|
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 Right
|
Professional
|
Both
|
$5,162.00
|
|
|
Service Code
|
CPT 73219
|
| Hospital Charge Code |
631379
|
| 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 Right
|
Facility
|
IP
|
$5,162.00
|
|
|
Service Code
|
CPT 73219
|
| Hospital Charge Code |
631379
|
| 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 Right
|
Facility
|
OP
|
$5,063.00
|
|
|
Service Code
|
CPT 73219 TC,RT
|
| Hospital Charge Code |
2980034
|
|
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 Right
|
Professional
|
Both
|
$5,063.00
|
|
|
Service Code
|
CPT 73219 TC,RT
|
| Hospital Charge Code |
2980034
|
|
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 Right
|
Facility
|
OP
|
$5,162.00
|
|
|
Service Code
|
CPT 73219
|
| Hospital Charge Code |
631379
|
| 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 Right
|
Facility
|
OP
|
$5,063.00
|
|
|
Service Code
|
CPT 73219 RT,TC
|
| Hospital Charge Code |
1611377
|
|
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 Right
|
Facility
|
IP
|
$5,063.00
|
|
|
Service Code
|
CPT 73219 TC,RT
|
| Hospital Charge Code |
2980034
|
|
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 Right
|
Professional
|
Both
|
$5,063.00
|
|
|
Service Code
|
CPT 73219 RT,TC
|
| Hospital Charge Code |
1611377
|
|
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 Right
|
Facility
|
IP
|
$5,063.00
|
|
|
Service Code
|
CPT 73219 RT,TC
|
| Hospital Charge Code |
1611377
|
|
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/o Contrast Bilateral
|
Facility
|
IP
|
$4,631.00
|
|
|
Service Code
|
CPT 73218 LT,TC
|
| Hospital Charge Code |
1611379
|
|
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 UE Non Joint w/o Contrast Bilateral
|
Facility
|
OP
|
$4,631.00
|
|
|
Service Code
|
CPT 73218 LT,TC
|
| Hospital Charge Code |
1611379
|
|
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 UE Non Joint w/o Contrast Bilateral
|
Professional
|
Both
|
$4,631.00
|
|
|
Service Code
|
CPT 73218 LT,TC
|
| Hospital Charge Code |
1611379
|
|
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 UE Non Joint w/o Contrast Bilateral
|
Professional
|
Both
|
$9,441.00
|
|
|
Service Code
|
CPT 73218
|
| Hospital Charge Code |
631386
|
| Min. Negotiated Rate |
$1,180.61 |
| Max. Negotiated Rate |
$8,968.95 |
| Rate for Payer: Aetna Commercial |
$8,968.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,119.26
|
| Rate for Payer: Cash Price |
$2,832.30
|
| Rate for Payer: Cash Price |
$2,832.30
|
| Rate for Payer: Cash Price |
$2,832.30
|
| Rate for Payer: Cigna Commercial |
$8,968.95
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$4,720.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,664.60
|
| Rate for Payer: Health EOS Commercial |
$8,591.31
|
| Rate for Payer: HFN Commercial |
$8,968.95
|
| 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 |
$7,552.80
|
| Rate for Payer: Preferred Network Access Commercial |
$8,968.95
|
| Rate for Payer: Quartz Beloit One Network |
$4,154.04
|
| Rate for Payer: Quartz Commercial |
$5,381.37
|
| Rate for Payer: The Alliance Commercial |
$4,720.50
|
| Rate for Payer: WEA Trust Commercial |
$5,192.55
|
| Rate for Payer: WPS Commercial |
$6,992.95
|
|
|
MRI UE Non Joint w/o Contrast Bilateral
|
Facility
|
IP
|
$9,441.00
|
|
|
Service Code
|
CPT 73218
|
| Hospital Charge Code |
631386
|
| Min. Negotiated Rate |
$4,626.09 |
| Max. Negotiated Rate |
$8,685.72 |
| Rate for Payer: Aetna Commercial |
$8,496.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,119.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,003.73
|
| Rate for Payer: Cash Price |
$2,832.30
|
| Rate for Payer: Cigna Commercial |
$8,685.72
|
| Rate for Payer: Health EOS Commercial |
$8,402.49
|
| Rate for Payer: HFN Commercial |
$8,685.72
|
| Rate for Payer: Multiplan Commercial |
$7,552.80
|
| Rate for Payer: NAPHCARE Commercial |
$5,664.60
|
| Rate for Payer: Preferred Network Access Commercial |
$8,685.72
|
| Rate for Payer: Quartz Beloit One Network |
$4,626.09
|
| Rate for Payer: Quartz Commercial |
$5,664.60
|
| Rate for Payer: WEA Trust Commercial |
$5,192.55
|
| Rate for Payer: WPS Commercial |
$6,992.95
|
|
|
MRI UE Non Joint w/o Contrast Bilateral
