|
MRI Forearm w/ + w/o Contrast Left
|
Facility
|
IP
|
$6,636.00
|
|
|
Service Code
|
CPT 73220 TC,LT
|
| Hospital Charge Code |
1611099
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$3,381.71 |
| Max. Negotiated Rate |
$6,349.32 |
| Rate for Payer: Aetna Commercial |
$6,211.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,935.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,657.76
|
| Rate for Payer: Cash Price |
$1,990.80
|
| Rate for Payer: Cigna Commercial |
$6,349.32
|
| Rate for Payer: Health EOS Commercial |
$6,142.28
|
| Rate for Payer: HFN Commercial |
$6,349.32
|
| Rate for Payer: Multiplan Commercial |
$5,521.15
|
| Rate for Payer: Preferred Network Access Commercial |
$6,349.32
|
| Rate for Payer: Quartz Beloit One Network |
$3,381.71
|
| Rate for Payer: Quartz Commercial |
$4,140.86
|
| Rate for Payer: WEA Trust Commercial |
$3,795.79
|
| Rate for Payer: WPS Commercial |
$5,111.71
|
|
|
MRI Forearm w/ + w/o Contrast Left
|
Facility
|
OP
|
$6,636.00
|
|
|
Service Code
|
CPT 73220 TC,LT
|
| Hospital Charge Code |
1611099
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,932.40 |
| Max. Negotiated Rate |
$6,349.32 |
| Rate for Payer: Aetna Commercial |
$6,211.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,935.24
|
| Rate for Payer: Aetna Managed Medicare |
$1,932.40
|
| 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 |
$3,657.76
|
| 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 |
$6,349.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,862.15
|
| Rate for Payer: Health EOS Commercial |
$6,142.28
|
| Rate for Payer: HFN Commercial |
$6,349.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,176.08
|
| Rate for Payer: Multiplan Commercial |
$5,521.15
|
| Rate for Payer: NAPHCARE Commercial |
$4,140.86
|
| Rate for Payer: Preferred Network Access Commercial |
$6,349.32
|
| Rate for Payer: Quartz Beloit One Network |
$3,381.71
|
| Rate for Payer: Quartz Commercial |
$4,485.94
|
| Rate for Payer: Quartz Medicare Advantage |
$4,140.86
|
| Rate for Payer: The Alliance Commercial |
$3,450.72
|
| Rate for Payer: United Healthcare PPO |
$3,142.88
|
| Rate for Payer: WEA Trust Commercial |
$3,795.79
|
| Rate for Payer: WPS Commercial |
$5,111.71
|
|
|
MRI Forearm w/ + w/o Contrast Right
|
Professional
|
Both
|
$6,636.00
|
|
|
Service Code
|
CPT 73220 TC,RT
|
| Hospital Charge Code |
1611101
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,659.96 |
| Max. Negotiated Rate |
$6,556.37 |
| Rate for Payer: Aetna Commercial |
$6,556.37
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,935.24
|
| 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 |
$6,556.37
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$3,450.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,140.86
|
| Rate for Payer: Health EOS Commercial |
$6,280.31
|
| Rate for Payer: HFN Commercial |
$6,556.37
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,659.96
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,659.96
|
| Rate for Payer: Multiplan Commercial |
$5,521.15
|
| Rate for Payer: Preferred Network Access Commercial |
$6,556.37
|
| Rate for Payer: Quartz Beloit One Network |
$3,036.63
|
| Rate for Payer: Quartz Commercial |
$3,933.82
|
| Rate for Payer: The Alliance Commercial |
$3,450.72
|
| Rate for Payer: WEA Trust Commercial |
$3,795.79
|
| Rate for Payer: WPS Commercial |
$5,111.71
|
|
|
MRI Forearm w/ + w/o Contrast Right
|
Facility
|
OP
|
$5,479.00
|
|
|
Service Code
|
CPT 73220
|
| Hospital Charge Code |
630913
|
| Min. Negotiated Rate |
$367.15 |
| Max. Negotiated Rate |
$5,242.31 |
| Rate for Payer: Aetna Commercial |
$5,128.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,900.42
|
