|
MRI UE Non Joint w/o Contrast Right
|
Facility
|
IP
|
$4,810.00
|
|
|
Service Code
|
CPT 73218 RT,TC
|
| Hospital Charge Code |
1611383
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$2,356.90 |
| Max. Negotiated Rate |
$4,425.20 |
| Rate for Payer: Aetna Commercial |
$4,329.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,136.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,549.30
|
| Rate for Payer: Cash Price |
$1,443.00
|
| Rate for Payer: Cigna Commercial |
$4,425.20
|
| Rate for Payer: Health EOS Commercial |
$4,280.90
|
| Rate for Payer: HFN Commercial |
$4,425.20
|
| Rate for Payer: Multiplan Commercial |
$3,848.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,886.00
|
| Rate for Payer: Preferred Network Access Commercial |
$4,425.20
|
| Rate for Payer: Quartz Beloit One Network |
$2,356.90
|
| Rate for Payer: Quartz Commercial |
$2,886.00
|
| Rate for Payer: WEA Trust Commercial |
$2,645.50
|
| Rate for Payer: WPS Commercial |
$3,562.77
|
|
|
MRI UE Non Joint w/o Contrast Right
|
Facility
|
OP
|
$4,631.00
|
|
|
Service Code
|
CPT 73218 TC,RT
|
| Hospital Charge Code |
2980030
|
|
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 Right
|
Professional
|
Both
|
$4,721.00
|
|
|
Service Code
|
CPT 73218
|
| Hospital Charge Code |
631408
|
| 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 Right
|
Facility
|
OP
|
$4,810.00
|
|
|
Service Code
|
CPT 73218 RT,TC
|
| Hospital Charge Code |
1611383
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$242.20 |
| Max. Negotiated Rate |
$4,425.20 |
| Rate for Payer: Aetna Commercial |
$4,329.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,136.60
|
| Rate for Payer: Aetna Managed Medicare |
$242.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,496.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,871.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,726.00
|
| Rate for Payer: Anthem Medicare Advantage |
$242.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,549.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$242.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$242.20
|
| Rate for Payer: Cash Price |
$1,443.00
|
| Rate for Payer: Cash Price |
$1,443.00
|
| Rate for Payer: Cash Price |
$1,443.00
|
| Rate for Payer: Cash Price |
$1,443.00
|
| Rate for Payer: Cigna Commercial |
$4,425.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$242.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,691.68
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$242.20
|
| Rate for Payer: Health EOS Commercial |
$4,280.90
|
| Rate for Payer: HFN Commercial |
$4,425.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$900.98
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$242.20
|
| Rate for Payer: Independent Care Health Plan Medicare |
$242.20
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$242.20
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$242.20
|
| Rate for Payer: Multiplan Commercial |
$3,848.00
|
| Rate for Payer: NAPHCARE Commercial |
$363.30
|
| Rate for Payer: Preferred Network Access Commercial |
$4,425.20
|
| Rate for Payer: Quartz Beloit One Network |
$2,356.90
|
| Rate for Payer: Quartz Commercial |
$3,126.50
|
| Rate for Payer: Quartz Medicare Advantage |
$242.20
|
| Rate for Payer: The Alliance Commercial |
$968.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$242.20
|
| Rate for Payer: United Healthcare PPO |
$3,022.00
|
| Rate for Payer: WEA Trust Commercial |
$2,645.50
|
| Rate for Payer: Wellcare Medicare |
$242.20
|
| Rate for Payer: WPS Commercial |
$3,562.77
|
|
|
MRI UE Non Joint w/o Contrast Right
|
Professional
|
Both
|
$4,810.00
|
|
|
Service Code
|
CPT 73218 RT,TC
|
| Hospital Charge Code |
1611383
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,180.61 |
| Max. Negotiated Rate |
$4,569.50 |
| Rate for Payer: Aetna Commercial |
$4,569.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,136.60
