|
MRI Sacrum/ SI Joint w
|
Facility
|
IP
|
$5,965.00
|
|
|
Service Code
|
CPT 72196 TC
|
| Hospital Charge Code |
1611234
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$3,039.76 |
| Max. Negotiated Rate |
$5,707.31 |
| Rate for Payer: Aetna Commercial |
$5,583.24
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,335.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,287.91
|
| Rate for Payer: Cash Price |
$1,789.50
|
| Rate for Payer: Cigna Commercial |
$5,707.31
|
| Rate for Payer: Health EOS Commercial |
$5,521.20
|
| Rate for Payer: HFN Commercial |
$5,707.31
|
| Rate for Payer: Multiplan Commercial |
$4,962.88
|
| Rate for Payer: Preferred Network Access Commercial |
$5,707.31
|
| Rate for Payer: Quartz Beloit One Network |
$3,039.76
|
| Rate for Payer: Quartz Commercial |
$3,722.16
|
| Rate for Payer: WEA Trust Commercial |
$3,411.98
|
| Rate for Payer: WPS Commercial |
$4,594.84
|
|
|
MRI Sacrum/ SI Joint w
|
Professional
|
Both
|
$5,965.00
|
|
|
Service Code
|
CPT 72196 TC
|
| Hospital Charge Code |
1611234
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$187.35 |
| Max. Negotiated Rate |
$5,893.42 |
| Rate for Payer: Aetna Commercial |
$5,893.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,335.10
|
| Rate for Payer: Aetna Managed Medicare |
$187.35
|
| Rate for Payer: Anthem Medicare Advantage |
$187.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$187.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$187.35
|
| Rate for Payer: Cash Price |
$1,789.50
|
| Rate for Payer: Cash Price |
$1,789.50
|
| Rate for Payer: Cash Price |
$1,789.50
|
| Rate for Payer: Cigna Commercial |
$5,893.42
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$3,101.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$187.35
|
| Rate for Payer: Health EOS Commercial |
$5,645.28
|
| Rate for Payer: HFN Commercial |
$5,893.42
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$774.26
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$774.26
|
| Rate for Payer: Independent Care Health Plan Medicare |
$187.35
|
| Rate for Payer: Multiplan Commercial |
$4,962.88
|
| Rate for Payer: NAPHCARE Commercial |
$281.02
|
| Rate for Payer: Preferred Network Access Commercial |
$5,893.42
|
| Rate for Payer: Quartz Beloit One Network |
$2,729.58
|
| Rate for Payer: Quartz Commercial |
$3,536.05
|
| Rate for Payer: Quartz Medicare Advantage |
$187.35
|
| Rate for Payer: The Alliance Commercial |
$711.91
|
| Rate for Payer: United Healthcare Medicare Advantage |
$187.35
|
| Rate for Payer: WEA Trust Commercial |
$3,411.98
|
| Rate for Payer: WPS Commercial |
$936.73
|
|
|
MRI Sacrum/ SI Joint w
|
Facility
|
OP
|
$5,965.00
|
|
|
Service Code
|
CPT 72196 TC
|
| Hospital Charge Code |
1611234
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$749.38 |
| Max. Negotiated Rate |
$5,707.31 |
| Rate for Payer: Aetna Commercial |
$5,583.24
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,335.10
|
| Rate for Payer: Aetna Managed Medicare |
$1,737.01
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,635.84
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,985.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,835.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,287.91
|
| Rate for Payer: Cash Price |
$1,789.50
|
| Rate for Payer: Cash Price |
$1,789.50
|
| Rate for Payer: Cash Price |
$1,789.50
|
| Rate for Payer: Cash Price |
$1,789.50
|
| Rate for Payer: Cigna Commercial |
$5,707.31
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,471.63
|
| Rate for Payer: Health EOS Commercial |
$5,521.20
|
| Rate for Payer: HFN Commercial |
$5,707.31
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,652.70
|
| Rate for Payer: Multiplan Commercial |
$4,962.88
|
| Rate for Payer: NAPHCARE Commercial |
$3,722.16
|
| Rate for Payer: Preferred Network Access Commercial |
$5,707.31
|
| Rate for Payer: Quartz Beloit One Network |
$3,039.76
|
| Rate for Payer: Quartz Commercial |
$4,032.34
|
| Rate for Payer: Quartz Medicare Advantage |
$3,722.16
|
| Rate for Payer: The Alliance Commercial |
$749.38
|
| Rate for Payer: United Healthcare PPO |
$3,142.88
|
| Rate for Payer: WEA Trust Commercial |
$3,411.98
|
| Rate for Payer: WPS Commercial |
$1,311.42
|
|
|
MRI Sacrum/ SI Joint w/o
|
Professional
|
Both
|
$5,248.00
|
|
|
Service Code
|
CPT 72195 TC
|
| Hospital Charge Code |
1611240
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$159.62 |
| Max. Negotiated Rate |
$5,185.02 |
| Rate for Payer: Aetna Commercial |
$5,185.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,693.81
|
| Rate for Payer: Aetna Managed Medicare |
