|
MRI Humerus w/o Contrast Right
|
Professional
|
Both
|
$4,721.00
|
|
|
Service Code
|
CPT 73218
|
| Hospital Charge Code |
631073
|
| Min. Negotiated Rate |
$301.83 |
| Max. Negotiated Rate |
$4,664.35 |
| Rate for Payer: Aetna Commercial |
$4,664.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,222.46
|
| Rate for Payer: Aetna Managed Medicare |
$301.83
|
| Rate for Payer: Anthem Medicare Advantage |
$301.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$301.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$301.83
|
| Rate for Payer: Cash Price |
$1,416.30
|
| Rate for Payer: Cash Price |
$1,416.30
|
| Rate for Payer: Cash Price |
$1,416.30
|
| Rate for Payer: Cigna Commercial |
$4,664.35
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,454.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$301.83
|
| Rate for Payer: Health EOS Commercial |
$4,467.95
|
| Rate for Payer: HFN Commercial |
$4,664.35
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,227.83
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,227.83
|
| Rate for Payer: Independent Care Health Plan Medicare |
$301.83
|
| Rate for Payer: Multiplan Commercial |
$3,927.87
|
| Rate for Payer: NAPHCARE Commercial |
$452.74
|
| Rate for Payer: Preferred Network Access Commercial |
$4,664.35
|
| Rate for Payer: Quartz Beloit One Network |
$2,160.33
|
| Rate for Payer: Quartz Commercial |
$2,798.61
|
| Rate for Payer: Quartz Medicare Advantage |
$301.83
|
| Rate for Payer: The Alliance Commercial |
$1,146.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$301.83
|
| Rate for Payer: WEA Trust Commercial |
$2,700.41
|
| Rate for Payer: WPS Commercial |
$1,509.14
|
|
|
MRI Humerus w/o Contrast Right
|
Facility
|
IP
|
$4,631.00
|
|
|
Service Code
|
CPT 73218 TC,RT
|
| Hospital Charge Code |
2980029
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$2,359.96 |
| Max. Negotiated Rate |
$4,430.94 |
| Rate for Payer: Aetna Commercial |
$4,334.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,141.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,552.61
|
| Rate for Payer: Cash Price |
$1,389.30
|
| Rate for Payer: Cigna Commercial |
$4,430.94
|
| Rate for Payer: Health EOS Commercial |
$4,286.45
|
| Rate for Payer: HFN Commercial |
$4,430.94
|
| Rate for Payer: Multiplan Commercial |
$3,852.99
|
| Rate for Payer: Preferred Network Access Commercial |
$4,430.94
|
| Rate for Payer: Quartz Beloit One Network |
$2,359.96
|
| Rate for Payer: Quartz Commercial |
$2,889.74
|
| Rate for Payer: WEA Trust Commercial |
$2,648.93
|
| Rate for Payer: WPS Commercial |
$3,567.26
|
|
|
MRI Humerus w/o Contrast Right
|
Facility
|
OP
|
$4,631.00
|
|
|
Service Code
|
CPT 73218 TC,RT
|
| Hospital Charge Code |
2980029
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,348.55 |
| Max. Negotiated Rate |
$4,430.94 |
| Rate for Payer: Aetna Commercial |
$4,334.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,141.97
|
| Rate for Payer: Aetna Managed Medicare |
$1,348.55
|
| 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 |
$2,552.61
|
| 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 |
$4,430.94
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,695.24
|
| Rate for Payer: Health EOS Commercial |
$4,286.45
|
| Rate for Payer: HFN Commercial |
$4,430.94
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,612.18
|
| Rate for Payer: Multiplan Commercial |
$3,852.99
|
| Rate for Payer: NAPHCARE Commercial |
$2,889.74
|
| Rate for Payer: Preferred Network Access Commercial |
$4,430.94
|
| Rate for Payer: Quartz Beloit One Network |
$2,359.96
|
| Rate for Payer: Quartz Commercial |
$3,130.56
|
| Rate for Payer: Quartz Medicare Advantage |
$2,889.74
|
| Rate for Payer: The Alliance Commercial |