|
| 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 |
$4,569.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,405.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,886.00
|
| Rate for Payer: Health EOS Commercial |
$4,377.10
|
| Rate for Payer: HFN Commercial |
$4,569.50
|
| 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 |
$3,848.00
|
| Rate for Payer: Preferred Network Access Commercial |
$4,569.50
|
| Rate for Payer: Quartz Beloit One Network |
$2,116.40
|
| Rate for Payer: Quartz Commercial |
$2,741.70
|
| Rate for Payer: The Alliance Commercial |
$2,405.00
|
| Rate for Payer: WEA Trust Commercial |
$2,645.50
|
| Rate for Payer: WPS Commercial |
$3,562.77
|
|
|
MRI UE Non Joint w/o Contrast Right
|
Facility
|
IP
|
$4,631.00
|
|
|
Service Code
|
CPT 73218 TC,RT
|
| Hospital Charge Code |
2980030
|
|
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/ + w/o Contrast Bilat
|
Professional
|
Both
|
$10,957.00
|
|
|
Service Code
|
CPT 73220
|
| Hospital Charge Code |
631349
|
| Min. Negotiated Rate |
$1,596.12 |
| Max. Negotiated Rate |
$10,409.15 |
| Rate for Payer: Aetna Commercial |
$10,409.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,423.02
|
| 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 |
$10,409.15
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$5,478.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,574.20
|
| Rate for Payer: Health EOS Commercial |
$9,970.87
|
| Rate for Payer: HFN Commercial |
$10,409.15
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,596.12
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,596.12
|
| Rate for Payer: Multiplan Commercial |
$8,765.60
|
| Rate for Payer: Preferred Network Access Commercial |
$10,409.15
|
| Rate for Payer: Quartz Beloit One Network |
$4,821.08
|
| Rate for Payer: Quartz Commercial |
$6,245.49
|
| Rate for Payer: The Alliance Commercial |
$5,478.50
|
| Rate for Payer: WEA Trust Commercial |
$6,026.35
|
| Rate for Payer: WPS Commercial |
$8,115.85
|
|
|
MRI UE Non Joint w/ + w/o Contrast Bilat
|
Facility
|
OP
|
$10,957.00
|
|
|
Service Code
|
CPT 73220
|
| Hospital Charge Code |
631349
|
| Min. Negotiated Rate |
$380.12 |
| Max. Negotiated Rate |
$10,080.44 |
| Rate for Payer: Aetna Commercial |
$9,861.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,423.02
|
| Rate for Payer: Aetna Managed Medicare |
$380.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$7,122.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,478.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,259.36
|
| Rate for Payer: Anthem Medicare Advantage |
$380.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,807.21
|
| 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 |
$3,287.10
|
| Rate for Payer: Cash Price |
$3,287.10
|
| Rate for Payer: Cigna Commercial |
$10,080.44
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$380.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,131.54
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$380.12
|
| Rate for Payer: Health EOS Commercial |
$9,751.73
|
| Rate for Payer: HFN Commercial |
$10,080.44
|
| 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 |
$8,765.60
|
| Rate for Payer: NAPHCARE Commercial |
$570.18
|
| Rate for Payer: Preferred Network Access Commercial |
$10,080.44
|
| Rate for Payer: Quartz Beloit One Network |
$5,368.93
|
| Rate for Payer: Quartz Commercial |
$7,122.05
|
| 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: WEA Trust Commercial |
$6,026.35
|
| Rate for Payer: Wellcare Medicare |
$380.12
|
| Rate for Payer: WPS Commercial |
$8,115.85
|
|
|
MRI UE Non Joint w/ + w/o Contrast Bilat
|
Facility
|
IP
|
$10,957.00
|
|
|
Service Code
|
CPT 73220
|
| Hospital Charge Code |
631349
|
| Min. Negotiated Rate |
$5,368.93 |
| Max. Negotiated Rate |
$10,080.44 |
| Rate for Payer: Aetna Commercial |
$9,861.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,423.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,807.21