$159.62
|
| Rate for Payer: Anthem Medicare Advantage |
$159.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$159.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$159.62
|
| Rate for Payer: Cash Price |
$1,574.40
|
| Rate for Payer: Cash Price |
$1,574.40
|
| Rate for Payer: Cash Price |
$1,574.40
|
| Rate for Payer: Cigna Commercial |
$5,185.02
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,728.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$159.62
|
| Rate for Payer: Health EOS Commercial |
$4,966.71
|
| Rate for Payer: HFN Commercial |
$5,185.02
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$663.24
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$663.24
|
| Rate for Payer: Independent Care Health Plan Medicare |
$159.62
|
| Rate for Payer: Multiplan Commercial |
$4,366.34
|
| Rate for Payer: NAPHCARE Commercial |
$239.43
|
| Rate for Payer: Preferred Network Access Commercial |
$5,185.02
|
| Rate for Payer: Quartz Beloit One Network |
$2,401.48
|
| Rate for Payer: Quartz Commercial |
$3,111.01
|
| Rate for Payer: Quartz Medicare Advantage |
$159.62
|
| Rate for Payer: The Alliance Commercial |
$606.55
|
| Rate for Payer: United Healthcare Medicare Advantage |
$159.62
|
| Rate for Payer: WEA Trust Commercial |
$3,001.86
|
| Rate for Payer: WPS Commercial |
$798.10
|
|
|
MRI Sacrum/ SI Joint w/o
|
Facility
|
IP
|
$5,248.00
|
|
|
Service Code
|
CPT 72195 TC
|
| Hospital Charge Code |
1611240
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$2,674.38 |
| Max. Negotiated Rate |
$5,021.29 |
| Rate for Payer: Aetna Commercial |
$4,912.13
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,693.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,892.70
|
| Rate for Payer: Cash Price |
$1,574.40
|
| Rate for Payer: Cigna Commercial |
$5,021.29
|
| Rate for Payer: Health EOS Commercial |
$4,857.55
|
| Rate for Payer: HFN Commercial |
$5,021.29
|
| Rate for Payer: Multiplan Commercial |
$4,366.34
|
| Rate for Payer: Preferred Network Access Commercial |
$5,021.29
|
| Rate for Payer: Quartz Beloit One Network |
$2,674.38
|
| Rate for Payer: Quartz Commercial |
$3,274.75
|
| Rate for Payer: WEA Trust Commercial |
$3,001.86
|
| Rate for Payer: WPS Commercial |
$4,042.53
|
|
|
MRI Sacrum/ SI Joint w/o
|
Facility
|
OP
|
$4,576.00
|
|
|
Service Code
|
CPT 72195
|
| Hospital Charge Code |
1608823
|
| Min. Negotiated Rate |
$251.10 |
| Max. Negotiated Rate |
$4,378.32 |
| Rate for Payer: Aetna Commercial |
$4,283.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,092.77
|
| Rate for Payer: Aetna Managed Medicare |
$251.10
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,093.38
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,379.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,284.34
|
| Rate for Payer: Anthem Medicare Advantage |
$251.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,522.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$251.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$251.10
|
| Rate for Payer: Cash Price |
$1,372.80
|
| Rate for Payer: Cash Price |
$1,372.80
|
| Rate for Payer: Cigna Commercial |
$4,378.32
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$251.10
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,663.23
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$251.10
|
| Rate for Payer: Health EOS Commercial |
$4,235.55
|
| Rate for Payer: HFN Commercial |
$4,378.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$934.08
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$251.10
|
| Rate for Payer: Independent Care Health Plan Medicare |
$251.10
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$251.10
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$251.10
|
| Rate for Payer: Multiplan Commercial |
$3,807.23
|
| Rate for Payer: NAPHCARE Commercial |
$376.65
|
| Rate for Payer: Preferred Network Access Commercial |
$4,378.32
|
| Rate for Payer: Quartz Beloit One Network |
$2,331.93
|
| Rate for Payer: Quartz Commercial |
$3,093.38
|
| Rate for Payer: Quartz Medicare Advantage |
$251.10
|
| Rate for Payer: The Alliance Commercial |
$1,004.39
|
| Rate for Payer: United Healthcare Medicare Advantage |
$251.10
|
| Rate for Payer: WEA Trust Commercial |
$2,617.47
|
| Rate for Payer: Wellcare Medicare |
$251.10
|
| Rate for Payer: WPS Commercial |
$3,524.89
|
|
|
MRI Sacrum/ SI Joint w/o
|
Facility
|
OP
|
$5,248.00
|
|
|
Service Code
|
CPT 72195 TC
|
| Hospital Charge Code |
1611240
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$638.48 |
| Max. Negotiated Rate |
$5,021.29 |