$2,408.12
|
| Rate for Payer: United Healthcare PPO |
$3,142.88
|
| Rate for Payer: WEA Trust Commercial |
$2,648.93
|
| Rate for Payer: WPS Commercial |
$3,567.26
|
|
|
MRI Humerus w/o Contrast Right
|
Professional
|
Both
|
$4,810.00
|
|
|
Service Code
|
CPT 73218 TC,RT
|
| Hospital Charge Code |
1611169
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,227.83 |
| Max. Negotiated Rate |
$4,752.28 |
| Rate for Payer: Aetna Commercial |
$4,752.28
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,302.06
|
| 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 |
$4,752.28
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,501.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,001.44
|
| Rate for Payer: Health EOS Commercial |
$4,552.18
|
| Rate for Payer: HFN Commercial |
$4,752.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,227.83
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,227.83
|
| Rate for Payer: Multiplan Commercial |
$4,001.92
|
| Rate for Payer: Preferred Network Access Commercial |
$4,752.28
|
| Rate for Payer: Quartz Beloit One Network |
$2,201.06
|
| Rate for Payer: Quartz Commercial |
$2,851.37
|
| Rate for Payer: The Alliance Commercial |
$2,501.20
|
| Rate for Payer: WEA Trust Commercial |
$2,751.32
|
| Rate for Payer: WPS Commercial |
$3,705.14
|
|
|
MRI Humerus w/o Contrast Right
|
Professional
|
Both
|
$4,631.00
|
|
|
Service Code
|
CPT 73218 TC,RT
|
| Hospital Charge Code |
2980029
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,227.83 |
| Max. Negotiated Rate |
$4,575.43 |
| Rate for Payer: Aetna Commercial |
$4,575.43
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,141.97
|
| 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 |
$4,575.43
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,408.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,889.74
|
| Rate for Payer: Health EOS Commercial |
$4,382.78
|
| Rate for Payer: HFN Commercial |
$4,575.43
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,227.83
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,227.83
|
| Rate for Payer: Multiplan Commercial |
$3,852.99
|
| Rate for Payer: Preferred Network Access Commercial |
$4,575.43
|
| Rate for Payer: Quartz Beloit One Network |
$2,119.15
|
| Rate for Payer: Quartz Commercial |
$2,745.26
|
| Rate for Payer: The Alliance Commercial |
$2,408.12
|
| Rate for Payer: WEA Trust Commercial |
$2,648.93
|
| Rate for Payer: WPS Commercial |
$3,567.26
|
|
|
MRI Humerus w/o Contrast Right
|
Facility
|
IP
|
$4,810.00
|
|
|
Service Code
|
CPT 73218 TC,RT
|
| Hospital Charge Code |
1611169
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$2,451.18 |
| Max. Negotiated Rate |
$4,602.21 |
| Rate for Payer: Aetna Commercial |
$4,502.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,302.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,651.27
|
| Rate for Payer: Cash Price |
$1,443.00
|
| Rate for Payer: Cigna Commercial |
$4,602.21
|
| Rate for Payer: Health EOS Commercial |
$4,452.14
|
| Rate for Payer: HFN Commercial |
$4,602.21
|
| Rate for Payer: Multiplan Commercial |
$4,001.92
|
| Rate for Payer: Preferred Network Access Commercial |
$4,602.21
|
| Rate for Payer: Quartz Beloit One Network |
$2,451.18
|
| Rate for Payer: Quartz Commercial |
$3,001.44
|
| Rate for Payer: WEA Trust Commercial |
$2,751.32
|
| Rate for Payer: WPS Commercial |
$3,705.14
|
|
|
MRI Humerus w/o Contrast Right
|
Facility
|
OP
|
$4,810.00
|
|
|
Service Code
|
CPT 73218 TC,RT
|
| Hospital Charge Code |
1611169
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,400.67 |
| Max. Negotiated Rate |
$4,602.21 |
| Rate for Payer: Aetna Commercial |
$4,502.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,302.06
|
