|
MRI Shoulder w/ + w/o Contrast Bilateral
|
Facility
|
OP
|
$11,703.00
|
|
|
Service Code
|
CPT 73223
|
| Hospital Charge Code |
631215
|
| Min. Negotiated Rate |
$380.12 |
| Max. Negotiated Rate |
$10,766.76 |
| Rate for Payer: Aetna Commercial |
$10,532.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,064.58
|
| Rate for Payer: Aetna Managed Medicare |
$380.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$7,606.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,851.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,617.44
|
| Rate for Payer: Anthem Medicare Advantage |
$380.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,202.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$380.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$380.12
|
| Rate for Payer: Cash Price |
$3,510.90
|
| Rate for Payer: Cash Price |
$3,510.90
|
| Rate for Payer: Cigna Commercial |
$10,766.76
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$380.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,549.00
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$380.12
|
| Rate for Payer: Health EOS Commercial |
$10,415.67
|
| Rate for Payer: HFN Commercial |
$10,766.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,414.05
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$380.12
|
| Rate for Payer: Independent Care Health Plan Medicare |
$380.12
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$380.12
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$380.12
|
| Rate for Payer: Multiplan Commercial |
$9,362.40
|
| Rate for Payer: NAPHCARE Commercial |
$570.18
|
| Rate for Payer: Preferred Network Access Commercial |
$10,766.76
|
| Rate for Payer: Quartz Beloit One Network |
$5,734.47
|
| Rate for Payer: Quartz Commercial |
$7,606.95
|
| Rate for Payer: Quartz Medicare Advantage |
$380.12
|
| Rate for Payer: The Alliance Commercial |
$1,520.48
|
| Rate for Payer: United Healthcare Medicare Advantage |
$380.12
|
| Rate for Payer: WEA Trust Commercial |
$6,436.65
|
| Rate for Payer: Wellcare Medicare |
$380.12
|
| Rate for Payer: WPS Commercial |
$8,668.41
|
|
|
MRI Shoulder w/ + w/o Contrast Bilateral
|
Facility
|
IP
|
$6,397.00
|
|
|
Service Code
|
CPT 73223 TC,LT
|
| Hospital Charge Code |
1611243
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$3,134.53 |
| Max. Negotiated Rate |
$5,885.24 |
| Rate for Payer: Aetna Commercial |
$5,757.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,501.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,390.41
|
| Rate for Payer: Cash Price |
$1,919.10
|
| Rate for Payer: Cigna Commercial |
$5,885.24
|
| Rate for Payer: Health EOS Commercial |
$5,693.33
|
| Rate for Payer: HFN Commercial |
$5,885.24
|
| Rate for Payer: Multiplan Commercial |
$5,117.60
|
| Rate for Payer: NAPHCARE Commercial |
$3,838.20
|
| Rate for Payer: Preferred Network Access Commercial |
$5,885.24
|
| Rate for Payer: Quartz Beloit One Network |
$3,134.53
|
| Rate for Payer: Quartz Commercial |
$3,838.20
|
| Rate for Payer: WEA Trust Commercial |
$3,518.35
|
| Rate for Payer: WPS Commercial |
$4,738.26
|
|
|
MRI Shoulder w/ + w/o Contrast Left
|
Facility
|
IP
|
$5,851.00
|
|
|
Service Code
|
CPT 73223
|
| Hospital Charge Code |
631217
|
| Min. Negotiated Rate |
$2,866.99 |
| Max. Negotiated Rate |
$5,382.92 |
| Rate for Payer: Aetna Commercial |
$5,265.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,031.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,101.03
|
| Rate for Payer: Cash Price |
$1,755.30
|
| Rate for Payer: Cigna Commercial |
$5,382.92
|
| Rate for Payer: Health EOS Commercial |
$5,207.39
|
| Rate for Payer: HFN Commercial |
$5,382.92
|
| Rate for Payer: Multiplan Commercial |
$4,680.80
|
| Rate for Payer: NAPHCARE Commercial |
$3,510.60
|
| Rate for Payer: Preferred Network Access Commercial |
$5,382.92
|
| Rate for Payer: Quartz Beloit One Network |
$2,866.99
|
| Rate for Payer: Quartz Commercial |
$3,510.60
|
| Rate for Payer: WEA Trust Commercial |
$3,218.05
|
| Rate for Payer: WPS Commercial |
$4,333.84
|
|
|
MRI Shoulder w/ + w/o Contrast Left
|
Facility
|
OP
|
$6,421.00
|
|
|
Service Code
|
CPT 73223 TC,LT
|
| Hospital Charge Code |
1611245
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$380.12 |
| Max. Negotiated Rate |
$5,907.32 |
