.25
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$829.20
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$829.20
|
| Rate for Payer: Multiplan Commercial |
$4,892.00
|
| Rate for Payer: Preferred Network Access Commercial |
$5,809.25
|
| Rate for Payer: Quartz Beloit One Network |
$2,690.60
|
| Rate for Payer: Quartz Commercial |
$3,485.55
|
| Rate for Payer: The Alliance Commercial |
$3,057.50
|
| Rate for Payer: WEA Trust Commercial |
$3,363.25
|
| Rate for Payer: WPS Commercial |
$4,529.38
|
|
|
MRI IAC w + w/o Contrast
|
Facility
|
OP
|
$6,115.00
|
|
|
Service Code
|
CPT 70553 TC
|
| Hospital Charge Code |
5382962
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$380.12 |
| Max. Negotiated Rate |
$5,625.80 |
| Rate for Payer: Aetna Commercial |
$5,503.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,258.90
|
| 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 |
$3,240.95
|
| 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 |
$1,834.50
|
| Rate for Payer: Cash Price |
$1,834.50
|
| Rate for Payer: Cash Price |
$1,834.50
|
| Rate for Payer: Cash Price |
$1,834.50
|
| Rate for Payer: Cigna Commercial |
$5,625.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$380.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,421.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$380.12
|
| Rate for Payer: Health EOS Commercial |
$5,442.35
|
| Rate for Payer: HFN Commercial |
$5,625.80
|
| 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 |
$4,892.00
|
| Rate for Payer: NAPHCARE Commercial |
$570.18
|
| Rate for Payer: Preferred Network Access Commercial |
$5,625.80
|
| Rate for Payer: Quartz Beloit One Network |
$2,996.35
|
| Rate for Payer: Quartz Commercial |
$3,974.75
|
| 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 |
$3,363.25
|
| Rate for Payer: Wellcare Medicare |
$380.12
|
| Rate for Payer: WPS Commercial |
$4,529.38
|
|
|
MRI IAC w + w/o Contrast
|
Facility
|
IP
|
$6,115.00
|
|
|
Service Code
|
CPT 70553 TC
|
| Hospital Charge Code |
5382962
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$2,996.35 |
| Max. Negotiated Rate |
$5,625.80 |
| Rate for Payer: Aetna Commercial |
$5,503.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,258.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,240.95
|
| Rate for Payer: Cash Price |
$1,834.50
|
| Rate for Payer: Cigna Commercial |
$5,625.80
|
| Rate for Payer: Health EOS Commercial |
$5,442.35
|
| Rate for Payer: HFN Commercial |
$5,625.80
|
| Rate for Payer: Multiplan Commercial |
$4,892.00
|
| Rate for Payer: NAPHCARE Commercial |
$3,669.00
|
| Rate for Payer: Preferred Network Access Commercial |
$5,625.80
|
| Rate for Payer: Quartz Beloit One Network |
$2,996.35
|
| Rate for Payer: Quartz Commercial |
$3,669.00
|
| Rate for Payer: WEA Trust Commercial |
$3,363.25
|
| Rate for Payer: WPS Commercial |
$4,529.38
|
|
|
MRI Knee w/ Contrast Bilateral
|
Professional
|
Both
|
$10,169.00
|
|
|
Service Code
|
CPT 73722
|
| Hospital Charge Code |
631093
|
| Min. Negotiated Rate |
$1,222.30 |
| Max. Negotiated Rate |
$9,660.55 |
| Rate for Payer: Aetna Commercial |
$9,660.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,745.34
|
| Rate for Payer: Cash Price |
$3,050.70
|
| Rate for Payer: Cash Price |
$3,050.70
|
| Rate for Payer: Cash Price |
$3,050.70
|
| Rate for Payer: Cigna Commercial |
$9,660.55
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$5,084.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,101.40
|
| Rate for Payer: Health EOS Commercial |
$9,253.79
|
| Rate for Payer: HFN Commercial |
$9,660.55
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,222.30
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,222.30
|
| Rate for Payer: Multiplan Commercial |
$8,135.20
|
| Rate for Payer: Preferred Network Access Commercial |
$9,660.55
|
| Rate for Payer: Quartz Beloit One Network |
$4,474.36
|
| Rate for Payer: Quartz Commercial |
$5,796.33
|
| Rate for Payer: The Alliance Commercial |
$5,084.50
|
| Rate for Payer: WEA Trust Commercial |
$5,592.95
|
| Rate for Payer: WPS Commercial |
$7,532.18
|
|
|
MRI Knee w/ Contrast Bilateral
|
Professional
|
Both
|
$4,988.00
|
|
|
Service Code
|
CPT 73722 TC,LT
|