|
Facility
|
OP
|
$9,441.00
|
|
|
Service Code
|
CPT 73218
|
| Hospital Charge Code |
631386
|
| Min. Negotiated Rate |
$242.20 |
| Max. Negotiated Rate |
$8,685.72 |
| Rate for Payer: Aetna Commercial |
$8,496.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,119.26
|
| Rate for Payer: Aetna Managed Medicare |
$242.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,136.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,720.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,531.68
|
| Rate for Payer: Anthem Medicare Advantage |
$242.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,003.73
|
| 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 |
$2,832.30
|
| Rate for Payer: Cash Price |
$2,832.30
|
| Rate for Payer: Cigna Commercial |
$8,685.72
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$242.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,283.18
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$242.20
|
| Rate for Payer: Health EOS Commercial |
$8,402.49
|
| Rate for Payer: HFN Commercial |
$8,685.72
|
| 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 |
$7,552.80
|
| Rate for Payer: NAPHCARE Commercial |
$363.30
|
| Rate for Payer: Preferred Network Access Commercial |
$8,685.72
|
| Rate for Payer: Quartz Beloit One Network |
$4,626.09
|
| Rate for Payer: Quartz Commercial |
$6,136.65
|
| 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: WEA Trust Commercial |
$5,192.55
|
| Rate for Payer: Wellcare Medicare |
$242.20
|
| Rate for Payer: WPS Commercial |
$6,992.95
|
|
|
MRI UE Non Joint w/o Contrast Left
|
Facility
|
OP
|
$4,631.00
|
|
|
Service Code
|
CPT 73218 LT,TC
|
| Hospital Charge Code |
1611381
|
|
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 UE Non Joint w/o Contrast Left
|
Facility
|
IP
|
$4,721.00
|
|
|
Service Code
|
CPT 73218
|
| Hospital Charge Code |
631400
|
| Min. Negotiated Rate |
$2,313.29 |
| Max. Negotiated Rate |
$4,343.32 |
| Rate for Payer: Aetna Commercial |
$4,248.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,060.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,502.13
|
| Rate for Payer: Cash Price |
$1,416.30
|
| Rate for Payer: Cigna Commercial |
$4,343.32
|
| Rate for Payer: Health EOS Commercial |
$4,201.69
|
| Rate for Payer: HFN Commercial |
$4,343.32
|
| Rate for Payer: Multiplan Commercial |
$3,776.80
|
| Rate for Payer: NAPHCARE Commercial |
$2,832.60
|
| Rate for Payer: Preferred Network Access Commercial |
$4,343.32
|
| Rate for Payer: Quartz Beloit One Network |
$2,313.29
|
| Rate for Payer: Quartz Commercial |
$2,832.60
|
| Rate for Payer: WEA Trust Commercial |
$2,596.55
|
| Rate for Payer: WPS Commercial |
$3,496.84
|
|
|
MRI UE Non Joint w/o Contrast Left
|
Professional
|
Both
|
$4,631.00
|
|
|
Service Code
|
CPT 73218 LT,TC
|
| Hospital Charge Code |
1611381
|
|
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 UE Non Joint w/o Contrast Left
|
Facility
|
IP
|
$4,631.00
|
|
|
Service Code
|
CPT 73218 LT,TC
|
| Hospital Charge Code |
1611381
|
|
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 UE Non Joint w/o Contrast Left
|
Professional
|
Both
|
$4,721.00
|
|
|
Service Code
|
CPT 73218
|
| Hospital Charge Code |
631400
|
| Min. Negotiated Rate |
$1,180.61 |
| Max. Negotiated Rate |
$4,484.95 |
| Rate for Payer: Aetna Commercial |
$4,484.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,060.06
|
| 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 |
$4,484.95
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,360.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,832.60
|
| Rate for Payer: Health EOS Commercial |
$4,296.11
|
| Rate for Payer: HFN Commercial |
$4,484.95
|
| 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 |
$3,776.80
|
| Rate for Payer: Preferred Network Access Commercial |
$4,484.95
|
| Rate for Payer: Quartz Beloit One Network |
$2,077.24
|
| Rate for Payer: Quartz Commercial |
$2,690.97
|
| Rate for Payer: The Alliance Commercial |
$2,360.50
|
| Rate for Payer: WEA Trust Commercial |
$2,596.55
|
| Rate for Payer: WPS Commercial |
$3,496.84
|
|
|
MRI UE Non Joint w/o Contrast Left
|
Facility
|
OP
|
$4,721.00
|
|
|
Service Code
|
CPT 73218
|