| Rate for Payer: Aetna Commercial |
$5,778.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,522.06
|
| 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 |
$3,403.13
|
| 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 |
$1,926.30
|
| Rate for Payer: Cash Price |
$1,926.30
|
| Rate for Payer: Cash Price |
$1,926.30
|
| Rate for Payer: Cash Price |
$1,926.30
|
| Rate for Payer: Cigna Commercial |
$5,907.32
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$380.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,593.19
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$380.12
|
| Rate for Payer: Health EOS Commercial |
$5,714.69
|
| Rate for Payer: HFN Commercial |
$5,907.32
|
| 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 |
$5,136.80
|
| Rate for Payer: NAPHCARE Commercial |
$570.18
|
| Rate for Payer: Preferred Network Access Commercial |
$5,907.32
|
| Rate for Payer: Quartz Beloit One Network |
$3,146.29
|
| Rate for Payer: Quartz Commercial |
$4,173.65
|
| 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 |
$3,531.55
|
| Rate for Payer: Wellcare Medicare |
$380.12
|
| Rate for Payer: WPS Commercial |
$4,756.03
|
|
|
MRI Shoulder w/ + w/o Contrast Left
|
Professional
|
Both
|
$6,680.00
|
|
|
Service Code
|
CPT 73223 TC,LT
|
| Hospital Charge Code |
3072691
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,507.24 |
| Max. Negotiated Rate |
$6,346.00 |
| Rate for Payer: Aetna Commercial |
$6,346.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,744.80
|
| Rate for Payer: Cash Price |
$2,004.00
|
| Rate for Payer: Cash Price |
$2,004.00
|
| Rate for Payer: Cash Price |
$2,004.00
|
| Rate for Payer: Cigna Commercial |
$6,346.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$3,340.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,008.00
|
| Rate for Payer: Health EOS Commercial |
$6,078.80
|
| Rate for Payer: HFN Commercial |
$6,346.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,507.24
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,507.24
|
| Rate for Payer: Multiplan Commercial |
$5,344.00
|
| Rate for Payer: Preferred Network Access Commercial |
$6,346.00
|
| Rate for Payer: Quartz Beloit One Network |
$2,939.20
|
| Rate for Payer: Quartz Commercial |
$3,807.60
|
| Rate for Payer: The Alliance Commercial |
$3,340.00
|
| Rate for Payer: WEA Trust Commercial |
$3,674.00
|
| Rate for Payer: WPS Commercial |
$4,947.88
|
|
|
MRI Shoulder w/ + w/o Contrast Left
|
Facility
|
IP
|
$6,421.00
|
|
|
Service Code
|
CPT 73223 TC,LT
|
| Hospital Charge Code |
1611245
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$3,146.29 |
| Max. Negotiated Rate |
$5,907.32 |
| Rate for Payer: Aetna Commercial |
$5,778.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,522.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,403.13
|
| Rate for Payer: Cash Price |
$1,926.30
|
| Rate for Payer: Cigna Commercial |
$5,907.32
|
| Rate for Payer: Health EOS Commercial |
$5,714.69
|
| Rate for Payer: HFN Commercial |
$5,907.32
|
| Rate for Payer: Multiplan Commercial |
$5,136.80
|
| Rate for Payer: NAPHCARE Commercial |
$3,852.60
|
| Rate for Payer: Preferred Network Access Commercial |
$5,907.32
|
| Rate for Payer: Quartz Beloit One Network |
$3,146.29
|
| Rate for Payer: Quartz Commercial |
$3,852.60
|
| Rate for Payer: WEA Trust Commercial |
$3,531.55
|
| Rate for Payer: WPS Commercial |
$4,756.03
|
|
|
MRI Shoulder w/ + w/o Contrast Left
|
Facility
|
OP
|
$5,851.00
|
|
|
Service Code
|
CPT 73223
|
| Hospital Charge Code |
631217
|
| Min. Negotiated Rate |
$380.12 |
| Max. Negotiated Rate |
$5,382.92 |
| Rate for Payer: Aetna Commercial |
$5,265.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,031.86
|
| Rate for Payer: Aetna Managed Medicare |
$380.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,803.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,925.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,808.48
|
| Rate for Payer: Anthem Medicare Advantage |
$380.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,101.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$380.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$380.12
|
| Rate for Payer: Cash Price |
$1,755.30
|
| Rate for Payer: Cash Price |
$1,755.30
|
| Rate for Payer: Cigna Commercial |