| Rate for Payer: Aetna Managed Medicare |
$367.15
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,703.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,849.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,735.12
|
| Rate for Payer: Anthem Medicare Advantage |
$367.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,020.02
|
| 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 |
$1,643.70
|
| Rate for Payer: Cash Price |
$1,643.70
|
| Rate for Payer: Cigna Commercial |
$5,242.31
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$367.15
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,188.78
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$367.15
|
| Rate for Payer: Health EOS Commercial |
$5,071.36
|
| Rate for Payer: HFN Commercial |
$5,242.31
|
| 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 |
$4,558.53
|
| Rate for Payer: NAPHCARE Commercial |
$550.73
|
| Rate for Payer: Preferred Network Access Commercial |
$5,242.31
|
| Rate for Payer: Quartz Beloit One Network |
$2,792.10
|
| Rate for Payer: Quartz Commercial |
$3,703.80
|
| 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 |
$3,133.99
|
| Rate for Payer: Wellcare Medicare |
$367.15
|
| Rate for Payer: WPS Commercial |
$4,220.47
|
|
|
MRI Forearm w/ + w/o Contrast Right
|
Professional
|
Both
|
$5,479.00
|
|
|
Service Code
|
CPT 73220
|
| Hospital Charge Code |
630913
|
| Min. Negotiated Rate |
$404.78 |
| Max. Negotiated Rate |
$5,413.25 |
| Rate for Payer: Aetna Commercial |
$5,413.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,900.42
|
| Rate for Payer: Aetna Managed Medicare |
$404.78
|
| Rate for Payer: Anthem Medicare Advantage |
$404.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$404.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$404.78
|
| 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 |
$5,413.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,849.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$404.78
|
| Rate for Payer: Health EOS Commercial |
$5,185.33
|
| Rate for Payer: HFN Commercial |
$5,413.25
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,659.96
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,659.96
|
| Rate for Payer: Independent Care Health Plan Medicare |
$404.78
|
| Rate for Payer: Multiplan Commercial |
$4,558.53
|
| Rate for Payer: NAPHCARE Commercial |
$607.17
|
| Rate for Payer: Preferred Network Access Commercial |
$5,413.25
|
| Rate for Payer: Quartz Beloit One Network |
$2,507.19
|
| Rate for Payer: Quartz Commercial |
$3,247.95
|
| Rate for Payer: Quartz Medicare Advantage |
$404.78
|
| Rate for Payer: The Alliance Commercial |
$1,538.16
|
| Rate for Payer: United Healthcare Medicare Advantage |
$404.78
|
| Rate for Payer: WEA Trust Commercial |
$3,133.99
|
| Rate for Payer: WPS Commercial |
$2,023.89
|
|
|
MRI Forearm w/ + w/o Contrast Right
|
Facility
|
IP
|
$5,479.00
|
|
|
Service Code
|
CPT 73220
|
| Hospital Charge Code |
630913
|
| Min. Negotiated Rate |
$2,792.10 |
| Max. Negotiated Rate |
$5,242.31 |
| Rate for Payer: Aetna Commercial |
$5,128.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,900.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,020.02
|
| Rate for Payer: Cash Price |
$1,643.70
|
| Rate for Payer: Cigna Commercial |
$5,242.31
|
| Rate for Payer: Health EOS Commercial |
$5,071.36
|
| Rate for Payer: HFN Commercial |
$5,242.31
|
| Rate for Payer: Multiplan Commercial |
$4,558.53
|
| Rate for Payer: Preferred Network Access Commercial |
$5,242.31
|
| Rate for Payer: Quartz Beloit One Network |
$2,792.10
|
| Rate for Payer: Quartz Commercial |
$3,418.90
|
| Rate for Payer: WEA Trust Commercial |
$3,133.99
|
| Rate for Payer: WPS Commercial |