| Rate for Payer: Aetna Managed Medicare |
$1,400.67
|
| 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 |
$2,651.27
|
| 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 |
$4,602.21
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,799.42
|
| Rate for Payer: Health EOS Commercial |
$4,452.14
|
| Rate for Payer: HFN Commercial |
$4,602.21
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,751.80
|
| Rate for Payer: Multiplan Commercial |
$4,001.92
|
| Rate for Payer: NAPHCARE Commercial |
$3,001.44
|
| Rate for Payer: Preferred Network Access Commercial |
$4,602.21
|
| Rate for Payer: Quartz Beloit One Network |
$2,451.18
|
| Rate for Payer: Quartz Commercial |
$3,251.56
|
| Rate for Payer: Quartz Medicare Advantage |
$3,001.44
|
| Rate for Payer: The Alliance Commercial |
$2,501.20
|
| Rate for Payer: United Healthcare PPO |
$3,142.88
|
| Rate for Payer: WEA Trust Commercial |
$2,751.32
|
| Rate for Payer: WPS Commercial |
$3,705.14
|
|
|
MRI Humerus w/o Contrast Right
|
Facility
|
IP
|
$4,721.00
|
|
|
Service Code
|
CPT 73218
|
| Hospital Charge Code |
631073
|
| Min. Negotiated Rate |
$2,405.82 |
| Max. Negotiated Rate |
$4,517.05 |
| Rate for Payer: Aetna Commercial |
$4,418.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,222.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,602.22
|
| Rate for Payer: Cash Price |
$1,416.30
|
| Rate for Payer: Cigna Commercial |
$4,517.05
|
| Rate for Payer: Health EOS Commercial |
$4,369.76
|
| Rate for Payer: HFN Commercial |
$4,517.05
|
| Rate for Payer: Multiplan Commercial |
$3,927.87
|
| Rate for Payer: Preferred Network Access Commercial |
$4,517.05
|
| Rate for Payer: Quartz Beloit One Network |
$2,405.82
|
| Rate for Payer: Quartz Commercial |
$2,945.90
|
| Rate for Payer: WEA Trust Commercial |
$2,700.41
|
| Rate for Payer: WPS Commercial |
$3,636.59
|
|
|
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 |
$1,659.96 |
| 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 Humerus w/ + w/o Contrast Bilateral
|
Facility
|
IP
|
$10,957.00
|
|
|
Service Code
|
CPT 73220
|
| Hospital Charge Code |
631015
|
| Min. Negotiated Rate |
$5,583.69 |
| Max. Negotiated Rate |
$10,483.66 |
| Rate for Payer: Aetna Commercial |
$10,255.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,799.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,039.50
|
| Rate for Payer: Cash Price |
$3,287.10
|
| Rate for Payer: Cigna Commercial |
$10,483.66
|
| Rate for Payer: Health EOS Commercial |
$10,141.80
|
| Rate for Payer: HFN Commercial |
$10,483.66
|
| Rate for Payer: Multiplan Commercial |
$9,116.22
|
| Rate for Payer: Preferred Network Access Commercial |
$10,483.66
|
| Rate for Payer: Quartz Beloit One Network |
$5,583.69
|
| Rate for Payer: Quartz Commercial |
$6,837.17
|
| Rate for Payer: WEA Trust Commercial |
$6,267.40
|
| Rate for Payer: WPS Commercial |
$8,440.18
|
|
|
MRI Humerus w/ + w/o Contrast Bilateral
|
Professional
|
Both
|
$10,957.00
|
|
|
Service Code
|
CPT 73220
|
| Hospital Charge Code |
631015
|
| Min. Negotiated Rate |
$404.78 |
| Max. Negotiated Rate |
$10,825.52 |
| Rate for Payer: Aetna Commercial |
$10,825.52
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,799.94
|
| 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 |
$3,287.10
|
| Rate for Payer: Cash Price |
$3,287.10
|
| Rate for Payer: Cash Price |
$3,287.10
|
| Rate for Payer: Cigna Commercial |
$10,825.52
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$5,697.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$404.78
|
| Rate for Payer: Health EOS Commercial |
$10,369.70
|
| Rate for Payer: HFN Commercial |
$10,825.52
|
| 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 |
$9,116.22
|
| Rate for Payer: NAPHCARE Commercial |
$607.17
|