| Rate for Payer: Aetna Commercial |
$4,912.13
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,693.81
|
| Rate for Payer: Aetna Managed Medicare |
$1,528.22
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,635.84
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,985.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,835.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,892.70
|
| Rate for Payer: Cash Price |
$1,574.40
|
| Rate for Payer: Cash Price |
$1,574.40
|
| Rate for Payer: Cash Price |
$1,574.40
|
| Rate for Payer: Cash Price |
$1,574.40
|
| Rate for Payer: Cigna Commercial |
$5,021.29
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,054.34
|
| Rate for Payer: Health EOS Commercial |
$4,857.55
|
| Rate for Payer: HFN Commercial |
$5,021.29
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,093.44
|
| Rate for Payer: Multiplan Commercial |
$4,366.34
|
| Rate for Payer: NAPHCARE Commercial |
$3,274.75
|
| Rate for Payer: Preferred Network Access Commercial |
$5,021.29
|
| Rate for Payer: Quartz Beloit One Network |
$2,674.38
|
| Rate for Payer: Quartz Commercial |
$3,547.65
|
| Rate for Payer: Quartz Medicare Advantage |
$3,274.75
|
| Rate for Payer: The Alliance Commercial |
$638.48
|
| Rate for Payer: United Healthcare PPO |
$3,142.88
|
| Rate for Payer: WEA Trust Commercial |
$3,001.86
|
| Rate for Payer: WPS Commercial |
$1,117.33
|
|
|
MRI Sacrum/ SI Joint w/o
|
Facility
|
IP
|
$4,576.00
|
|
|
Service Code
|
CPT 72195
|
| Hospital Charge Code |
1608823
|
| Min. Negotiated Rate |
$2,331.93 |
| Max. Negotiated Rate |
$4,378.32 |
| Rate for Payer: Aetna Commercial |
$4,283.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,092.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,522.29
|
| Rate for Payer: Cash Price |
$1,372.80
|
| Rate for Payer: Cigna Commercial |
$4,378.32
|
| Rate for Payer: Health EOS Commercial |
$4,235.55
|
| Rate for Payer: HFN Commercial |
$4,378.32
|
| Rate for Payer: Multiplan Commercial |
$3,807.23
|
| Rate for Payer: Preferred Network Access Commercial |
$4,378.32
|
| Rate for Payer: Quartz Beloit One Network |
$2,331.93
|
| Rate for Payer: Quartz Commercial |
$2,855.42
|
| Rate for Payer: WEA Trust Commercial |
$2,617.47
|
| Rate for Payer: WPS Commercial |
$3,524.89
|
|
|
MRI Sacrum/ SI Joint w/o
|
Professional
|
Both
|
$4,576.00
|
|
|
Service Code
|
CPT 72195
|
| Hospital Charge Code |
1608823
|
| Min. Negotiated Rate |
$226.66 |
| Max. Negotiated Rate |
$4,521.09 |
| Rate for Payer: Aetna Commercial |
$4,521.09
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,092.77
|
| Rate for Payer: Aetna Managed Medicare |
$226.66
|
| Rate for Payer: Anthem Medicare Advantage |
$226.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$226.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$226.66
|
| Rate for Payer: Cash Price |
$1,372.80
|
| Rate for Payer: Cash Price |
$1,372.80
|
| Rate for Payer: Cash Price |
$1,372.80
|
| Rate for Payer: Cigna Commercial |
$4,521.09
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,379.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$226.66
|
| Rate for Payer: Health EOS Commercial |
$4,330.73
|
| Rate for Payer: HFN Commercial |
$4,521.09
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$916.48
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$916.48
|
| Rate for Payer: Independent Care Health Plan Medicare |
$226.66
|
| Rate for Payer: Multiplan Commercial |
$3,807.23
|
| Rate for Payer: NAPHCARE Commercial |
$339.99
|
| Rate for Payer: Preferred Network Access Commercial |
$4,521.09
|
| Rate for Payer: Quartz Beloit One Network |
$2,093.98
|
| Rate for Payer: Quartz Commercial |
$2,712.65
|
| Rate for Payer: Quartz Medicare Advantage |
$226.66
|
| Rate for Payer: The Alliance Commercial |
$861.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$226.66
|
| Rate for Payer: WEA Trust Commercial |
$2,617.47
|
| Rate for Payer: WPS Commercial |
$1,133.29
|
|
|
MRI Sacrum/ SI Joint w + w/o
|
Facility
|
IP
|
$6,946.00
|
|
|
Service Code
|
CPT 72197 TC
|
| Hospital Charge Code |
1611237
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$3,539.68 |
| Max. Negotiated Rate |
$6,645.93 |
| Rate for Payer: Aetna Commercial |
$6,501.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,212.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,828.64
|
| Rate for Payer: Cash Price |
$2,083.80
|
| Rate for Payer: Cigna Commercial |
$6,645.93
|
| Rate for Payer: Health EOS Commercial |
$6,429.22
|
| Rate for Payer: HFN Commercial |
$6,645.93
|
| Rate for Payer: Multiplan Commercial |
$5,779.07
|