$4,220.47
|
|
|
MRI Forearm w/ + w/o Contrast Right
|
Facility
|
OP
|
$6,077.00
|
|
|
Service Code
|
CPT 73220 TC,RT
|
| Hospital Charge Code |
2980035
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,769.62 |
| Max. Negotiated Rate |
$5,814.47 |
| Rate for Payer: Aetna Commercial |
$5,688.07
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,435.27
|
| Rate for Payer: Aetna Managed Medicare |
$1,769.62
|
| 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 |
$3,349.64
|
| 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 |
$5,814.47
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,536.81
|
| Rate for Payer: Health EOS Commercial |
$5,624.87
|
| Rate for Payer: HFN Commercial |
$5,814.47
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,740.06
|
| Rate for Payer: Multiplan Commercial |
$5,056.06
|
| Rate for Payer: NAPHCARE Commercial |
$3,792.05
|
| Rate for Payer: Preferred Network Access Commercial |
$5,814.47
|
| Rate for Payer: Quartz Beloit One Network |
$3,096.84
|
| Rate for Payer: Quartz Commercial |
$4,108.05
|
| Rate for Payer: Quartz Medicare Advantage |
$3,792.05
|
| Rate for Payer: The Alliance Commercial |
$3,160.04
|
| Rate for Payer: United Healthcare PPO |
$3,142.88
|
| Rate for Payer: WEA Trust Commercial |
$3,476.04
|
| Rate for Payer: WPS Commercial |
$4,681.11
|
|
|
MRI Forearm w/ + w/o Contrast Right
|
Professional
|
Both
|
$6,077.00
|
|
|
Service Code
|
CPT 73220 TC,RT
|
| Hospital Charge Code |
2980035
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,659.96 |
| Max. Negotiated Rate |
$6,004.08 |
| Rate for Payer: Aetna Commercial |
$6,004.08
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,435.27
|
| 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 |
$6,004.08
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$3,160.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,792.05
|
| Rate for Payer: Health EOS Commercial |
$5,751.27
|
| Rate for Payer: HFN Commercial |
$6,004.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,659.96
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,659.96
|
| Rate for Payer: Multiplan Commercial |
$5,056.06
|
| Rate for Payer: Preferred Network Access Commercial |
$6,004.08
|
| Rate for Payer: Quartz Beloit One Network |
$2,780.84
|
| Rate for Payer: Quartz Commercial |
$3,602.45
|
| Rate for Payer: The Alliance Commercial |
$3,160.04
|
| Rate for Payer: WEA Trust Commercial |
$3,476.04
|
| Rate for Payer: WPS Commercial |
$4,681.11
|
|
|
MRI Forearm w/ + w/o Contrast Right
|
Facility
|
IP
|
$6,077.00
|
|
|
Service Code
|
CPT 73220 TC,RT
|
| Hospital Charge Code |
2980035
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$3,096.84 |
| Max. Negotiated Rate |
$5,814.47 |
| Rate for Payer: Aetna Commercial |
$5,688.07
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,435.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,349.64
|
| Rate for Payer: Cash Price |
$1,823.10
|
| Rate for Payer: Cigna Commercial |
$5,814.47
|
| Rate for Payer: Health EOS Commercial |
$5,624.87
|
| Rate for Payer: HFN Commercial |
$5,814.47
|
| Rate for Payer: Multiplan Commercial |
$5,056.06
|
| Rate for Payer: Preferred Network Access Commercial |
$5,814.47
|
| Rate for Payer: Quartz Beloit One Network |
$3,096.84
|
| Rate for Payer: Quartz Commercial |
$3,792.05
|
| Rate for Payer: WEA Trust Commercial |
$3,476.04
|
| Rate for Payer: WPS Commercial |
$4,681.11
|
|
|
MRI Forearm w/ + w/o Contrast Right
|
Facility
|
OP
|
$6,636.00
|
|
|
Service Code
|
CPT 73220 TC,RT
|
| Hospital Charge Code |
1611101
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,932.40 |
| Max. Negotiated Rate |
$6,349.32 |
| Rate for Payer: Aetna Commercial |