|
| Rate for Payer: Cash Price |
$3,287.10
|
| Rate for Payer: Cigna Commercial |
$10,080.44
|
| Rate for Payer: Health EOS Commercial |
$9,751.73
|
| Rate for Payer: HFN Commercial |
$10,080.44
|
| Rate for Payer: Multiplan Commercial |
$8,765.60
|
| Rate for Payer: NAPHCARE Commercial |
$6,574.20
|
| Rate for Payer: Preferred Network Access Commercial |
$10,080.44
|
| Rate for Payer: Quartz Beloit One Network |
$5,368.93
|
| Rate for Payer: Quartz Commercial |
$6,574.20
|
| Rate for Payer: WEA Trust Commercial |
$6,026.35
|
| Rate for Payer: WPS Commercial |
$8,115.85
|
|
|
MRI UE Non Joint w/ + w/o Contrast Bilat
|
Facility
|
IP
|
$6,077.00
|
|
|
Service Code
|
CPT 73220 LT,TC
|
| Hospital Charge Code |
1611367
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$2,977.73 |
| Max. Negotiated Rate |
$5,590.84 |
| Rate for Payer: Aetna Commercial |
$5,469.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,226.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,220.81
|
| Rate for Payer: Cash Price |
$1,823.10
|
| Rate for Payer: Cigna Commercial |
$5,590.84
|
| Rate for Payer: Health EOS Commercial |
$5,408.53
|
| Rate for Payer: HFN Commercial |
$5,590.84
|
| Rate for Payer: Multiplan Commercial |
$4,861.60
|
| Rate for Payer: NAPHCARE Commercial |
$3,646.20
|
| Rate for Payer: Preferred Network Access Commercial |
$5,590.84
|
| Rate for Payer: Quartz Beloit One Network |
$2,977.73
|
| Rate for Payer: Quartz Commercial |
$3,646.20
|
| Rate for Payer: WEA Trust Commercial |
$3,342.35
|
| Rate for Payer: WPS Commercial |
$4,501.23
|
|
|
MRI UE Non Joint w/ + w/o Contrast Bilat
|
Facility
|
OP
|
$6,077.00
|
|
|
Service Code
|
CPT 73220 LT,TC
|
| Hospital Charge Code |
1611367
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$380.12 |
| Max. Negotiated Rate |
$5,590.84 |
| Rate for Payer: Aetna Commercial |
$5,469.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,226.22
|
| 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 |
$3,220.81
|
| 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 |
$1,823.10
|
| 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 |
$5,590.84
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$380.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,400.69
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$380.12
|
| Rate for Payer: Health EOS Commercial |
$5,408.53
|
| Rate for Payer: HFN Commercial |
$5,590.84
|
| 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 |
$4,861.60
|
| Rate for Payer: NAPHCARE Commercial |
$570.18
|
| Rate for Payer: Preferred Network Access Commercial |
$5,590.84
|
| Rate for Payer: Quartz Beloit One Network |
$2,977.73
|
| Rate for Payer: Quartz Commercial |
$3,950.05
|
| 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 |
$3,342.35
|
| Rate for Payer: Wellcare Medicare |
$380.12
|
| Rate for Payer: WPS Commercial |
$4,501.23
|
|
|
MRI UE Non Joint w/ + w/o Contrast Bilat
|
Professional
|
Both
|
$6,077.00
|
|
|
Service Code
|
CPT 73220 LT,TC
|
| Hospital Charge Code |
1611367
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,596.12 |
| Max. Negotiated Rate |
$5,773.15 |
| Rate for Payer: Aetna Commercial |
$5,773.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,226.22
|
| 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 |
$5,773.15
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$3,038.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,646.20
|
| Rate for Payer: Health EOS Commercial |
$5,530.07
|
| Rate for Payer: HFN Commercial |
$5,773.15
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,596.12
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,596.12
|
| Rate for Payer: Multiplan Commercial |
$4,861.60
|
| Rate for Payer: Preferred Network Access Commercial |
$5,773.15
|
| Rate for Payer: Quartz Beloit One Network |
$2,673.88
|
| Rate for Payer: Quartz Commercial |