| Rate for Payer: Preferred Network Access Commercial |
$6,645.93
|
| Rate for Payer: Quartz Beloit One Network |
$3,539.68
|
| Rate for Payer: Quartz Commercial |
$4,334.30
|
| Rate for Payer: WEA Trust Commercial |
$3,973.11
|
| Rate for Payer: WPS Commercial |
$5,350.50
|
|
|
MRI Sacrum/ SI Joint w + w/o
|
Professional
|
Both
|
$6,092.00
|
|
|
Service Code
|
CPT 72197
|
| Hospital Charge Code |
1608824
|
| Min. Negotiated Rate |
$332.63 |
| Max. Negotiated Rate |
$6,018.90 |
| Rate for Payer: Aetna Commercial |
$6,018.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,448.68
|
| Rate for Payer: Aetna Managed Medicare |
$332.63
|
| Rate for Payer: Anthem Medicare Advantage |
$332.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$332.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$332.63
|
| Rate for Payer: Cash Price |
$1,827.60
|
| Rate for Payer: Cash Price |
$1,827.60
|
| Rate for Payer: Cash Price |
$1,827.60
|
| Rate for Payer: Cigna Commercial |
$6,018.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$3,167.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$332.63
|
| Rate for Payer: Health EOS Commercial |
$5,765.47
|
| Rate for Payer: HFN Commercial |
$6,018.90
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,351.89
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,351.89
|
| Rate for Payer: Independent Care Health Plan Medicare |
$332.63
|
| Rate for Payer: Multiplan Commercial |
$5,068.54
|
| Rate for Payer: NAPHCARE Commercial |
$498.95
|
| Rate for Payer: Preferred Network Access Commercial |
$6,018.90
|
| Rate for Payer: Quartz Beloit One Network |
$2,787.70
|
| Rate for Payer: Quartz Commercial |
$3,611.34
|
| Rate for Payer: Quartz Medicare Advantage |
$332.63
|
| Rate for Payer: The Alliance Commercial |
$1,264.01
|
| Rate for Payer: United Healthcare Medicare Advantage |
$332.63
|
| Rate for Payer: WEA Trust Commercial |
$3,484.62
|
| Rate for Payer: WPS Commercial |
$1,663.17
|
|
|
MRI Sacrum/ SI Joint w + w/o
|
Facility
|
OP
|
$6,092.00
|
|
|
Service Code
|
CPT 72197
|
| Hospital Charge Code |
1608824
|
| Min. Negotiated Rate |
$367.15 |
| Max. Negotiated Rate |
$5,828.83 |
| Rate for Payer: Aetna Commercial |
$5,702.11
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,448.68
|
| Rate for Payer: Aetna Managed Medicare |
$367.15
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,118.19
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,167.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,041.13
|
| Rate for Payer: Anthem Medicare Advantage |
$367.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,357.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$367.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$367.15
|
| Rate for Payer: Cash Price |
$1,827.60
|
| Rate for Payer: Cash Price |
$1,827.60
|
| Rate for Payer: Cigna Commercial |
$5,828.83
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$367.15
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,545.54
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$367.15
|
| Rate for Payer: Health EOS Commercial |
$5,638.76
|
| Rate for Payer: HFN Commercial |
$5,828.83
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,365.80
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$367.15
|
| Rate for Payer: Independent Care Health Plan Medicare |
$367.15
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$367.15
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$367.15
|
| Rate for Payer: Multiplan Commercial |
$5,068.54
|
| Rate for Payer: NAPHCARE Commercial |
$550.73
|
| Rate for Payer: Preferred Network Access Commercial |
$5,828.83
|
| Rate for Payer: Quartz Beloit One Network |
$3,104.48
|
| Rate for Payer: Quartz Commercial |
$4,118.19
|
| Rate for Payer: Quartz Medicare Advantage |
$367.15
|
| Rate for Payer: The Alliance Commercial |
$1,468.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$367.15
|
| Rate for Payer: WEA Trust Commercial |
$3,484.62
|
| Rate for Payer: Wellcare Medicare |
$367.15
|
| Rate for Payer: WPS Commercial |
$4,692.67
|
|
|
MRI Sacrum/ SI Joint w + w/o
|
Facility
|
IP
|
$6,092.00
|
|
|
Service Code
|
CPT 72197
|
| Hospital Charge Code |
1608824
|
| Min. Negotiated Rate |
$3,104.48 |
| Max. Negotiated Rate |
$5,828.83 |
| Rate for Payer: Aetna Commercial |
$5,702.11
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,448.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,357.91
|
| Rate for Payer: Cash Price |
$1,827.60
|
| Rate for Payer: Cigna Commercial |
$5,828.83
|
| Rate for Payer: Health EOS Commercial |
$5,638.76
|
| Rate for Payer: HFN Commercial |
