|
MRI UE Joint w/ + w/o Contrast Left
|
Facility
|
OP
|
$6,397.00
|
|
|
Service Code
|
CPT 73223 TC,LT
|
| Hospital Charge Code |
1611351
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$380.12 |
| 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: 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 |
$3,390.41
|
| 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 |
$1,919.10
|
| Rate for Payer: Cash Price |
$1,919.10
|
| Rate for Payer: Cash Price |
$1,919.10
|
| Rate for Payer: Cash Price |
$1,919.10
|
| Rate for Payer: Cigna Commercial |
$5,885.24
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$380.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,579.76
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$380.12
|
| Rate for Payer: Health EOS Commercial |
$5,693.33
|
| Rate for Payer: HFN Commercial |
$5,885.24
|
| 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 |
$5,117.60
|
| Rate for Payer: NAPHCARE Commercial |
$570.18
|
| 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 |
$4,158.05
|
| Rate for Payer: Quartz Medicare Advantage |
$380.12
|
| Rate for Payer: The Alliance Commercial |
$1,520.48
|
| Rate for Payer: United Healthcare Medicare Advantage |
$380.12
|
| Rate for Payer: United Healthcare PPO |
$3,022.00
|
| Rate for Payer: WEA Trust Commercial |
$3,518.35
|
| Rate for Payer: Wellcare Medicare |
$380.12
|
| Rate for Payer: WPS Commercial |
$4,738.26
|
|
|
MRI UE Joint w/ + w/o Contrast Left
|
Facility
|
IP
|
$6,397.00
|
|
|
Service Code
|
CPT 73223 TC,LT
|
| Hospital Charge Code |
1611351
|
|
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 UE Joint w/ + w/o Contrast Left
|
Professional
|
Both
|
$6,397.00
|
|
|
Service Code
|
CPT 73223 TC,LT
|
| Hospital Charge Code |
1611351
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,507.24 |
| Max. Negotiated Rate |
$6,077.15 |
| Rate for Payer: Aetna Commercial |
$6,077.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,501.42
|
| Rate for Payer: Cash Price |
$1,919.10
|
| Rate for Payer: Cash Price |
$1,919.10
|
| Rate for Payer: Cash Price |
$1,919.10
|
| Rate for Payer: Cigna Commercial |
$6,077.15
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$3,198.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,838.20
|
| Rate for Payer: Health EOS Commercial |
$5,821.27
|
| Rate for Payer: HFN Commercial |
$6,077.15
|
| 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 |
$5,117.60
|
| Rate for Payer: Preferred Network Access Commercial |
$6,077.15
|
| Rate for Payer: Quartz Beloit One Network |
$2,814.68
|
| Rate for Payer: Quartz Commercial |
$3,646.29
|
| Rate for Payer: The Alliance Commercial |
$3,198.50
|
| Rate for Payer: WEA Trust Commercial |
$3,518.35
|
| Rate for Payer: WPS Commercial |
$4,738.26
|
|
|
MRI UE Joint w/ + w/o Contrast Left
|
Professional
|
Both
|
$5,851.00
|
|
|
Service Code
|
CPT 73223
|
| Hospital Charge Code |
631242
|
| 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 UE Joint w/ + w/o Contrast Left
|
Facility
|
IP
|
$5,851.00
|
|
|
Service Code
|
CPT 73223
|
| Hospital Charge Code |
631242
|
| 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 UE Joint w/ + w/o Contrast Right
|
Facility
|
OP
|
$5,851.00
|
|
|
Service Code
|
CPT 73223
|
| Hospital Charge Code |
631246
|
| 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 UE Joint w/ + w/o Contrast Right
|
Facility
|
OP
|
$6,421.00
|
|
|
Service Code
|
CPT 73223 TC,RT
|
| Hospital Charge Code |
1611353
|
|
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 UE Joint w/ + w/o Contrast Right
|
Facility
|
IP
|
$6,397.00
|
|
|
Service Code
|
CPT 73223 TC,RT
|
| Hospital Charge Code |
2980049
|
|
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 UE Joint w/ + w/o Contrast Right
|
Professional
|
Both
|
$5,851.00
|
|
|
Service Code
|
CPT 73223
|
| Hospital Charge Code |
631246
|
| 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 UE Joint w/ + w/o Contrast Right
|
Facility
|
IP
|
$5,851.00
|
|
|
Service Code
|
CPT 73223
|
| Hospital Charge Code |
631246
|
| 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 UE Joint w/ + w/o Contrast Right