| Rate for Payer: Preferred Network Access Commercial |
$10,825.52
|
| Rate for Payer: Quartz Beloit One Network |
$5,013.92
|
| Rate for Payer: Quartz Commercial |
$6,495.31
|
| 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 |
$6,267.40
|
| Rate for Payer: WPS Commercial |
$2,023.89
|
|
|
MRI Humerus w/ + w/o Contrast Bilateral
|
Facility
|
OP
|
$10,957.00
|
|
|
Service Code
|
CPT 73220
|
| Hospital Charge Code |
631015
|
| Min. Negotiated Rate |
$367.15 |
| Max. Negotiated Rate |
$10,483.66 |
| Rate for Payer: Aetna Commercial |
$10,255.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,799.94
|
| Rate for Payer: Aetna Managed Medicare |
$367.15
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$7,406.93
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,697.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,469.73
|
| Rate for Payer: Anthem Medicare Advantage |
$367.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,039.50
|
| 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 |
$3,287.10
|
| Rate for Payer: Cash Price |
$3,287.10
|
| Rate for Payer: Cigna Commercial |
$10,483.66
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$367.15
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,376.97
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$367.15
|
| Rate for Payer: Health EOS Commercial |
$10,141.80
|
| Rate for Payer: HFN Commercial |
$10,483.66
|
| 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 |
$9,116.22
|
| Rate for Payer: NAPHCARE Commercial |
$550.73
|
| Rate for Payer: Preferred Network Access Commercial |
$10,483.66
|
| Rate for Payer: Quartz Beloit One Network |
$5,583.69
|
| Rate for Payer: Quartz Commercial |
$7,406.93
|
| 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 |
$6,267.40
|
| Rate for Payer: Wellcare Medicare |
$367.15
|
| Rate for Payer: WPS Commercial |
$8,440.18
|
|
|
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 |
$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 Humerus w/ + w/o Contrast Bilateral
|
Facility
|
OP
|
$6,077.00
|
|
|
Service Code
|
CPT 73220 TC,LT
|
| Hospital Charge Code |
1611153
|
|
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 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 |
$1,659.96 |
| 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 Humerus w/ + w/o Contrast Left
|
Facility
|
IP
|
$5,479.00
|
|
|
Service Code
|
CPT 73220
|
| Hospital Charge Code |
631021
|
| 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 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 |
$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 Humerus w/ + w/o Contrast Left
|
Professional
|
Both
|
$5,479.00
|
|
|
Service Code
|
CPT 73220
|
| Hospital Charge Code |
631021
|
| 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 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 |
$3,381.71 |
| 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 Humerus w/ + w/o Contrast Left
|
Facility
|
OP
|
$5,479.00
|
|
|
Service Code
|
CPT 73220
|
| Hospital Charge Code |
631021
|
| 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 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 |
$1,659.96 |
| 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 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 |
$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 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 |
$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 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 |
$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 Humerus w/ + w/o Contrast Right
|
Professional
|
Both
|
$5,479.00
|
|
|
Service Code
|
CPT 73220
|
| Hospital Charge Code |
631027
|
| 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
|
|