$5,828.83
|
| Rate for Payer: Multiplan Commercial |
$5,068.54
|
| Rate for Payer: Preferred Network Access Commercial |
$5,828.83
|
| Rate for Payer: Quartz Beloit One Network |
$3,104.48
|
| Rate for Payer: Quartz Commercial |
$3,801.41
|
| Rate for Payer: WEA Trust Commercial |
$3,484.62
|
| Rate for Payer: WPS Commercial |
$4,692.67
|
|
|
MRI Sacrum/ SI Joint w + w/o
|
Facility
|
OP
|
$6,946.00
|
|
|
Service Code
|
CPT 72197 TC
|
| Hospital Charge Code |
1611237
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$925.10 |
| Max. Negotiated Rate |
$6,645.93 |
| Rate for Payer: Aetna Commercial |
$6,501.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,212.50
|
| Rate for Payer: Aetna Managed Medicare |
$2,022.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,635.84
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,985.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,835.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,828.64
|
| Rate for Payer: Cash Price |
$2,083.80
|
| Rate for Payer: Cash Price |
$2,083.80
|
| Rate for Payer: Cash Price |
$2,083.80
|
| Rate for Payer: Cash Price |
$2,083.80
|
| Rate for Payer: Cigna Commercial |
$6,645.93
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,042.57
|
| Rate for Payer: Health EOS Commercial |
$6,429.22
|
| Rate for Payer: HFN Commercial |
$6,645.93
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,417.88
|
| Rate for Payer: Multiplan Commercial |
$5,779.07
|
| Rate for Payer: NAPHCARE Commercial |
$4,334.30
|
| Rate for Payer: Preferred Network Access Commercial |
$6,645.93
|
| Rate for Payer: Quartz Beloit One Network |
$3,539.68
|
| Rate for Payer: Quartz Commercial |
$4,695.50
|
| Rate for Payer: Quartz Medicare Advantage |
$4,334.30
|
| Rate for Payer: The Alliance Commercial |
$925.10
|
| Rate for Payer: United Healthcare PPO |
$3,142.88
|
| Rate for Payer: WEA Trust Commercial |
$3,973.11
|
| Rate for Payer: WPS Commercial |
$1,618.93
|
|
|
MRI Sacrum/ SI Joint w + w/o
|
Professional
|
Both
|
$6,946.00
|
|
|
Service Code
|
CPT 72197 TC
|
| Hospital Charge Code |
1611237
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$231.28 |
| Max. Negotiated Rate |
$6,862.65 |
| Rate for Payer: Aetna Commercial |
$6,862.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,212.50
|
| Rate for Payer: Aetna Managed Medicare |
$231.28
|
| Rate for Payer: Anthem Medicare Advantage |
$231.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$231.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$231.28
|
| Rate for Payer: Cash Price |
$2,083.80
|
| Rate for Payer: Cash Price |
$2,083.80
|
| Rate for Payer: Cash Price |
$2,083.80
|
| Rate for Payer: Cigna Commercial |
$6,862.65
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$3,611.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$231.28
|
| Rate for Payer: Health EOS Commercial |
$6,573.69
|
| Rate for Payer: HFN Commercial |
$6,862.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$970.95
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$970.95
|
| Rate for Payer: Independent Care Health Plan Medicare |
$231.28
|
| Rate for Payer: Multiplan Commercial |
$5,779.07
|
| Rate for Payer: NAPHCARE Commercial |
$346.91
|
| Rate for Payer: Preferred Network Access Commercial |
$6,862.65
|
| Rate for Payer: Quartz Beloit One Network |
$3,178.49
|
| Rate for Payer: Quartz Commercial |
$4,117.59
|
| Rate for Payer: Quartz Medicare Advantage |
$231.28
|
| Rate for Payer: The Alliance Commercial |
$878.85
|
| Rate for Payer: United Healthcare Medicare Advantage |
$231.28
|
| Rate for Payer: WEA Trust Commercial |
$3,973.11
|
| Rate for Payer: WPS Commercial |
$1,156.38
|
|
|
MRI Shoulder w/ Contrast Bilateral
|
Facility
|
IP
|
$5,965.00
|
|
|
Service Code
|
CPT 73222 TC,LT
|
| Hospital Charge Code |
1611249
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$3,039.76 |
| Max. Negotiated Rate |
$5,707.31 |
| Rate for Payer: Aetna Commercial |
$5,583.24
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,335.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,287.91
|
| Rate for Payer: Cash Price |
$1,789.50
|
| Rate for Payer: Cigna Commercial |
$5,707.31
|
| Rate for Payer: Health EOS Commercial |
$5,521.20
|
| Rate for Payer: HFN Commercial |
$5,707.31
|
| Rate for Payer: Multiplan Commercial |
$4,962.88
|
| Rate for Payer: Preferred Network Access Commercial |
$5,707.31
|
| Rate for Payer: Quartz Beloit One Network |
$3,039.76
|
| Rate for Payer: Quartz Commercial |
$3,722.16
|
| Rate for Payer: WEA Trust Commercial |
$3,411.98
|
| Rate for Payer: WPS Commercial |
$4,594.84