|
Professional
|
Both
|
$6,397.00
|
|
|
Service Code
|
CPT 73223 TC,RT
|
| Hospital Charge Code |
2980049
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,507.24 |
| Max. Negotiated Rate |
$6,077.15 |
| Rate for Payer: Aetna Commercial |
$6,077.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,501.42
|
| Rate for Payer: Cash Price |
$1,919.10
|
| Rate for Payer: Cash Price |
$1,919.10
|
| Rate for Payer: Cash Price |
$1,919.10
|
| Rate for Payer: Cigna Commercial |
$6,077.15
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$3,198.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,838.20
|
| Rate for Payer: Health EOS Commercial |
$5,821.27
|
| Rate for Payer: HFN Commercial |
$6,077.15
|
| 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 |
$5,117.60
|
| Rate for Payer: Preferred Network Access Commercial |
$6,077.15
|
| Rate for Payer: Quartz Beloit One Network |
$2,814.68
|
| Rate for Payer: Quartz Commercial |
$3,646.29
|
| Rate for Payer: The Alliance Commercial |
$3,198.50
|
| Rate for Payer: WEA Trust Commercial |
$3,518.35
|
| Rate for Payer: WPS Commercial |
$4,738.26
|
|
|
MRI UE Joint w/ + w/o Contrast Right
|
Professional
|
Both
|
$6,421.00
|
|
|
Service Code
|
CPT 73223 TC,RT
|
| Hospital Charge Code |
1611353
|
|
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 UE Joint w/ + w/o Contrast Right
|
Facility
|
IP
|
$6,421.00
|
|
|
Service Code
|
CPT 73223 TC,RT
|
| Hospital Charge Code |
1611353
|
|
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 UE Joint w/ + w/o Contrast Right
|
Facility
|
OP
|
$6,397.00
|
|
|
Service Code
|
CPT 73223 TC,RT
|
| Hospital Charge Code |
2980049
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$380.12 |
| 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: 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 |
$3,390.41
|
| 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 |
$1,919.10
|
| Rate for Payer: Cash Price |
$1,919.10
|
| Rate for Payer: Cash Price |
$1,919.10
|
| Rate for Payer: Cash Price |
$1,919.10
|
| Rate for Payer: Cigna Commercial |
$5,885.24
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$380.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,579.76
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$380.12
|
| Rate for Payer: Health EOS Commercial |
$5,693.33
|
| Rate for Payer: HFN Commercial |
$5,885.24
|
| 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 |
$5,117.60
|
| Rate for Payer: NAPHCARE Commercial |
$570.18
|
| 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 |
$4,158.05
|
| Rate for Payer: Quartz Medicare Advantage |
$380.12
|
| Rate for Payer: The Alliance Commercial |
$1,520.48
|
| Rate for Payer: United Healthcare Medicare Advantage |
$380.12
|
| Rate for Payer: United Healthcare PPO |
$3,022.00
|
| Rate for Payer: WEA Trust Commercial |
$3,518.35
|
| Rate for Payer: Wellcare Medicare |
$380.12
|
| Rate for Payer: WPS Commercial |
$4,738.26
|
|
|
MRI UE Non Joint w/ Contrast Bilateral
|
Facility
|
IP
|
$5,063.00
|
|
|
Service Code
|
CPT 73219 LT,TC
|
| Hospital Charge Code |
1611373
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$2,480.87 |
| Max. Negotiated Rate |
$4,657.96 |
| Rate for Payer: Aetna Commercial |
$4,556.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,354.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,683.39
|
| Rate for Payer: Cash Price |
$1,518.90
|
| Rate for Payer: Cigna Commercial |
$4,657.96
|
| Rate for Payer: Health EOS Commercial |
$4,506.07
|
| Rate for Payer: HFN Commercial |
$4,657.96
|
| Rate for Payer: Multiplan Commercial |
$4,050.40
|
| Rate for Payer: NAPHCARE Commercial |
$3,037.80
|
| Rate for Payer: Preferred Network Access Commercial |
$4,657.96
|
| Rate for Payer: Quartz Beloit One Network |
$2,480.87
|
| Rate for Payer: Quartz Commercial |
$3,037.80
|
| Rate for Payer: WEA Trust Commercial |
$2,784.65
|
| Rate for Payer: WPS Commercial |
$3,750.16
|
|
|
MRI UE Non Joint w/ Contrast Bilateral
|
Facility
|
OP
|
$5,063.00
|
|
|
Service Code
|
CPT 73219 LT,TC
|
| Hospital Charge Code |
1611373