$3,463.89
|
| Rate for Payer: The Alliance Commercial |
$3,038.50
|
| Rate for Payer: WEA Trust Commercial |
$3,342.35
|
| Rate for Payer: WPS Commercial |
$4,501.23
|
|
|
MRI UE Non Joint w/ + w/o Contrast Left
|
Facility
|
IP
|
$5,479.00
|
|
|
Service Code
|
CPT 73220
|
| Hospital Charge Code |
631355
|
| Min. Negotiated Rate |
$2,684.71 |
| Max. Negotiated Rate |
$5,040.68 |
| Rate for Payer: Aetna Commercial |
$4,931.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,711.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,903.87
|
| Rate for Payer: Cash Price |
$1,643.70
|
| Rate for Payer: Cigna Commercial |
$5,040.68
|
| Rate for Payer: Health EOS Commercial |
$4,876.31
|
| Rate for Payer: HFN Commercial |
$5,040.68
|
| Rate for Payer: Multiplan Commercial |
$4,383.20
|
| Rate for Payer: NAPHCARE Commercial |
$3,287.40
|
| Rate for Payer: Preferred Network Access Commercial |
$5,040.68
|
| Rate for Payer: Quartz Beloit One Network |
$2,684.71
|
| Rate for Payer: Quartz Commercial |
$3,287.40
|
| Rate for Payer: WEA Trust Commercial |
$3,013.45
|
| Rate for Payer: WPS Commercial |
$4,058.30
|
|
|
MRI UE Non Joint w/ + w/o Contrast Left
|
Professional
|
Both
|
$6,077.00
|
|
|
Service Code
|
CPT 73220 LT,TC
|
| Hospital Charge Code |
1611369
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,596.12 |
| Max. Negotiated Rate |
$5,773.15 |
| Rate for Payer: Aetna Commercial |
$5,773.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,226.22
|
| 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 |
$5,773.15
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$3,038.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,646.20
|
| Rate for Payer: Health EOS Commercial |
$5,530.07
|
| Rate for Payer: HFN Commercial |
$5,773.15
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,596.12
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,596.12
|
| Rate for Payer: Multiplan Commercial |
$4,861.60
|
| Rate for Payer: Preferred Network Access Commercial |
$5,773.15
|
| Rate for Payer: Quartz Beloit One Network |
$2,673.88
|
| Rate for Payer: Quartz Commercial |
$3,463.89
|
| Rate for Payer: The Alliance Commercial |
$3,038.50
|
| Rate for Payer: WEA Trust Commercial |
$3,342.35
|
| Rate for Payer: WPS Commercial |
$4,501.23
|
|
|
MRI UE Non Joint w/ + w/o Contrast Left
|
Professional
|
Both
|
$5,479.00
|
|
|
Service Code
|
CPT 73220
|
| Hospital Charge Code |
631355
|
| Min. Negotiated Rate |
$1,596.12 |
| Max. Negotiated Rate |
$5,205.05 |
| Rate for Payer: Aetna Commercial |
$5,205.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,711.94
|
| 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 |
$5,205.05
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,739.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,287.40
|
| Rate for Payer: Health EOS Commercial |
$4,985.89
|
| Rate for Payer: HFN Commercial |
$5,205.05
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,596.12
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,596.12
|
| Rate for Payer: Multiplan Commercial |
$4,383.20
|
| Rate for Payer: Preferred Network Access Commercial |
$5,205.05
|
| Rate for Payer: Quartz Beloit One Network |
$2,410.76
|
| Rate for Payer: Quartz Commercial |
$3,123.03
|
| Rate for Payer: The Alliance Commercial |
$2,739.50
|
| Rate for Payer: WEA Trust Commercial |
$3,013.45
|
| Rate for Payer: WPS Commercial |
$4,058.30
|
|
|
MRI UE Non Joint w/ + w/o Contrast Left
|
Facility
|
OP
|
$6,077.00
|
|
|
Service Code
|
CPT 73220 LT,TC
|
| Hospital Charge Code |
1611369
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$380.12 |
| Max. Negotiated Rate |
$5,590.84 |
| Rate for Payer: Aetna Commercial |
$5,469.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,226.22
|
| 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 |
$3,220.81
|
| 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 |
$1,823.10
|
| 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 |