$5,382.92
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$380.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,274.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$380.12
|
| Rate for Payer: Health EOS Commercial |
$5,207.39
|
| Rate for Payer: HFN Commercial |
$5,382.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,414.05
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$380.12
|
| Rate for Payer: Independent Care Health Plan Medicare |
$380.12
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$380.12
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$380.12
|
| Rate for Payer: Multiplan Commercial |
$4,680.80
|
| Rate for Payer: NAPHCARE Commercial |
$570.18
|
| Rate for Payer: Preferred Network Access Commercial |
$5,382.92
|
| Rate for Payer: Quartz Beloit One Network |
$2,866.99
|
| Rate for Payer: Quartz Commercial |
$3,803.15
|
| Rate for Payer: Quartz Medicare Advantage |
$380.12
|
| Rate for Payer: The Alliance Commercial |
$1,520.48
|
| Rate for Payer: United Healthcare Medicare Advantage |
$380.12
|
| Rate for Payer: WEA Trust Commercial |
$3,218.05
|
| Rate for Payer: Wellcare Medicare |
$380.12
|
| Rate for Payer: WPS Commercial |
$4,333.84
|
|
|
MRI Shoulder w/ + w/o Contrast Left
|
Professional
|
Both
|
$6,421.00
|
|
|
Service Code
|
CPT 73223 TC,LT
|
| Hospital Charge Code |
1611245
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,507.24 |
| Max. Negotiated Rate |
$6,099.95 |
| Rate for Payer: Aetna Commercial |
$6,099.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,522.06
|
| Rate for Payer: Cash Price |
$1,926.30
|
| Rate for Payer: Cash Price |
$1,926.30
|
| Rate for Payer: Cash Price |
$1,926.30
|
| Rate for Payer: Cigna Commercial |
$6,099.95
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$3,210.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,852.60
|
| Rate for Payer: Health EOS Commercial |
$5,843.11
|
| Rate for Payer: HFN Commercial |
$6,099.95
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,507.24
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,507.24
|
| Rate for Payer: Multiplan Commercial |
$5,136.80
|
| Rate for Payer: Preferred Network Access Commercial |
$6,099.95
|
| Rate for Payer: Quartz Beloit One Network |
$2,825.24
|
| Rate for Payer: Quartz Commercial |
$3,659.97
|
| Rate for Payer: The Alliance Commercial |
$3,210.50
|
| Rate for Payer: WEA Trust Commercial |
$3,531.55
|
| Rate for Payer: WPS Commercial |
$4,756.03
|
|
|
MRI Shoulder w/ + w/o Contrast Left
|
Professional
|
Both
|
$5,851.00
|
|
|
Service Code
|
CPT 73223
|
| Hospital Charge Code |
631217
|
| Min. Negotiated Rate |
$1,507.24 |
| Max. Negotiated Rate |
$5,558.45 |
| Rate for Payer: Aetna Commercial |
$5,558.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,031.86
|
| Rate for Payer: Cash Price |
$1,755.30
|
| Rate for Payer: Cash Price |
$1,755.30
|
| Rate for Payer: Cash Price |
$1,755.30
|
| Rate for Payer: Cigna Commercial |
$5,558.45
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,925.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,510.60
|
| Rate for Payer: Health EOS Commercial |
$5,324.41
|
| Rate for Payer: HFN Commercial |
$5,558.45
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,507.24
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,507.24
|
| Rate for Payer: Multiplan Commercial |
$4,680.80
|
| Rate for Payer: Preferred Network Access Commercial |
$5,558.45
|
| Rate for Payer: Quartz Beloit One Network |
$2,574.44
|
| Rate for Payer: Quartz Commercial |
$3,335.07
|
| Rate for Payer: The Alliance Commercial |
$2,925.50
|
| Rate for Payer: WEA Trust Commercial |
$3,218.05
|
| Rate for Payer: WPS Commercial |
$4,333.84
|
|
|
MRI Shoulder w/ + w/o Contrast Left
|
Facility
|
OP
|
$6,680.00
|
|
|
Service Code
|
CPT 73223 TC,LT
|
| Hospital Charge Code |
3072691
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$380.12 |
| Max. Negotiated Rate |
$6,145.60 |
| Rate for Payer: Aetna Commercial |
$6,012.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,744.80
|
| 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 |
$3,540.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$380.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$380.12
|
| Rate for Payer: Cash Price |
$2,004.00
|