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$380.12 |
| Max. Negotiated Rate |
$4,657.96 |
| Rate for Payer: Aetna Commercial |
$4,556.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,354.18
|
| 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 |
$2,683.39
|
| 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 |
$1,518.90
|
| 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 |
$4,657.96
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$380.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,833.25
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$380.12
|
| Rate for Payer: Health EOS Commercial |
$4,506.07
|
| Rate for Payer: HFN Commercial |
$4,657.96
|
| 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 |
$4,050.40
|
| Rate for Payer: NAPHCARE Commercial |
$570.18
|
| Rate for Payer: Preferred Network Access Commercial |
$4,657.96
|
| Rate for Payer: Quartz Beloit One Network |
$2,480.87
|
| Rate for Payer: Quartz Commercial |
$3,290.95
|
| 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: United Healthcare PPO |
$3,022.00
|
| Rate for Payer: WEA Trust Commercial |
$2,784.65
|
| Rate for Payer: Wellcare Medicare |
$380.12
|
| Rate for Payer: WPS Commercial |
$3,750.16
|
|
|
MRI UE Non Joint w/ Contrast Bilateral
|
Professional
|
Both
|
$5,063.00
|
|
|
Service Code
|
CPT 73219 LT,TC
|
| Hospital Charge Code |
1611373
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,288.41 |
| Max. Negotiated Rate |
$4,809.85 |
| Rate for Payer: Aetna Commercial |
$4,809.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,354.18
|
| 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 |
$4,809.85
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,531.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,037.80
|
| Rate for Payer: Health EOS Commercial |
$4,607.33
|
| Rate for Payer: HFN Commercial |
$4,809.85
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,288.41
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,288.41
|
| Rate for Payer: Multiplan Commercial |
$4,050.40
|
| Rate for Payer: Preferred Network Access Commercial |
$4,809.85
|
| Rate for Payer: Quartz Beloit One Network |
$2,227.72
|
| Rate for Payer: Quartz Commercial |
$2,885.91
|
| Rate for Payer: The Alliance Commercial |
$2,531.50
|
| Rate for Payer: WEA Trust Commercial |
$2,784.65
|
| Rate for Payer: WPS Commercial |
$3,750.16
|
|
|
MRI UE Non Joint w/ Contrast Bilateral
|
Facility
|
IP
|
$10,322.00
|
|
|
Service Code
|
CPT 73219
|
| Hospital Charge Code |
631371
|
| Min. Negotiated Rate |
$5,057.78 |
| Max. Negotiated Rate |
$9,496.24 |
| Rate for Payer: Aetna Commercial |
$9,289.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,876.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,470.66
|
| Rate for Payer: Cash Price |
$3,096.60
|
| Rate for Payer: Cigna Commercial |
$9,496.24
|
| Rate for Payer: Health EOS Commercial |
$9,186.58
|
| Rate for Payer: HFN Commercial |
$9,496.24
|
| Rate for Payer: Multiplan Commercial |
$8,257.60
|
| Rate for Payer: NAPHCARE Commercial |
$6,193.20
|
| Rate for Payer: Preferred Network Access Commercial |
$9,496.24
|
| Rate for Payer: Quartz Beloit One Network |
$5,057.78
|
| Rate for Payer: Quartz Commercial |
$6,193.20
|
| Rate for Payer: WEA Trust Commercial |
$5,677.10
|
| Rate for Payer: WPS Commercial |
$7,645.51
|
|
|
MRI UE Non Joint w/ Contrast Bilateral
|
Professional
|
Both
|
$10,322.00
|
|
|
Service Code
|
CPT 73219
|
| Hospital Charge Code |
631371
|
| Min. Negotiated Rate |
$1,288.41 |
| Max. Negotiated Rate |
$9,805.90 |
| Rate for Payer: Aetna Commercial |
$9,805.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,876.92
|
| 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 |
$9,805.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$5,161.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,193.20
|
| Rate for Payer: Health EOS Commercial |
$9,393.02
|
| Rate for Payer: HFN Commercial |
$9,805.90
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,288.41
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,288.41
|
| Rate for Payer: Multiplan Commercial |