$5,590.84
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$380.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,400.69
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$380.12
|
| Rate for Payer: Health EOS Commercial |
$5,408.53
|
| Rate for Payer: HFN Commercial |
$5,590.84
|
| 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 |
$4,861.60
|
| Rate for Payer: NAPHCARE Commercial |
$570.18
|
| Rate for Payer: Preferred Network Access Commercial |
$5,590.84
|
| Rate for Payer: Quartz Beloit One Network |
$2,977.73
|
| Rate for Payer: Quartz Commercial |
$3,950.05
|
| 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 |
$3,342.35
|
| Rate for Payer: Wellcare Medicare |
$380.12
|
| Rate for Payer: WPS Commercial |
$4,501.23
|
|
|
MRI UE Non Joint w/ + w/o Contrast Left
|
Facility
|
OP
|
$5,479.00
|
|
|
Service Code
|
CPT 73220
|
| Hospital Charge Code |
631355
|
| Min. Negotiated Rate |
$380.12 |
| Max. Negotiated Rate |
$5,040.68 |
| Rate for Payer: Aetna Commercial |
$4,931.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,711.94
|
| Rate for Payer: Aetna Managed Medicare |
$380.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,561.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,739.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,629.92
|
| Rate for Payer: Anthem Medicare Advantage |
$380.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,903.87
|
| 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 |
$1,643.70
|
| Rate for Payer: Cash Price |
$1,643.70
|
| Rate for Payer: Cigna Commercial |
$5,040.68
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$380.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,066.05
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$380.12
|
| Rate for Payer: Health EOS Commercial |
$4,876.31
|
| Rate for Payer: HFN Commercial |
$5,040.68
|
| 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 |
$4,383.20
|
| Rate for Payer: NAPHCARE Commercial |
$570.18
|
| Rate for Payer: Preferred Network Access Commercial |
$5,040.68
|
| Rate for Payer: Quartz Beloit One Network |
$2,684.71
|
| Rate for Payer: Quartz Commercial |
$3,561.35
|
| 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 |
$3,013.45
|
| Rate for Payer: Wellcare Medicare |
$380.12
|
| Rate for Payer: WPS Commercial |
$4,058.30
|
|
|
MRI UE Non Joint w/ + w/o Contrast Left
|
Facility
|
IP
|
$6,077.00
|
|
|
Service Code
|
CPT 73220 LT,TC
|
| Hospital Charge Code |
1611369
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$2,977.73 |
| Max. Negotiated Rate |
$5,590.84 |
| Rate for Payer: Aetna Commercial |
$5,469.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,226.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,220.81
|
| Rate for Payer: Cash Price |
$1,823.10
|
| Rate for Payer: Cigna Commercial |
$5,590.84
|
| Rate for Payer: Health EOS Commercial |
$5,408.53
|
| Rate for Payer: HFN Commercial |
$5,590.84
|
| Rate for Payer: Multiplan Commercial |
$4,861.60
|
| Rate for Payer: NAPHCARE Commercial |
$3,646.20
|
| Rate for Payer: Preferred Network Access Commercial |
$5,590.84
|
| Rate for Payer: Quartz Beloit One Network |
$2,977.73
|
| Rate for Payer: Quartz Commercial |
$3,646.20
|
| Rate for Payer: WEA Trust Commercial |
$3,342.35
|
| Rate for Payer: WPS Commercial |
$4,501.23
|
|
|
MRI UE Non Joint w/ + w/o Contrast Right
|
Facility
|
IP
|
$5,479.00
|
|
|
Service Code
|
CPT 73220
|
| Hospital Charge Code |
631359
|
| Min. Negotiated Rate |
$2,684.71 |
| Max. Negotiated Rate |
$5,040.68 |
| Rate for Payer: Aetna Commercial |
$4,931.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,711.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,903.87
|
| Rate for Payer: Cash Price |
$1,643.70
|
| Rate for Payer: Cigna Commercial |
$5,040.68
|
| Rate for Payer: Health EOS Commercial |
$4,876.31
|
| Rate for Payer: HFN Commercial |
$5,040.68
|