$6,211.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,935.24
|
| Rate for Payer: Aetna Managed Medicare |
$1,932.40
|
| 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 |
$3,657.76
|
| 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 |
$6,349.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,862.15
|
| Rate for Payer: Health EOS Commercial |
$6,142.28
|
| Rate for Payer: HFN Commercial |
$6,349.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,176.08
|
| Rate for Payer: Multiplan Commercial |
$5,521.15
|
| Rate for Payer: NAPHCARE Commercial |
$4,140.86
|
| Rate for Payer: Preferred Network Access Commercial |
$6,349.32
|
| Rate for Payer: Quartz Beloit One Network |
$3,381.71
|
| Rate for Payer: Quartz Commercial |
$4,485.94
|
| Rate for Payer: Quartz Medicare Advantage |
$4,140.86
|
| Rate for Payer: The Alliance Commercial |
$3,450.72
|
| Rate for Payer: United Healthcare PPO |
$3,142.88
|
| Rate for Payer: WEA Trust Commercial |
$3,795.79
|
| Rate for Payer: WPS Commercial |
$5,111.71
|
|
|
MRI Forearm w/ + w/o Contrast Right
|
Facility
|
IP
|
$6,636.00
|
|
|
Service Code
|
CPT 73220 TC,RT
|
| Hospital Charge Code |
1611101
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$3,381.71 |
| Max. Negotiated Rate |
$6,349.32 |
| Rate for Payer: Aetna Commercial |
$6,211.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,935.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,657.76
|
| Rate for Payer: Cash Price |
$1,990.80
|
| Rate for Payer: Cigna Commercial |
$6,349.32
|
| Rate for Payer: Health EOS Commercial |
$6,142.28
|
| Rate for Payer: HFN Commercial |
$6,349.32
|
| Rate for Payer: Multiplan Commercial |
$5,521.15
|
| Rate for Payer: Preferred Network Access Commercial |
$6,349.32
|
| Rate for Payer: Quartz Beloit One Network |
$3,381.71
|
| Rate for Payer: Quartz Commercial |
$4,140.86
|
| Rate for Payer: WEA Trust Commercial |
$3,795.79
|
| Rate for Payer: WPS Commercial |
$5,111.71
|
|
|
MRI GUIDANCE
|
Facility
|
OP
|
$187.37
|
|
|
Service Code
|
EAPG 00475
|
| Min. Negotiated Rate |
$180.17 |
| Max. Negotiated Rate |
$187.37 |
| Rate for Payer: Anthem Medicaid |
$180.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$180.17
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$180.17
|
| Rate for Payer: Dean Health Medicaid |
$180.17
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$180.17
|
| Rate for Payer: Managed Health Services Medicaid |
$187.37
|
| Rate for Payer: Molina Healthcare Medicaid |
$180.17
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$180.17
|
| Rate for Payer: United Healthcare Medicaid |
$180.17
|
|
|
MRI Hand w/ Contrast Bilateral
|
Professional
|
Both
|
$10,322.00
|
|
|
Service Code
|
CPT 73219
|
| Hospital Charge Code |
630959
|
| Min. Negotiated Rate |
$328.28 |
| Max. Negotiated Rate |
$10,198.14 |
| Rate for Payer: Aetna Commercial |
$10,198.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,232.00
|
| Rate for Payer: Aetna Managed Medicare |
$328.28
|
| Rate for Payer: Anthem Medicare Advantage |
$328.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$328.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$328.28
|
| 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 |
$10,198.14
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$5,367.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$328.28
|
| Rate for Payer: Health EOS Commercial |
$9,768.74
|
| Rate for Payer: HFN Commercial |
$10,198.14
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,339.95
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,339.95
|
| Rate for Payer: Independent Care Health Plan Medicare |
$328.28
|
| Rate for Payer: Multiplan Commercial |
$8,587.90
|
| Rate for Payer: NAPHCARE Commercial |