$8,257.60
|
| Rate for Payer: Preferred Network Access Commercial |
$9,805.90
|
| Rate for Payer: Quartz Beloit One Network |
$4,541.68
|
| Rate for Payer: Quartz Commercial |
$5,883.54
|
| Rate for Payer: The Alliance Commercial |
$5,161.00
|
| Rate for Payer: WEA Trust Commercial |
$5,677.10
|
| Rate for Payer: WPS Commercial |
$7,645.51
|
|
|
MRI UE Non Joint w/ Contrast Bilateral
|
Facility
|
OP
|
$10,322.00
|
|
|
Service Code
|
CPT 73219
|
| Hospital Charge Code |
631371
|
| Min. Negotiated Rate |
$380.12 |
| Max. Negotiated Rate |
$9,496.24 |
| Rate for Payer: Aetna Commercial |
$9,289.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,876.92
|
| Rate for Payer: Aetna Managed Medicare |
$380.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,709.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,161.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,954.56
|
| Rate for Payer: Anthem Medicare Advantage |
$380.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,470.66
|
| 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 |
$3,096.60
|
| Rate for Payer: Cash Price |
$3,096.60
|
| Rate for Payer: Cigna Commercial |
$9,496.24
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$380.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,776.19
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$380.12
|
| Rate for Payer: Health EOS Commercial |
$9,186.58
|
| Rate for Payer: HFN Commercial |
$9,496.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,414.05
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$380.12
|
| Rate for Payer: Independent Care Health Plan Medicare |
$380.12
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$380.12
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$380.12
|
| Rate for Payer: Multiplan Commercial |
$8,257.60
|
| Rate for Payer: NAPHCARE Commercial |
$570.18
|
| Rate for Payer: Preferred Network Access Commercial |
$9,496.24
|
| Rate for Payer: Quartz Beloit One Network |
$5,057.78
|
| Rate for Payer: Quartz Commercial |
$6,709.30
|
| 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 |
$5,677.10
|
| Rate for Payer: Wellcare Medicare |
$380.12
|
| Rate for Payer: WPS Commercial |
$7,645.51
|
|
|
MRI UE Non Joint w/ Contrast Left
|
Professional
|
Both
|
$5,162.00
|
|
|
Service Code
|
CPT 73219
|
| Hospital Charge Code |
631367
|
| Min. Negotiated Rate |
$1,288.41 |
| Max. Negotiated Rate |
$4,903.90 |
| Rate for Payer: Aetna Commercial |
$4,903.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,439.32
|
| 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 |
$4,903.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,581.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,097.20
|
| Rate for Payer: Health EOS Commercial |
$4,697.42
|
| Rate for Payer: HFN Commercial |
$4,903.90
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,288.41
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,288.41
|
| Rate for Payer: Multiplan Commercial |
$4,129.60
|
| Rate for Payer: Preferred Network Access Commercial |
$4,903.90
|
| Rate for Payer: Quartz Beloit One Network |
$2,271.28
|
| Rate for Payer: Quartz Commercial |
$2,942.34
|
| Rate for Payer: The Alliance Commercial |
$2,581.00
|
| Rate for Payer: WEA Trust Commercial |
$2,839.10
|
| Rate for Payer: WPS Commercial |
$3,823.49
|
|
|
MRI UE Non Joint w/ Contrast Left
|
Facility
|
IP
|
$5,162.00
|
|
|
Service Code
|
CPT 73219
|
| Hospital Charge Code |
631367
|
| Min. Negotiated Rate |
$2,529.38 |
| Max. Negotiated Rate |
$4,749.04 |
| Rate for Payer: Aetna Commercial |
$4,645.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,439.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,735.86
|
| Rate for Payer: Cash Price |
$1,548.60
|
| Rate for Payer: Cigna Commercial |
$4,749.04
|
| Rate for Payer: Health EOS Commercial |
$4,594.18
|
| Rate for Payer: HFN Commercial |
$4,749.04
|
| Rate for Payer: Multiplan Commercial |
$4,129.60
|
| Rate for Payer: NAPHCARE Commercial |
$3,097.20
|
| Rate for Payer: Preferred Network Access Commercial |
$4,749.04
|
| Rate for Payer: Quartz Beloit One Network |