| Rate for Payer: Multiplan Commercial |
$4,383.20
|
| Rate for Payer: NAPHCARE Commercial |
$3,287.40
|
| Rate for Payer: Preferred Network Access Commercial |
$5,040.68
|
| Rate for Payer: Quartz Beloit One Network |
$2,684.71
|
| Rate for Payer: Quartz Commercial |
$3,287.40
|
| Rate for Payer: WEA Trust Commercial |
$3,013.45
|
| Rate for Payer: WPS Commercial |
$4,058.30
|
|
|
MRI UE Non Joint w/ + w/o Contrast Right
|
Professional
|
Both
|
$6,077.00
|
|
|
Service Code
|
CPT 73220 TC,RT
|
| Hospital Charge Code |
2980038
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,596.12 |
| Max. Negotiated Rate |
$5,773.15 |
| Rate for Payer: Aetna Commercial |
$5,773.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,226.22
|
| 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 |
$5,773.15
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$3,038.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,646.20
|
| Rate for Payer: Health EOS Commercial |
$5,530.07
|
| Rate for Payer: HFN Commercial |
$5,773.15
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,596.12
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,596.12
|
| Rate for Payer: Multiplan Commercial |
$4,861.60
|
| Rate for Payer: Preferred Network Access Commercial |
$5,773.15
|
| Rate for Payer: Quartz Beloit One Network |
$2,673.88
|
| Rate for Payer: Quartz Commercial |
$3,463.89
|
| Rate for Payer: The Alliance Commercial |
$3,038.50
|
| Rate for Payer: WEA Trust Commercial |
$3,342.35
|
| Rate for Payer: WPS Commercial |
$4,501.23
|
|
|
MRI UE Non Joint w/ + w/o Contrast Right
|
Facility
|
OP
|
$5,479.00
|
|
|
Service Code
|
CPT 73220
|
| Hospital Charge Code |
631359
|
| Min. Negotiated Rate |
$380.12 |
| Max. Negotiated Rate |
$5,040.68 |
| Rate for Payer: Aetna Commercial |
$4,931.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,711.94
|
| Rate for Payer: Aetna Managed Medicare |
$380.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,561.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,739.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,629.92
|
| Rate for Payer: Anthem Medicare Advantage |
$380.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,903.87
|
| 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 |
$1,643.70
|
| Rate for Payer: Cash Price |
$1,643.70
|
| Rate for Payer: Cigna Commercial |
$5,040.68
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$380.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,066.05
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$380.12
|
| Rate for Payer: Health EOS Commercial |
$4,876.31
|
| Rate for Payer: HFN Commercial |
$5,040.68
|
| 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 |
$4,383.20
|
| Rate for Payer: NAPHCARE Commercial |
$570.18
|
| Rate for Payer: Preferred Network Access Commercial |
$5,040.68
|
| Rate for Payer: Quartz Beloit One Network |
$2,684.71
|
| Rate for Payer: Quartz Commercial |
$3,561.35
|
| 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 |
$3,013.45
|
| Rate for Payer: Wellcare Medicare |
$380.12
|
| Rate for Payer: WPS Commercial |
$4,058.30
|
|
|
MRI UE Non Joint w/ + w/o Contrast Right
|
Facility
|
OP
|
$6,077.00
|
|
|
Service Code
|
CPT 73220 RT,TC
|
| Hospital Charge Code |
1611371
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$380.12 |
| Max. Negotiated Rate |
$5,590.84 |
| Rate for Payer: Aetna Commercial |
$5,469.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,226.22
|
| 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 |
$3,220.81
|
| 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 |
$1,823.10
|
| 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 |
$5,590.84
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$380.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,400.69
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$380.12
|
| Rate for Payer: Health EOS Commercial |
$5,408.53
|
| Rate for Payer: HFN Commercial |