$492.41
|
| Rate for Payer: Preferred Network Access Commercial |
$10,198.14
|
| Rate for Payer: Quartz Beloit One Network |
$4,723.35
|
| Rate for Payer: Quartz Commercial |
$6,118.88
|
| Rate for Payer: Quartz Medicare Advantage |
$328.28
|
| Rate for Payer: The Alliance Commercial |
$1,247.45
|
| Rate for Payer: United Healthcare Medicare Advantage |
$328.28
|
| Rate for Payer: WEA Trust Commercial |
$5,904.18
|
| Rate for Payer: WPS Commercial |
$1,641.38
|
|
|
MRI Hand w/ Contrast Bilateral
|
Facility
|
OP
|
$10,322.00
|
|
|
Service Code
|
CPT 73219
|
| Hospital Charge Code |
630959
|
| Min. Negotiated Rate |
$367.15 |
| Max. Negotiated Rate |
$9,876.09 |
| Rate for Payer: Aetna Commercial |
$9,661.39
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,232.00
|
| Rate for Payer: Aetna Managed Medicare |
$367.15
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,977.67
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,367.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,152.74
|
| Rate for Payer: Anthem Medicare Advantage |
$367.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,689.49
|
| 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 |
$3,096.60
|
| Rate for Payer: Cash Price |
$3,096.60
|
| Rate for Payer: Cigna Commercial |
$9,876.09
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$367.15
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,007.40
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$367.15
|
| Rate for Payer: Health EOS Commercial |
$9,554.04
|
| Rate for Payer: HFN Commercial |
$9,876.09
|
| 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 |
$8,587.90
|
| Rate for Payer: NAPHCARE Commercial |
$550.73
|
| Rate for Payer: Preferred Network Access Commercial |
$9,876.09
|
| Rate for Payer: Quartz Beloit One Network |
$5,260.09
|
| Rate for Payer: Quartz Commercial |
$6,977.67
|
| 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 |
$5,904.18
|
| Rate for Payer: Wellcare Medicare |
$367.15
|
| Rate for Payer: WPS Commercial |
$7,951.04
|
|
|
MRI Hand w/ Contrast Bilateral
|
Facility
|
OP
|
$5,063.00
|
|
|
Service Code
|
CPT 73219 TC,LT
|
| Hospital Charge Code |
1611123
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,474.35 |
| Max. Negotiated Rate |
$4,844.28 |
| Rate for Payer: Aetna Commercial |
$4,738.97
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,528.35
|
| Rate for Payer: Aetna Managed Medicare |
$1,474.35
|
| 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 |
$2,790.73
|
| 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 |
$4,844.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,946.67
|
| Rate for Payer: Health EOS Commercial |
$4,686.31
|
| Rate for Payer: HFN Commercial |
$4,844.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,949.14
|
| Rate for Payer: Multiplan Commercial |
$4,212.42
|
| Rate for Payer: NAPHCARE Commercial |
$3,159.31
|
| Rate for Payer: Preferred Network Access Commercial |
$4,844.28
|
| Rate for Payer: Quartz Beloit One Network |
$2,580.10
|
| Rate for Payer: Quartz Commercial |
$3,422.59
|
| Rate for Payer: Quartz Medicare Advantage |
$3,159.31
|
| Rate for Payer: The Alliance Commercial |
$2,632.76
|
| Rate for Payer: United Healthcare PPO |
$3,142.88
|
| Rate for Payer: WEA Trust Commercial |
$2,896.04
|
| Rate for Payer: WPS Commercial |
$3,900.03
|
|
|
MRI Hand w/ Contrast Bilateral
|
Professional
|
Both
|
$5,063.00
|
|
|
Service Code
|
CPT 73219 TC,LT
|
| Hospital Charge Code |
1611123
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,339.95 |
| Max. Negotiated Rate |
$5,002.24 |
| Rate for Payer: Aetna Commercial |
$5,002.24
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,528.35
|