| Hospital Charge Code |
1611177
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,222.30 |
| Max. Negotiated Rate |
$4,738.60 |
| Rate for Payer: Aetna Commercial |
$4,738.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,289.68
|
| Rate for Payer: Cash Price |
$1,496.40
|
| Rate for Payer: Cash Price |
$1,496.40
|
| Rate for Payer: Cash Price |
$1,496.40
|
| Rate for Payer: Cigna Commercial |
$4,738.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,494.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,992.80
|
| Rate for Payer: Health EOS Commercial |
$4,539.08
|
| Rate for Payer: HFN Commercial |
$4,738.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,222.30
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,222.30
|
| Rate for Payer: Multiplan Commercial |
$3,990.40
|
| Rate for Payer: Preferred Network Access Commercial |
$4,738.60
|
| Rate for Payer: Quartz Beloit One Network |
$2,194.72
|
| Rate for Payer: Quartz Commercial |
$2,843.16
|
| Rate for Payer: The Alliance Commercial |
$2,494.00
|
| Rate for Payer: WEA Trust Commercial |
$2,743.40
|
| Rate for Payer: WPS Commercial |
$3,694.61
|
|
|
MRI Knee w/ Contrast Bilateral
|
Facility
|
OP
|
$10,169.00
|
|
|
Service Code
|
CPT 73722
|
| Hospital Charge Code |
631093
|
| Min. Negotiated Rate |
$791.40 |
| Max. Negotiated Rate |
$9,355.48 |
| Rate for Payer: Aetna Commercial |
$9,152.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,745.34
|
| Rate for Payer: Aetna Managed Medicare |
$791.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,609.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,084.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,881.12
|
| Rate for Payer: Anthem Medicare Advantage |
$791.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,389.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$791.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$791.40
|
| Rate for Payer: Cash Price |
$3,050.70
|
| Rate for Payer: Cash Price |
$3,050.70
|
| Rate for Payer: Cigna Commercial |
$9,355.48
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$791.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,690.57
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$791.40
|
| Rate for Payer: Health EOS Commercial |
$9,050.41
|
| Rate for Payer: HFN Commercial |
$9,355.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,944.01
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$791.40
|
| Rate for Payer: Independent Care Health Plan Medicare |
$791.40
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$791.40
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$791.40
|
| Rate for Payer: Multiplan Commercial |
$8,135.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,187.10
|
| Rate for Payer: Preferred Network Access Commercial |
$9,355.48
|
| Rate for Payer: Quartz Beloit One Network |
$4,982.81
|
| Rate for Payer: Quartz Commercial |
$6,609.85
|
| Rate for Payer: Quartz Medicare Advantage |
$791.40
|
| Rate for Payer: The Alliance Commercial |
$3,165.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$791.40
|
| Rate for Payer: WEA Trust Commercial |
$5,592.95
|
| Rate for Payer: Wellcare Medicare |
$791.40
|
| Rate for Payer: WPS Commercial |
$7,532.18
|
|
|
MRI Knee w/ Contrast Bilateral
|
Facility
|
IP
|
$4,988.00
|
|
|
Service Code
|
CPT 73722 TC,LT
|
| Hospital Charge Code |
1611177
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$2,444.12 |
| Max. Negotiated Rate |
$4,588.96 |
| Rate for Payer: Aetna Commercial |
$4,489.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,289.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,643.64
|
| Rate for Payer: Cash Price |
$1,496.40
|
| Rate for Payer: Cigna Commercial |
$4,588.96
|
| Rate for Payer: Health EOS Commercial |
$4,439.32
|
| Rate for Payer: HFN Commercial |
$4,588.96
|
| Rate for Payer: Multiplan Commercial |
$3,990.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,992.80
|
| Rate for Payer: Preferred Network Access Commercial |
$4,588.96
|
| Rate for Payer: Quartz Beloit One Network |
$2,444.12
|
| Rate for Payer: Quartz Commercial |
$2,992.80
|
| Rate for Payer: WEA Trust Commercial |
$2,743.40
|
| Rate for Payer: WPS Commercial |
$3,694.61
|
|