$5,590.84
|
| 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 |
$4,861.60
|
| Rate for Payer: NAPHCARE Commercial |
$570.18
|
| Rate for Payer: Preferred Network Access Commercial |
$5,590.84
|
| Rate for Payer: Quartz Beloit One Network |
$2,977.73
|
| Rate for Payer: Quartz Commercial |
$3,950.05
|
| 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 |
$3,342.35
|
| Rate for Payer: Wellcare Medicare |
$380.12
|
| Rate for Payer: WPS Commercial |
$4,501.23
|
|
|
MRI UE Non Joint w/ + w/o Contrast Right
|
Facility
|
IP
|
$6,077.00
|
|
|
Service Code
|
CPT 73220 TC,RT
|
| Hospital Charge Code |
2980038
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$2,977.73 |
| Max. Negotiated Rate |
$5,590.84 |
| Rate for Payer: Aetna Commercial |
$5,469.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,226.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,220.81
|
| Rate for Payer: Cash Price |
$1,823.10
|
| Rate for Payer: Cigna Commercial |
$5,590.84
|
| Rate for Payer: Health EOS Commercial |
$5,408.53
|
| Rate for Payer: HFN Commercial |
$5,590.84
|
| Rate for Payer: Multiplan Commercial |
$4,861.60
|
| Rate for Payer: NAPHCARE Commercial |
$3,646.20
|
| Rate for Payer: Preferred Network Access Commercial |
$5,590.84
|
| Rate for Payer: Quartz Beloit One Network |
$2,977.73
|
| Rate for Payer: Quartz Commercial |
$3,646.20
|
| Rate for Payer: WEA Trust Commercial |
$3,342.35
|
| Rate for Payer: WPS Commercial |
$4,501.23
|
|
|
MRI UE Non Joint w/ + w/o Contrast Right
|
Facility
|
OP
|
$6,077.00
|
|
|
Service Code
|
CPT 73220 TC,RT
|
| Hospital Charge Code |
2980038
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$380.12 |
| Max. Negotiated Rate |
$5,590.84 |
| Rate for Payer: Aetna Commercial |
$5,469.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,226.22
|
| 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 |
$3,220.81
|
| 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 |
$1,823.10
|
| 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 |
$5,590.84
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$380.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,400.69
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$380.12
|
| Rate for Payer: Health EOS Commercial |
$5,408.53
|
| Rate for Payer: HFN Commercial |
$5,590.84
|
| 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 |
$4,861.60
|
| Rate for Payer: NAPHCARE Commercial |
$570.18
|
| Rate for Payer: Preferred Network Access Commercial |
$5,590.84
|
| Rate for Payer: Quartz Beloit One Network |
$2,977.73
|
| Rate for Payer: Quartz Commercial |
$3,950.05
|
| 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 |
$3,342.35
|
| Rate for Payer: Wellcare Medicare |
$380.12
|
| Rate for Payer: WPS Commercial |
$4,501.23
|
|
|
MRI UE Non Joint w/ + w/o Contrast Right
|
Professional
|
Both
|
$6,077.00
|
|
|
Service Code
|
CPT 73220 RT,TC
|
| Hospital Charge Code |
1611371
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,596.12 |
| Max. Negotiated Rate |
$5,773.15 |
| Rate for Payer: Aetna Commercial |
$5,773.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,226.22
|
| 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 |
$5,773.15
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$3,038.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,646.20
|
| Rate for Payer: Health EOS Commercial |
$5,530.07
|
| Rate for Payer: HFN Commercial |
$5,773.15
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,596.12
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,596.12
|
| Rate for Payer: Multiplan Commercial |
$4,861.60
|
| Rate for Payer: Preferred Network Access Commercial |
$5,773.15
|
| Rate for Payer: Quartz Beloit One Network |
$2,673.88
|
| Rate for Payer: Quartz Commercial |
$3,463.89
|
| Rate for Payer: The Alliance Commercial |
$3,038.50
|
| Rate for Payer: WEA Trust Commercial |
$3,342.35
|
| Rate for Payer: WPS Commercial |
$4,501.23
|
|