| Hospital Charge Code |
631400
|
| Min. Negotiated Rate |
$242.20 |
| Max. Negotiated Rate |
$4,343.32 |
| Rate for Payer: Aetna Commercial |
$4,248.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,060.06
|
| Rate for Payer: Aetna Managed Medicare |
$242.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,068.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,360.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,266.08
|
| Rate for Payer: Anthem Medicare Advantage |
$242.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,502.13
|
| 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 |
$1,416.30
|
| Rate for Payer: Cash Price |
$1,416.30
|
| Rate for Payer: Cigna Commercial |
$4,343.32
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$242.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,641.87
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$242.20
|
| Rate for Payer: Health EOS Commercial |
$4,201.69
|
| Rate for Payer: HFN Commercial |
$4,343.32
|
| 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 |
$3,776.80
|
| Rate for Payer: NAPHCARE Commercial |
$363.30
|
| Rate for Payer: Preferred Network Access Commercial |
$4,343.32
|
| Rate for Payer: Quartz Beloit One Network |
$2,313.29
|
| Rate for Payer: Quartz Commercial |
$3,068.65
|
| 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: WEA Trust Commercial |
$2,596.55
|
| Rate for Payer: Wellcare Medicare |
$242.20
|
| Rate for Payer: WPS Commercial |
$3,496.84
|
|
|
MRI UE Non Joint w/o Contrast Right
|
Professional
|
Both
|
$4,631.00
|
|
|
Service Code
|
CPT 73218 TC,RT
|
| Hospital Charge Code |
2980030
|
|
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 UE Non Joint w/o Contrast Right
|
Facility
|
IP
|
$4,721.00
|
|
|
Service Code
|
CPT 73218
|
| Hospital Charge Code |
631408
|
| Min. Negotiated Rate |
$2,313.29 |
| Max. Negotiated Rate |
$4,343.32 |
| Rate for Payer: Aetna Commercial |
$4,248.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,060.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,502.13
|
| Rate for Payer: Cash Price |
$1,416.30
|
| Rate for Payer: Cigna Commercial |
$4,343.32
|
| Rate for Payer: Health EOS Commercial |
$4,201.69
|
| Rate for Payer: HFN Commercial |
$4,343.32
|
| Rate for Payer: Multiplan Commercial |
$3,776.80
|
| Rate for Payer: NAPHCARE Commercial |
$2,832.60
|
| Rate for Payer: Preferred Network Access Commercial |
$4,343.32
|
| Rate for Payer: Quartz Beloit One Network |
$2,313.29
|
| Rate for Payer: Quartz Commercial |
$2,832.60
|
| Rate for Payer: WEA Trust Commercial |
$2,596.55
|
| Rate for Payer: WPS Commercial |
$3,496.84
|
|
|
MRI UE Non Joint w/o Contrast Right
|
Facility
|
OP
|
$4,721.00
|
|
|
Service Code
|
CPT 73218
|
| Hospital Charge Code |
631408
|
| Min. Negotiated Rate |
$242.20 |
| Max. Negotiated Rate |
$4,343.32 |
| Rate for Payer: Aetna Commercial |
$4,248.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,060.06
|
| Rate for Payer: Aetna Managed Medicare |
$242.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,068.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,360.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,266.08
|
| Rate for Payer: Anthem Medicare Advantage |
$242.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,502.13
|
| 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 |
$1,416.30
|
| Rate for Payer: Cash Price |
$1,416.30
|
| Rate for Payer: Cigna Commercial |
$4,343.32
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$242.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,641.87
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$242.20
|
| Rate for Payer: Health EOS Commercial |
$4,201.69
|
| Rate for Payer: HFN Commercial |
$4,343.32
|
| 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 |
$3,776.80
|
| Rate for Payer: NAPHCARE Commercial |
$363.30
|
| Rate for Payer: Preferred Network Access Commercial |
$4,343.32
|
| Rate for Payer: Quartz Beloit One Network |
$2,313.29
|
| Rate for Payer: Quartz Commercial |
$3,068.65
|
| 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: WEA Trust Commercial |
$2,596.55
|
| Rate for Payer: Wellcare Medicare |
$242.20
|
| Rate for Payer: WPS Commercial |
$3,496.84
|
|