| Rate for Payer: Cash Price |
$2,004.00
|
| Rate for Payer: Cash Price |
$2,004.00
|
| Rate for Payer: Cash Price |
$2,004.00
|
| Rate for Payer: Cigna Commercial |
$6,145.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$380.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,738.13
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$380.12
|
| Rate for Payer: Health EOS Commercial |
$5,945.20
|
| Rate for Payer: HFN Commercial |
$6,145.60
|
| 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 |
$5,344.00
|
| Rate for Payer: NAPHCARE Commercial |
$570.18
|
| Rate for Payer: Preferred Network Access Commercial |
$6,145.60
|
| Rate for Payer: Quartz Beloit One Network |
$3,273.20
|
| Rate for Payer: Quartz Commercial |
$4,342.00
|
| Rate for Payer: Quartz Medicare Advantage |
$380.12
|
| Rate for Payer: The Alliance Commercial |
$1,520.48
|
| Rate for Payer: United Healthcare Medicare Advantage |
$380.12
|
| Rate for Payer: United Healthcare PPO |
$3,022.00
|
| Rate for Payer: WEA Trust Commercial |
$3,674.00
|
| Rate for Payer: Wellcare Medicare |
$380.12
|
| Rate for Payer: WPS Commercial |
$4,947.88
|
|
|
MRI Shoulder w/ + w/o Contrast Left
|
Facility
|
IP
|
$6,680.00
|
|
|
Service Code
|
CPT 73223 TC,LT
|
| Hospital Charge Code |
3072691
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$3,273.20 |
| Max. Negotiated Rate |
$6,145.60 |
| Rate for Payer: Aetna Commercial |
$6,012.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,744.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,540.40
|
| Rate for Payer: Cash Price |
$2,004.00
|
| Rate for Payer: Cigna Commercial |
$6,145.60
|
| Rate for Payer: Health EOS Commercial |
$5,945.20
|
| Rate for Payer: HFN Commercial |
$6,145.60
|
| Rate for Payer: Multiplan Commercial |
$5,344.00
|
| Rate for Payer: NAPHCARE Commercial |
$4,008.00
|
| Rate for Payer: Preferred Network Access Commercial |
$6,145.60
|
| Rate for Payer: Quartz Beloit One Network |
$3,273.20
|
| Rate for Payer: Quartz Commercial |
$4,008.00
|
| Rate for Payer: WEA Trust Commercial |
$3,674.00
|
| Rate for Payer: WPS Commercial |
$4,947.88
|
|
|
MRI Shoulder w/ + w/o Contrast Right
|
Facility
|
IP
|
$6,421.00
|
|
|
Service Code
|
CPT 73223 TC,RT
|
| Hospital Charge Code |
1611247
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$3,146.29 |
| Max. Negotiated Rate |
$5,907.32 |
| Rate for Payer: Aetna Commercial |
$5,778.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,522.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,403.13
|
| Rate for Payer: Cash Price |
$1,926.30
|
| Rate for Payer: Cigna Commercial |
$5,907.32
|
| Rate for Payer: Health EOS Commercial |
$5,714.69
|
| Rate for Payer: HFN Commercial |
$5,907.32
|
| Rate for Payer: Multiplan Commercial |
$5,136.80
|
| Rate for Payer: NAPHCARE Commercial |
$3,852.60
|
| Rate for Payer: Preferred Network Access Commercial |
$5,907.32
|
| Rate for Payer: Quartz Beloit One Network |
$3,146.29
|
| Rate for Payer: Quartz Commercial |
$3,852.60
|
| Rate for Payer: WEA Trust Commercial |
$3,531.55
|
| Rate for Payer: WPS Commercial |
$4,756.03
|
|
|
MRI Shoulder w/ + w/o Contrast Right
|
Professional
|
Both
|
$6,421.00
|
|
|
Service Code
|
CPT 73223 TC,RT
|
| Hospital Charge Code |
1611247
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,507.24 |
| Max. Negotiated Rate |
$6,099.95 |
| Rate for Payer: Aetna Commercial |
$6,099.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,522.06
|
| Rate for Payer: Cash Price |
$1,926.30
|
| Rate for Payer: Cash Price |
$1,926.30
|
| Rate for Payer: Cash Price |
$1,926.30
|
| Rate for Payer: Cigna Commercial |
$6,099.95
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$3,210.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,852.60
|
| Rate for Payer: Health EOS Commercial |
$5,843.11
|
| Rate for Payer: HFN Commercial |
$6,099.95
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,507.24
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,507.24
|
| Rate for Payer: Multiplan Commercial |
$5,136.80
|
| Rate for Payer: Preferred Network Access Commercial |
$6,099.95
|
| Rate for Payer: Quartz Beloit One Network |
$2,825.24
|
| Rate for Payer: Quartz Commercial |
$3,659.97
|
| Rate for Payer: The Alliance Commercial |
$3,210.50
|
| Rate for Payer: WEA Trust Commercial |