|
|
|
MRI Shoulder w/ Contrast Bilateral
|
Professional
|
Both
|
$9,376.00
|
|
|
Service Code
|
CPT 73222
|
| Hospital Charge Code |
631221
|
| Min. Negotiated Rate |
$311.30 |
| Max. Negotiated Rate |
$9,263.49 |
| Rate for Payer: Aetna Commercial |
$9,263.49
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,385.89
|
| Rate for Payer: Aetna Managed Medicare |
$311.30
|
| Rate for Payer: Anthem Medicare Advantage |
$311.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$311.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$311.30
|
| Rate for Payer: Cash Price |
$2,812.80
|
| Rate for Payer: Cash Price |
$2,812.80
|
| Rate for Payer: Cash Price |
$2,812.80
|
| Rate for Payer: Cigna Commercial |
$9,263.49
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$4,875.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$311.30
|
| Rate for Payer: Health EOS Commercial |
$8,873.45
|
| Rate for Payer: HFN Commercial |
$9,263.49
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,268.77
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,268.77
|
| Rate for Payer: Independent Care Health Plan Medicare |
$311.30
|
| Rate for Payer: Multiplan Commercial |
$7,800.83
|
| Rate for Payer: NAPHCARE Commercial |
$466.95
|
| Rate for Payer: Preferred Network Access Commercial |
$9,263.49
|
| Rate for Payer: Quartz Beloit One Network |
$4,290.46
|
| Rate for Payer: Quartz Commercial |
$5,558.09
|
| Rate for Payer: Quartz Medicare Advantage |
$311.30
|
| Rate for Payer: The Alliance Commercial |
$1,182.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$311.30
|
| Rate for Payer: WEA Trust Commercial |
$5,363.07
|
| Rate for Payer: WPS Commercial |
$1,556.52
|
|
|
MRI Shoulder w/ Contrast Bilateral
|
Facility
|
IP
|
$9,376.00
|
|
|
Service Code
|
CPT 73222
|
| Hospital Charge Code |
631221
|
| Min. Negotiated Rate |
$4,778.01 |
| Max. Negotiated Rate |
$8,970.96 |
| Rate for Payer: Aetna Commercial |
$8,775.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,385.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,168.05
|
| Rate for Payer: Cash Price |
$2,812.80
|
| Rate for Payer: Cigna Commercial |
$8,970.96
|
| Rate for Payer: Health EOS Commercial |
$8,678.43
|
| Rate for Payer: HFN Commercial |
$8,970.96
|
| Rate for Payer: Multiplan Commercial |
$7,800.83
|
| Rate for Payer: Preferred Network Access Commercial |
$8,970.96
|
| Rate for Payer: Quartz Beloit One Network |
$4,778.01
|
| Rate for Payer: Quartz Commercial |
$5,850.62
|
| Rate for Payer: WEA Trust Commercial |
$5,363.07
|
| Rate for Payer: WPS Commercial |
$7,222.33
|
|
|
MRI Shoulder w/ Contrast Bilateral
|
Facility
|
OP
|
$9,376.00
|
|
|
Service Code
|
CPT 73222
|
| Hospital Charge Code |
631221
|
| Min. Negotiated Rate |
$824.99 |
| Max. Negotiated Rate |
$8,970.96 |
| Rate for Payer: Aetna Commercial |
$8,775.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,385.89
|
| Rate for Payer: Aetna Managed Medicare |
$824.99
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,338.18
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,875.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,680.50
|
| Rate for Payer: Anthem Medicare Advantage |
$824.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,168.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$824.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$824.99
|
| Rate for Payer: Cash Price |
$2,812.80
|
| Rate for Payer: Cash Price |
$2,812.80
|
| Rate for Payer: Cigna Commercial |
$8,970.96
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$824.99
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,456.83
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$824.99
|
| Rate for Payer: Health EOS Commercial |
$8,678.43
|
| Rate for Payer: HFN Commercial |
$8,970.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,068.96
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$824.99
|
| Rate for Payer: Independent Care Health Plan Medicare |
$824.99
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$824.99
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$824.99
|
| Rate for Payer: Multiplan Commercial |
$7,800.83
|
| Rate for Payer: NAPHCARE Commercial |
$1,237.49
|
| Rate for Payer: Preferred Network Access Commercial |
$8,970.96
|
| Rate for Payer: Quartz Beloit One Network |
$4,778.01
|
| Rate for Payer: Quartz Commercial |
$6,338.18
|
| Rate for Payer: Quartz Medicare Advantage |
$824.99
|
| Rate for Payer: The Alliance Commercial |
$3,299.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$824.99
|
| Rate for Payer: WEA Trust Commercial |
$5,363.07
|