| 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 |
$5,002.24
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,632.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,159.31
|
| Rate for Payer: Health EOS Commercial |
$4,791.62
|
| Rate for Payer: HFN Commercial |
$5,002.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,339.95
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,339.95
|
| Rate for Payer: Multiplan Commercial |
$4,212.42
|
| Rate for Payer: Preferred Network Access Commercial |
$5,002.24
|
| Rate for Payer: Quartz Beloit One Network |
$2,316.83
|
| Rate for Payer: Quartz Commercial |
$3,001.35
|
| Rate for Payer: The Alliance Commercial |
$2,632.76
|
| Rate for Payer: WEA Trust Commercial |
$2,896.04
|
| Rate for Payer: WPS Commercial |
$3,900.03
|
|
|
MRI Hand w/ Contrast Bilateral
|
Facility
|
IP
|
$5,063.00
|
|
|
Service Code
|
CPT 73219 TC,LT
|
| Hospital Charge Code |
1611123
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$2,580.10 |
| Max. Negotiated Rate |
$4,844.28 |
| Rate for Payer: Aetna Commercial |
$4,738.97
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,528.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,790.73
|
| Rate for Payer: Cash Price |
$1,518.90
|
| Rate for Payer: Cigna Commercial |
$4,844.28
|
| Rate for Payer: Health EOS Commercial |
$4,686.31
|
| Rate for Payer: HFN Commercial |
$4,844.28
|
| Rate for Payer: Multiplan Commercial |
$4,212.42
|
| Rate for Payer: Preferred Network Access Commercial |
$4,844.28
|
| Rate for Payer: Quartz Beloit One Network |
$2,580.10
|
| Rate for Payer: Quartz Commercial |
$3,159.31
|
| Rate for Payer: WEA Trust Commercial |
$2,896.04
|
| Rate for Payer: WPS Commercial |
$3,900.03
|
|
|
MRI Hand w/ Contrast Bilateral
|
Facility
|
IP
|
$10,322.00
|
|
|
Service Code
|
CPT 73219
|
| Hospital Charge Code |
630959
|
| Min. Negotiated Rate |
$5,260.09 |
| Max. Negotiated Rate |
$9,876.09 |
| Rate for Payer: Aetna Commercial |
$9,661.39
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,232.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,689.49
|
| Rate for Payer: Cash Price |
$3,096.60
|
| Rate for Payer: Cigna Commercial |
$9,876.09
|
| Rate for Payer: Health EOS Commercial |
$9,554.04
|
| Rate for Payer: HFN Commercial |
$9,876.09
|
| Rate for Payer: Multiplan Commercial |
$8,587.90
|
| Rate for Payer: Preferred Network Access Commercial |
$9,876.09
|
| Rate for Payer: Quartz Beloit One Network |
$5,260.09
|
| Rate for Payer: Quartz Commercial |
$6,440.93
|
| Rate for Payer: WEA Trust Commercial |
$5,904.18
|
| Rate for Payer: WPS Commercial |
$7,951.04
|
|
|
MRI Hand w/ Contrast Left
|
Professional
|
Both
|
$5,162.00
|
|
|
Service Code
|
CPT 73219
|
| Hospital Charge Code |
630963
|
| Min. Negotiated Rate |
$328.28 |
| Max. Negotiated Rate |
$5,100.06 |
| Rate for Payer: Aetna Commercial |
$5,100.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,616.89
|
| Rate for Payer: Aetna Managed Medicare |
$328.28
|
| Rate for Payer: Anthem Medicare Advantage |
$328.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$328.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$328.28
|
| 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 |
$5,100.06
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,684.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$328.28
|
| Rate for Payer: Health EOS Commercial |
$4,885.32
|
| Rate for Payer: HFN Commercial |
$5,100.06
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,339.95
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,339.95
|
| Rate for Payer: Independent Care Health Plan Medicare |
$328.28
|
| Rate for Payer: Multiplan Commercial |
$4,294.78
|
| Rate for Payer: NAPHCARE Commercial |