$3,531.55
|
| Rate for Payer: WPS Commercial |
$4,756.03
|
|
|
MRI Shoulder w/ + w/o Contrast Right
|
Professional
|
Both
|
$6,680.00
|
|
|
Service Code
|
CPT 73223 TC,RT
|
| Hospital Charge Code |
2980048
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,507.24 |
| Max. Negotiated Rate |
$6,346.00 |
| Rate for Payer: Aetna Commercial |
$6,346.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,744.80
|
| Rate for Payer: Cash Price |
$2,004.00
|
| Rate for Payer: Cash Price |
$2,004.00
|
| Rate for Payer: Cash Price |
$2,004.00
|
| Rate for Payer: Cigna Commercial |
$6,346.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$3,340.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,008.00
|
| Rate for Payer: Health EOS Commercial |
$6,078.80
|
| Rate for Payer: HFN Commercial |
$6,346.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,507.24
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,507.24
|
| Rate for Payer: Multiplan Commercial |
$5,344.00
|
| Rate for Payer: Preferred Network Access Commercial |
$6,346.00
|
| Rate for Payer: Quartz Beloit One Network |
$2,939.20
|
| Rate for Payer: Quartz Commercial |
$3,807.60
|
| Rate for Payer: The Alliance Commercial |
$3,340.00
|
| Rate for Payer: WEA Trust Commercial |
$3,674.00
|
| Rate for Payer: WPS Commercial |
$4,947.88
|
|
|
MRI Shoulder w/ + w/o Contrast Right
|
Facility
|
IP
|
$5,851.00
|
|
|
Service Code
|
CPT 73223
|
| Hospital Charge Code |
631219
|
| Min. Negotiated Rate |
$2,866.99 |
| Max. Negotiated Rate |
$5,382.92 |
| Rate for Payer: Aetna Commercial |
$5,265.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,031.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,101.03
|
| Rate for Payer: Cash Price |
$1,755.30
|
| Rate for Payer: Cigna Commercial |
$5,382.92
|
| Rate for Payer: Health EOS Commercial |
$5,207.39
|
| Rate for Payer: HFN Commercial |
$5,382.92
|
| Rate for Payer: Multiplan Commercial |
$4,680.80
|
| Rate for Payer: NAPHCARE Commercial |
$3,510.60
|
| Rate for Payer: Preferred Network Access Commercial |
$5,382.92
|
| Rate for Payer: Quartz Beloit One Network |
$2,866.99
|
| Rate for Payer: Quartz Commercial |
$3,510.60
|
| Rate for Payer: WEA Trust Commercial |
$3,218.05
|
| Rate for Payer: WPS Commercial |
$4,333.84
|
|
|
MRI Shoulder w/ + w/o Contrast Right
|
Facility
|
OP
|
$5,851.00
|
|
|
Service Code
|
CPT 73223
|
| Hospital Charge Code |
631219
|
| Min. Negotiated Rate |
$380.12 |
| Max. Negotiated Rate |
$5,382.92 |
| Rate for Payer: Aetna Commercial |
$5,265.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,031.86
|
| Rate for Payer: Aetna Managed Medicare |
$380.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,803.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,925.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,808.48
|
| Rate for Payer: Anthem Medicare Advantage |
$380.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,101.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$380.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$380.12
|
| Rate for Payer: Cash Price |
$1,755.30
|
| Rate for Payer: Cash Price |
$1,755.30
|
| Rate for Payer: Cigna Commercial |
$5,382.92
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$380.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,274.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$380.12
|
| Rate for Payer: Health EOS Commercial |
$5,207.39
|
| Rate for Payer: HFN Commercial |
$5,382.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,414.05
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$380.12
|
| Rate for Payer: Independent Care Health Plan Medicare |
$380.12
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$380.12
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$380.12
|
| Rate for Payer: Multiplan Commercial |
$4,680.80
|
| Rate for Payer: NAPHCARE Commercial |
$570.18
|
| Rate for Payer: Preferred Network Access Commercial |
$5,382.92
|
| Rate for Payer: Quartz Beloit One Network |
$2,866.99
|
| Rate for Payer: Quartz Commercial |
$3,803.15
|
| Rate for Payer: Quartz Medicare Advantage |
$380.12
|
| Rate for Payer: The Alliance Commercial |
$1,520.48
|
| Rate for Payer: United Healthcare Medicare Advantage |
$380.12
|
| Rate for Payer: WEA Trust Commercial |
$3,218.05
|