$2,529.38
|
| Rate for Payer: Quartz Commercial |
$3,097.20
|
| Rate for Payer: WEA Trust Commercial |
$2,839.10
|
| Rate for Payer: WPS Commercial |
$3,823.49
|
|
|
MRI UE Non Joint w/ Contrast Left
|
Facility
|
IP
|
$5,063.00
|
|
|
Service Code
|
CPT 73219 LT,TC
|
| Hospital Charge Code |
1611375
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$2,480.87 |
| Max. Negotiated Rate |
$4,657.96 |
| Rate for Payer: Aetna Commercial |
$4,556.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,354.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,683.39
|
| Rate for Payer: Cash Price |
$1,518.90
|
| Rate for Payer: Cigna Commercial |
$4,657.96
|
| Rate for Payer: Health EOS Commercial |
$4,506.07
|
| Rate for Payer: HFN Commercial |
$4,657.96
|
| Rate for Payer: Multiplan Commercial |
$4,050.40
|
| Rate for Payer: NAPHCARE Commercial |
$3,037.80
|
| Rate for Payer: Preferred Network Access Commercial |
$4,657.96
|
| Rate for Payer: Quartz Beloit One Network |
$2,480.87
|
| Rate for Payer: Quartz Commercial |
$3,037.80
|
| Rate for Payer: WEA Trust Commercial |
$2,784.65
|
| Rate for Payer: WPS Commercial |
$3,750.16
|
|
|
MRI UE Non Joint w/ Contrast Left
|
Facility
|
OP
|
$5,162.00
|
|
|
Service Code
|
CPT 73219
|
| Hospital Charge Code |
631367
|
| Min. Negotiated Rate |
$380.12 |
| Max. Negotiated Rate |
$4,749.04 |
| Rate for Payer: Aetna Commercial |
$4,645.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,439.32
|
| Rate for Payer: Aetna Managed Medicare |
$380.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,355.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,581.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,477.76
|
| Rate for Payer: Anthem Medicare Advantage |
$380.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,735.86
|
| 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 |
$1,548.60
|
| Rate for Payer: Cash Price |
$1,548.60
|
| Rate for Payer: Cigna Commercial |
$4,749.04
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$380.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,888.66
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$380.12
|
| Rate for Payer: Health EOS Commercial |
$4,594.18
|
| Rate for Payer: HFN Commercial |
$4,749.04
|
| 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 |
$4,129.60
|
| Rate for Payer: NAPHCARE Commercial |
$570.18
|
| Rate for Payer: Preferred Network Access Commercial |
$4,749.04
|
| Rate for Payer: Quartz Beloit One Network |
$2,529.38
|
| Rate for Payer: Quartz Commercial |
$3,355.30
|
| 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 |
$2,839.10
|
| Rate for Payer: Wellcare Medicare |
$380.12
|
| Rate for Payer: WPS Commercial |
$3,823.49
|
|
|
MRI UE Non Joint w/ Contrast Left
|
Facility
|
OP
|
$5,063.00
|
|
|
Service Code
|
CPT 73219 LT,TC
|
| Hospital Charge Code |
1611375
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$380.12 |
| Max. Negotiated Rate |
$4,657.96 |
| Rate for Payer: Aetna Commercial |
$4,556.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,354.18
|
| 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 |
$2,683.39
|
| 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 |
$1,518.90
|
| 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 |
$4,657.96
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$380.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,833.25
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$380.12
|
| Rate for Payer: Health EOS Commercial |
$4,506.07
|
| Rate for Payer: HFN Commercial |
$4,657.96
|
| 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 |
$4,050.40
|
| Rate for Payer: NAPHCARE Commercial |
$570.18
|
| Rate for Payer: Preferred Network Access Commercial |
$4,657.96
|
| Rate for Payer: Quartz Beloit One Network |
$2,480.87
|
| Rate for Payer: Quartz Commercial |
$3,290.95
|
| 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: United Healthcare PPO |
$3,022.00
|
| Rate for Payer: WEA Trust Commercial |
$2,784.65
|
| Rate for Payer: Wellcare Medicare |
$380.12
|
| Rate for Payer: WPS Commercial |
$3,750.16
|
|