$492.41
|
| Rate for Payer: Preferred Network Access Commercial |
$5,100.06
|
| Rate for Payer: Quartz Beloit One Network |
$2,362.13
|
| Rate for Payer: Quartz Commercial |
$3,060.03
|
| Rate for Payer: Quartz Medicare Advantage |
$328.28
|
| Rate for Payer: The Alliance Commercial |
$1,247.45
|
| Rate for Payer: United Healthcare Medicare Advantage |
$328.28
|
| Rate for Payer: WEA Trust Commercial |
$2,952.66
|
| Rate for Payer: WPS Commercial |
$1,641.38
|
|
|
MRI Hand w/ Contrast Left
|
Facility
|
IP
|
$5,162.00
|
|
|
Service Code
|
CPT 73219
|
| Hospital Charge Code |
630963
|
| Min. Negotiated Rate |
$2,630.56 |
| Max. Negotiated Rate |
$4,939.00 |
| Rate for Payer: Aetna Commercial |
$4,831.63
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,616.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,845.29
|
| Rate for Payer: Cash Price |
$1,548.60
|
| Rate for Payer: Cigna Commercial |
$4,939.00
|
| Rate for Payer: Health EOS Commercial |
$4,777.95
|
| Rate for Payer: HFN Commercial |
$4,939.00
|
| Rate for Payer: Multiplan Commercial |
$4,294.78
|
| Rate for Payer: Preferred Network Access Commercial |
$4,939.00
|
| Rate for Payer: Quartz Beloit One Network |
$2,630.56
|
| Rate for Payer: Quartz Commercial |
$3,221.09
|
| Rate for Payer: WEA Trust Commercial |
$2,952.66
|
| Rate for Payer: WPS Commercial |
$3,976.29
|
|
|
MRI Hand w/ Contrast Left
|
Professional
|
Both
|
$5,063.00
|
|
|
Service Code
|
CPT 73219 TC,LT
|
| Hospital Charge Code |
1611125
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,339.95 |
| Max. Negotiated Rate |
$5,002.24 |
| Rate for Payer: Aetna Commercial |
$5,002.24
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,528.35
|
| 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 |
$5,002.24
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,632.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,159.31
|
| Rate for Payer: Health EOS Commercial |
$4,791.62
|
| Rate for Payer: HFN Commercial |
$5,002.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,339.95
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,339.95
|
| Rate for Payer: Multiplan Commercial |
$4,212.42
|
| Rate for Payer: Preferred Network Access Commercial |
$5,002.24
|
| Rate for Payer: Quartz Beloit One Network |
$2,316.83
|
| Rate for Payer: Quartz Commercial |
$3,001.35
|
| Rate for Payer: The Alliance Commercial |
$2,632.76
|
| Rate for Payer: WEA Trust Commercial |
$2,896.04
|
| Rate for Payer: WPS Commercial |
$3,900.03
|
|
|
MRI Hand w/ Contrast Left
|
Facility
|
OP
|
$5,162.00
|
|
|
Service Code
|
CPT 73219
|
| Hospital Charge Code |
630963
|
| Min. Negotiated Rate |
$367.15 |
| Max. Negotiated Rate |
$4,939.00 |
| Rate for Payer: Aetna Commercial |
$4,831.63
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,616.89
|
| Rate for Payer: Aetna Managed Medicare |
$367.15
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,489.51
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,684.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,576.87
|
| Rate for Payer: Anthem Medicare Advantage |
$367.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,845.29
|
| 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 |
$1,548.60
|
| Rate for Payer: Cash Price |
$1,548.60
|
| Rate for Payer: Cigna Commercial |
$4,939.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$367.15
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,004.28
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$367.15
|
| Rate for Payer: Health EOS Commercial |
$4,777.95
|
| Rate for Payer: HFN Commercial |
$4,939.00
|
| 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 |
$4,294.78
|
| Rate for Payer: NAPHCARE Commercial |
$550.73