| Rate for Payer: Wellcare Medicare |
$824.99
|
| Rate for Payer: WPS Commercial |
$7,222.33
|
|
|
MRI Shoulder w/ Contrast Bilateral
|
Professional
|
Both
|
$5,965.00
|
|
|
Service Code
|
CPT 73222 TC,LT
|
| Hospital Charge Code |
1611249
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,268.77 |
| Max. Negotiated Rate |
$5,893.42 |
| Rate for Payer: Aetna Commercial |
$5,893.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,335.10
|
| Rate for Payer: Cash Price |
$1,789.50
|
| Rate for Payer: Cash Price |
$1,789.50
|
| Rate for Payer: Cash Price |
$1,789.50
|
| Rate for Payer: Cigna Commercial |
$5,893.42
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$3,101.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,722.16
|
| Rate for Payer: Health EOS Commercial |
$5,645.28
|
| Rate for Payer: HFN Commercial |
$5,893.42
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,268.77
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,268.77
|
| Rate for Payer: Multiplan Commercial |
$4,962.88
|
| Rate for Payer: Preferred Network Access Commercial |
$5,893.42
|
| Rate for Payer: Quartz Beloit One Network |
$2,729.58
|
| Rate for Payer: Quartz Commercial |
$3,536.05
|
| Rate for Payer: The Alliance Commercial |
$3,101.80
|
| Rate for Payer: WEA Trust Commercial |
$3,411.98
|
| Rate for Payer: WPS Commercial |
$4,594.84
|
|
|
MRI Shoulder w/ Contrast Bilateral
|
Facility
|
OP
|
$5,965.00
|
|
|
Service Code
|
CPT 73222 TC,LT
|
| Hospital Charge Code |
1611249
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,737.01 |
| Max. Negotiated Rate |
$5,707.31 |
| Rate for Payer: Aetna Commercial |
$5,583.24
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,335.10
|
| Rate for Payer: Aetna Managed Medicare |
$1,737.01
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,635.84
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,985.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,835.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,287.91
|
| Rate for Payer: Cash Price |
$1,789.50
|
| Rate for Payer: Cash Price |
$1,789.50
|
| Rate for Payer: Cash Price |
$1,789.50
|
| Rate for Payer: Cigna Commercial |
$5,707.31
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,471.63
|
| Rate for Payer: Health EOS Commercial |
$5,521.20
|
| Rate for Payer: HFN Commercial |
$5,707.31
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,652.70
|
| Rate for Payer: Multiplan Commercial |
$4,962.88
|
| Rate for Payer: NAPHCARE Commercial |
$3,722.16
|
| Rate for Payer: Preferred Network Access Commercial |
$5,707.31
|
| Rate for Payer: Quartz Beloit One Network |
$3,039.76
|
| Rate for Payer: Quartz Commercial |
$4,032.34
|
| Rate for Payer: Quartz Medicare Advantage |
$3,722.16
|
| Rate for Payer: The Alliance Commercial |
$3,101.80
|
| Rate for Payer: United Healthcare PPO |
$3,142.88
|
| Rate for Payer: WEA Trust Commercial |
$3,411.98
|
| Rate for Payer: WPS Commercial |
$4,594.84
|
|
|
MRI Shoulder w/ Contrast Left
|
Professional
|
Both
|
$4,687.00
|
|
|
Service Code
|
CPT 73222
|
| Hospital Charge Code |
631227
|
| Min. Negotiated Rate |
$311.30 |
| Max. Negotiated Rate |
$4,630.76 |
| Rate for Payer: Aetna Commercial |
$4,630.76
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,192.05
|
| Rate for Payer: Aetna Managed Medicare |
$311.30
|
| Rate for Payer: Anthem Medicare Advantage |
$311.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$311.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$311.30
|
| Rate for Payer: Cash Price |
$1,406.10
|
| Rate for Payer: Cash Price |
$1,406.10
|
| Rate for Payer: Cash Price |
$1,406.10
|
| Rate for Payer: Cigna Commercial |
$4,630.76
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,437.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$311.30
|
| Rate for Payer: Health EOS Commercial |
$4,435.78
|
| Rate for Payer: HFN Commercial |
$4,630.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,268.77
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,268.77
|
| Rate for Payer: Independent Care Health Plan Medicare |
$311.30
|
| Rate for Payer: Multiplan Commercial |
$3,899.58
|
| Rate for Payer: NAPHCARE Commercial |
$466.95
|
| Rate for Payer: Preferred Network Access Commercial |
$4,630.76
|
| Rate for Payer: Quartz Beloit One Network |
$2,144.77
|
| Rate for Payer: Quartz Commercial |
$2,778.45
|
| Rate for Payer: Quartz Medicare Advantage |
$311.30
|
| Rate for Payer: The Alliance Commercial |
$1,182.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$311.30
|
| Rate for Payer: WEA Trust Commercial |
$2,680.96
|
| Rate for Payer: WPS Commercial |