| Rate for Payer: Wellcare Medicare |
$380.12
|
| Rate for Payer: WPS Commercial |
$4,333.84
|
|
|
MRI Shoulder w/ + w/o Contrast Right
|
Facility
|
OP
|
$6,680.00
|
|
|
Service Code
|
CPT 73223 TC,RT
|
| Hospital Charge Code |
2980048
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$380.12 |
| Max. Negotiated Rate |
$6,145.60 |
| Rate for Payer: Aetna Commercial |
$6,012.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,744.80
|
| 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 |
$3,540.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$380.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$380.12
|
| Rate for Payer: Cash Price |
$2,004.00
|
| Rate for Payer: Cash Price |
$2,004.00
|
| Rate for Payer: Cash Price |
$2,004.00
|
| Rate for Payer: Cash Price |
$2,004.00
|
| Rate for Payer: Cigna Commercial |
$6,145.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$380.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,738.13
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$380.12
|
| Rate for Payer: Health EOS Commercial |
$5,945.20
|
| Rate for Payer: HFN Commercial |
$6,145.60
|
| 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 |
$5,344.00
|
| Rate for Payer: NAPHCARE Commercial |
$570.18
|
| Rate for Payer: Preferred Network Access Commercial |
$6,145.60
|
| Rate for Payer: Quartz Beloit One Network |
$3,273.20
|
| Rate for Payer: Quartz Commercial |
$4,342.00
|
| Rate for Payer: Quartz Medicare Advantage |
$380.12
|
| Rate for Payer: The Alliance Commercial |
$1,520.48
|
| Rate for Payer: United Healthcare Medicare Advantage |
$380.12
|
| Rate for Payer: United Healthcare PPO |
$3,022.00
|
| Rate for Payer: WEA Trust Commercial |
$3,674.00
|
| Rate for Payer: Wellcare Medicare |
$380.12
|
| Rate for Payer: WPS Commercial |
$4,947.88
|
|
|
MRI Shoulder w/ + w/o Contrast Right
|
Facility
|
IP
|
$6,680.00
|
|
|
Service Code
|
CPT 73223 TC,RT
|
| Hospital Charge Code |
2980048
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$3,273.20 |
| Max. Negotiated Rate |
$6,145.60 |
| Rate for Payer: Aetna Commercial |
$6,012.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,744.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,540.40
|
| Rate for Payer: Cash Price |
$2,004.00
|
| Rate for Payer: Cigna Commercial |
$6,145.60
|
| Rate for Payer: Health EOS Commercial |
$5,945.20
|
| Rate for Payer: HFN Commercial |
$6,145.60
|
| Rate for Payer: Multiplan Commercial |
$5,344.00
|
| Rate for Payer: NAPHCARE Commercial |
$4,008.00
|
| Rate for Payer: Preferred Network Access Commercial |
$6,145.60
|
| Rate for Payer: Quartz Beloit One Network |
$3,273.20
|
| Rate for Payer: Quartz Commercial |
$4,008.00
|
| Rate for Payer: WEA Trust Commercial |
$3,674.00
|
| Rate for Payer: WPS Commercial |
$4,947.88
|
|
|
MRI Shoulder w/ + w/o Contrast Right
|
Professional
|
Both
|
$5,851.00
|
|
|
Service Code
|
CPT 73223
|
| Hospital Charge Code |
631219
|
| Min. Negotiated Rate |
$1,507.24 |
| Max. Negotiated Rate |
$5,558.45 |
| Rate for Payer: Aetna Commercial |
$5,558.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,031.86
|
| Rate for Payer: Cash Price |
$1,755.30
|
| Rate for Payer: Cash Price |
$1,755.30
|
| Rate for Payer: Cash Price |
$1,755.30
|
| Rate for Payer: Cigna Commercial |
$5,558.45
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,925.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,510.60
|
| Rate for Payer: Health EOS Commercial |
$5,324.41
|
| Rate for Payer: HFN Commercial |
$5,558.45
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,507.24
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,507.24
|
| Rate for Payer: Multiplan Commercial |
$4,680.80
|
| Rate for Payer: Preferred Network Access Commercial |
$5,558.45
|
| Rate for Payer: Quartz Beloit One Network |
$2,574.44
|
| Rate for Payer: Quartz Commercial |
$3,335.07
|
| Rate for Payer: The Alliance Commercial |
$2,925.50
|
| Rate for Payer: WEA Trust Commercial |
$3,218.05
|
| Rate for Payer: WPS Commercial |
$4,333.84
|
|
|
MRI Shoulder w/ + w/o Contrast Right
|
Facility
|
OP
|
$6,421.00
|
|
|
Service Code
|
CPT 73223 TC,RT
|
| Hospital Charge Code |
1611247
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$380.12 |
| Max. Negotiated Rate |
$5,907.32 |
| Rate for Payer: Aetna Commercial |