|
| Rate for Payer: Preferred Network Access Commercial |
$4,939.00
|
| Rate for Payer: Quartz Beloit One Network |
$2,630.56
|
| Rate for Payer: Quartz Commercial |
$3,489.51
|
| 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 |
$2,952.66
|
| Rate for Payer: Wellcare Medicare |
$367.15
|
| Rate for Payer: WPS Commercial |
$3,976.29
|
|
|
MRI Hand w/ Contrast Left
|
Facility
|
OP
|
$5,063.00
|
|
|
Service Code
|
CPT 73219 TC,LT
|
| Hospital Charge Code |
1611125
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,474.35 |
| Max. Negotiated Rate |
$4,844.28 |
| Rate for Payer: Aetna Commercial |
$4,738.97
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,528.35
|
| Rate for Payer: Aetna Managed Medicare |
$1,474.35
|
| 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 |
$2,790.73
|
| 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 |
$4,844.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,946.67
|
| Rate for Payer: Health EOS Commercial |
$4,686.31
|
| Rate for Payer: HFN Commercial |
$4,844.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,949.14
|
| Rate for Payer: Multiplan Commercial |
$4,212.42
|
| Rate for Payer: NAPHCARE Commercial |
$3,159.31
|
| Rate for Payer: Preferred Network Access Commercial |
$4,844.28
|
| Rate for Payer: Quartz Beloit One Network |
$2,580.10
|
| Rate for Payer: Quartz Commercial |
$3,422.59
|
| Rate for Payer: Quartz Medicare Advantage |
$3,159.31
|
| Rate for Payer: The Alliance Commercial |
$2,632.76
|
| Rate for Payer: United Healthcare PPO |
$3,142.88
|
| Rate for Payer: WEA Trust Commercial |
$2,896.04
|
| Rate for Payer: WPS Commercial |
$3,900.03
|
|
|
MRI Hand w/ Contrast Left
|
Facility
|
IP
|
$5,063.00
|
|
|
Service Code
|
CPT 73219 TC,LT
|
| Hospital Charge Code |
1611125
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$2,580.10 |
| Max. Negotiated Rate |
$4,844.28 |
| Rate for Payer: Aetna Commercial |
$4,738.97
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,528.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,790.73
|
| Rate for Payer: Cash Price |
$1,518.90
|
| Rate for Payer: Cigna Commercial |
$4,844.28
|
| Rate for Payer: Health EOS Commercial |
$4,686.31
|
| Rate for Payer: HFN Commercial |
$4,844.28
|
| Rate for Payer: Multiplan Commercial |
$4,212.42
|
| Rate for Payer: Preferred Network Access Commercial |
$4,844.28
|
| Rate for Payer: Quartz Beloit One Network |
$2,580.10
|
| Rate for Payer: Quartz Commercial |
$3,159.31
|
| Rate for Payer: WEA Trust Commercial |
$2,896.04
|
| Rate for Payer: WPS Commercial |
$3,900.03
|
|
|
MRI Hand w/ Contrast Right
|
Professional
|
Both
|
$5,063.00
|
|
|
Service Code
|
CPT 73219 TC,RT
|
| Hospital Charge Code |
1611127
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,339.95 |
| Max. Negotiated Rate |
$5,002.24 |
| Rate for Payer: Aetna Commercial |
$5,002.24
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,528.35
|
| 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 |
$5,002.24
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,632.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,159.31
|
| Rate for Payer: Health EOS Commercial |
$4,791.62
|
| Rate for Payer: HFN Commercial |
$5,002.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,339.95
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,339.95
|
| Rate for Payer: Multiplan Commercial |
$4,212.42
|
| Rate for Payer: Preferred Network Access Commercial |
$5,002.24
|
| Rate for Payer: Quartz Beloit One Network |
$2,316.83
|
| Rate for Payer: Quartz Commercial |
$3,001.35
|
| Rate for Payer: The Alliance Commercial |
$2,632.76
|
| Rate for Payer: WEA Trust Commercial |
$2,896.04
|
| Rate for Payer: WPS Commercial |
$3,900.03
|
|