$1,556.52
|
|
|
MRI Shoulder w/ Contrast Left
|
Facility
|
OP
|
$6,194.00
|
|
|
Service Code
|
CPT 73222 LT,TC
|
| Hospital Charge Code |
1611251
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,803.69 |
| Max. Negotiated Rate |
$5,926.42 |
| Rate for Payer: Aetna Commercial |
$5,797.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,539.91
|
| Rate for Payer: Aetna Managed Medicare |
$1,803.69
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,635.84
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,985.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,835.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,414.13
|
| Rate for Payer: Cash Price |
$1,858.20
|
| Rate for Payer: Cash Price |
$1,858.20
|
| Rate for Payer: Cash Price |
$1,858.20
|
| Rate for Payer: Cigna Commercial |
$5,926.42
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,604.91
|
| Rate for Payer: Health EOS Commercial |
$5,733.17
|
| Rate for Payer: HFN Commercial |
$5,926.42
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,831.32
|
| Rate for Payer: Multiplan Commercial |
$5,153.41
|
| Rate for Payer: NAPHCARE Commercial |
$3,865.06
|
| Rate for Payer: Preferred Network Access Commercial |
$5,926.42
|
| Rate for Payer: Quartz Beloit One Network |
$3,156.46
|
| Rate for Payer: Quartz Commercial |
$4,187.14
|
| Rate for Payer: Quartz Medicare Advantage |
$3,865.06
|
| Rate for Payer: The Alliance Commercial |
$3,220.88
|
| Rate for Payer: United Healthcare PPO |
$3,142.88
|
| Rate for Payer: WEA Trust Commercial |
$3,542.97
|
| Rate for Payer: WPS Commercial |
$4,771.24
|
|
|
MRI Shoulder w/ Contrast Left
|
Facility
|
IP
|
$4,687.00
|
|
|
Service Code
|
CPT 73222
|
| Hospital Charge Code |
631227
|
| Min. Negotiated Rate |
$2,388.50 |
| Max. Negotiated Rate |
$4,484.52 |
| Rate for Payer: Aetna Commercial |
$4,387.03
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,192.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,583.47
|
| Rate for Payer: Cash Price |
$1,406.10
|
| Rate for Payer: Cigna Commercial |
$4,484.52
|
| Rate for Payer: Health EOS Commercial |
$4,338.29
|
| Rate for Payer: HFN Commercial |
$4,484.52
|
| Rate for Payer: Multiplan Commercial |
$3,899.58
|
| Rate for Payer: Preferred Network Access Commercial |
$4,484.52
|
| Rate for Payer: Quartz Beloit One Network |
$2,388.50
|
| Rate for Payer: Quartz Commercial |
$2,924.69
|
| Rate for Payer: WEA Trust Commercial |
$2,680.96
|
| Rate for Payer: WPS Commercial |
$3,610.40
|
|
|
MRI Shoulder w/ Contrast Left
|
Facility
|
OP
|
$4,687.00
|
|
|
Service Code
|
CPT 73222
|
| Hospital Charge Code |
631227
|
| Min. Negotiated Rate |
$824.99 |
| Max. Negotiated Rate |
$4,484.52 |
| Rate for Payer: Aetna Commercial |
$4,387.03
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,192.05
|
| Rate for Payer: Aetna Managed Medicare |
$824.99
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,168.41
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,437.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,339.75
|
| Rate for Payer: Anthem Medicare Advantage |
$824.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,583.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$824.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$824.99
|
| Rate for Payer: Cash Price |
$1,406.10
|
| Rate for Payer: Cash Price |
$1,406.10
|
| Rate for Payer: Cigna Commercial |
$4,484.52
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$824.99
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,727.83
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$824.99
|
| Rate for Payer: Health EOS Commercial |
$4,338.29
|
| Rate for Payer: HFN Commercial |
$4,484.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,068.96
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$824.99
|
| Rate for Payer: Independent Care Health Plan Medicare |
$824.99
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$824.99
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$824.99
|
| Rate for Payer: Multiplan Commercial |
$3,899.58
|
| Rate for Payer: NAPHCARE Commercial |
$1,237.49
|
| Rate for Payer: Preferred Network Access Commercial |
$4,484.52
|
| Rate for Payer: Quartz Beloit One Network |
$2,388.50
|
| Rate for Payer: Quartz Commercial |
$3,168.41
|
| Rate for Payer: Quartz Medicare Advantage |
$824.99
|
| Rate for Payer: The Alliance Commercial |
$3,299.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$824.99
|
| Rate for Payer: WEA Trust Commercial |
$2,680.96
|
| Rate for Payer: Wellcare Medicare |
$824.99
|
| Rate for Payer: WPS Commercial |
$3,610.40
|
|