$5,778.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,522.06
|
| 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 |
$3,403.13
|
| 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 |
$1,926.30
|
| Rate for Payer: Cash Price |
$1,926.30
|
| Rate for Payer: Cash Price |
$1,926.30
|
| Rate for Payer: Cash Price |
$1,926.30
|
| Rate for Payer: Cigna Commercial |
$5,907.32
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$380.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,593.19
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$380.12
|
| Rate for Payer: Health EOS Commercial |
$5,714.69
|
| Rate for Payer: HFN Commercial |
$5,907.32
|
| 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 |
$5,136.80
|
| Rate for Payer: NAPHCARE Commercial |
$570.18
|
| Rate for Payer: Preferred Network Access Commercial |
$5,907.32
|
| Rate for Payer: Quartz Beloit One Network |
$3,146.29
|
| Rate for Payer: Quartz Commercial |
$4,173.65
|
| 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 |
$3,531.55
|
| Rate for Payer: Wellcare Medicare |
$380.12
|
| Rate for Payer: WPS Commercial |
$4,756.03
|
|
|
MRI Spine Cervical, Brac Plex w/o Left
|
Facility
|
IP
|
$4,631.00
|
|
|
Service Code
|
CPT 73218 TC,LT
|
| Hospital Charge Code |
1611275
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$2,269.19 |
| Max. Negotiated Rate |
$4,260.52 |
| Rate for Payer: Aetna Commercial |
$4,167.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,982.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,454.43
|
| Rate for Payer: Cash Price |
$1,389.30
|
| Rate for Payer: Cigna Commercial |
$4,260.52
|
| Rate for Payer: Health EOS Commercial |
$4,121.59
|
| Rate for Payer: HFN Commercial |
$4,260.52
|
| Rate for Payer: Multiplan Commercial |
$3,704.80
|
| Rate for Payer: NAPHCARE Commercial |
$2,778.60
|
| Rate for Payer: Preferred Network Access Commercial |
$4,260.52
|
| Rate for Payer: Quartz Beloit One Network |
$2,269.19
|
| Rate for Payer: Quartz Commercial |
$2,778.60
|
| Rate for Payer: WEA Trust Commercial |
$2,547.05
|
| Rate for Payer: WPS Commercial |
$3,430.18
|
|
|
MRI Spine Cervical, Brac Plex w/o Left
|
Facility
|
OP
|
$4,631.00
|
|
|
Service Code
|
CPT 73218 TC,LT
|
| Hospital Charge Code |
1611275
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$242.20 |
| Max. Negotiated Rate |
$4,260.52 |
| Rate for Payer: Aetna Commercial |
$4,167.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,982.66
|
| Rate for Payer: Aetna Managed Medicare |
$242.20
|
| 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 |
$242.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,454.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$242.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$242.20
|
| Rate for Payer: Cash Price |
$1,389.30
|
| Rate for Payer: Cash Price |
$1,389.30
|
| Rate for Payer: Cash Price |
$1,389.30
|
| Rate for Payer: Cash Price |
$1,389.30
|
| Rate for Payer: Cigna Commercial |
$4,260.52
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$242.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,591.51
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$242.20
|
| Rate for Payer: Health EOS Commercial |
$4,121.59
|
| Rate for Payer: HFN Commercial |
$4,260.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$900.98
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$242.20
|
| Rate for Payer: Independent Care Health Plan Medicare |
$242.20
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$242.20
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$242.20
|
| Rate for Payer: Multiplan Commercial |
$3,704.80
|
| Rate for Payer: NAPHCARE Commercial |
$363.30
|
| Rate for Payer: Preferred Network Access Commercial |
$4,260.52
|
| Rate for Payer: Quartz Beloit One Network |
$2,269.19
|
| Rate for Payer: Quartz Commercial |
$3,010.15
|
| Rate for Payer: Quartz Medicare Advantage |
$242.20
|
| Rate for Payer: The Alliance Commercial |
$968.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$242.20
|
| Rate for Payer: United Healthcare PPO |
$3,022.00
|
| Rate for Payer: WEA Trust Commercial |
$2,547.05
|
| Rate for Payer: Wellcare Medicare |
$242.20
|
| Rate for Payer: WPS Commercial |
$3,430.18
|
|
|
MRI Spine Cervical, Brac Plex w/o Left
|
Professional
|
Both
|
$4,631.00
|
|
|
Service Code
|
CPT 73218 TC,LT
|
| Hospital Charge Code |
1611275
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,180.61 |
| Max. Negotiated Rate |
$4,399.45 |
| Rate for Payer: Aetna Commercial |
$4,399.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,982.66
|
| Rate for Payer: Cash Price |
$1,389.30
|
| Rate for Payer: Cash Price |
$1,389.30
|
| Rate for Payer: Cash Price |
$1,389.30
|
| Rate for Payer: Cigna Commercial |
$4,399.45
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,315.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,778.60
|
| Rate for Payer: Health EOS Commercial |
$4,214.21
|
| Rate for Payer: HFN Commercial |
$4,399.45
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,180.61
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,180.61
|
| Rate for Payer: Multiplan Commercial |
$3,704.80
|
| Rate for Payer: Preferred Network Access Commercial |
$4,399.45
|
| Rate for Payer: Quartz Beloit One Network |
$2,037.64
|
| Rate for Payer: Quartz Commercial |
$2,639.67
|
| Rate for Payer: The Alliance Commercial |
$2,315.50
|
| Rate for Payer: WEA Trust Commercial |
$2,547.05
|
| Rate for Payer: WPS Commercial |
$3,430.18
|
|
|
MRI Spine Cervical, Brac Plex w/o Right
|
Facility
|
IP
|
$4,810.00
|
|
|
Service Code
|
CPT 73218 TC,RT
|
| Hospital Charge Code |
1611278
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$2,356.90 |
| Max. Negotiated Rate |
$4,425.20 |
| Rate for Payer: Aetna Commercial |
$4,329.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,136.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,549.30
|
| Rate for Payer: Cash Price |
$1,443.00
|
| Rate for Payer: Cigna Commercial |
$4,425.20
|
| Rate for Payer: Health EOS Commercial |
$4,280.90
|
| Rate for Payer: HFN Commercial |
$4,425.20
|
| Rate for Payer: Multiplan Commercial |
$3,848.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,886.00
|
| Rate for Payer: Preferred Network Access Commercial |
$4,425.20
|
| Rate for Payer: Quartz Beloit One Network |
$2,356.90
|
| Rate for Payer: Quartz Commercial |
$2,886.00
|
| Rate for Payer: WEA Trust Commercial |
$2,645.50
|
| Rate for Payer: WPS Commercial |
$3,562.77
|
|
|
MRI Spine Cervical, Brac Plex w/o Right
|
Facility
|
OP
|
$4,810.00
|
|
|
Service Code
|
CPT 73218 TC,RT
|
| Hospital Charge Code |
1611278
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$242.20 |
| Max. Negotiated Rate |
$4,425.20 |
| Rate for Payer: Aetna Commercial |
$4,329.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,136.60
|
| Rate for Payer: Aetna Managed Medicare |
$242.20
|
| 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 |
$242.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,549.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$242.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$242.20
|
| Rate for Payer: Cash Price |
$1,443.00
|
| Rate for Payer: Cash Price |
$1,443.00
|
| Rate for Payer: Cash Price |
$1,443.00
|
| Rate for Payer: Cash Price |
$1,443.00
|
| Rate for Payer: Cigna Commercial |
$4,425.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$242.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,691.68
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$242.20
|
| Rate for Payer: Health EOS Commercial |
$4,280.90
|
| Rate for Payer: HFN Commercial |
$4,425.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$900.98
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$242.20
|
| Rate for Payer: Independent Care Health Plan Medicare |
$242.20
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$242.20
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$242.20
|
| Rate for Payer: Multiplan Commercial |
$3,848.00
|
| Rate for Payer: NAPHCARE Commercial |
$363.30
|
| Rate for Payer: Preferred Network Access Commercial |
$4,425.20
|
| Rate for Payer: Quartz Beloit One Network |
$2,356.90
|
| Rate for Payer: Quartz Commercial |
$3,126.50
|
| Rate for Payer: Quartz Medicare Advantage |
$242.20
|
| Rate for Payer: The Alliance Commercial |
$968.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$242.20
|
| Rate for Payer: United Healthcare PPO |
$3,022.00
|
| Rate for Payer: WEA Trust Commercial |
$2,645.50
|
| Rate for Payer: Wellcare Medicare |
$242.20
|
| Rate for Payer: WPS Commercial |
$3,562.77
|
|
