|
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 |
$1,769.62 |
| Max. Negotiated Rate |
$5,814.47 |
| Rate for Payer: Aetna Commercial |
$5,688.07
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,435.27
|
| Rate for Payer: Aetna Managed Medicare |
$1,769.62
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,635.84
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,985.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,835.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,349.64
|
| Rate for Payer: Cash Price |
$1,823.10
|
| Rate for Payer: Cash Price |
$1,823.10
|
| Rate for Payer: Cash Price |
$1,823.10
|
| Rate for Payer: Cigna Commercial |
$5,814.47
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,536.81
|
| Rate for Payer: Health EOS Commercial |
$5,624.87
|
| Rate for Payer: HFN Commercial |
$5,814.47
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,740.06
|
| Rate for Payer: Multiplan Commercial |
$5,056.06
|
| Rate for Payer: NAPHCARE Commercial |
$3,792.05
|
| Rate for Payer: Preferred Network Access Commercial |
$5,814.47
|
| Rate for Payer: Quartz Beloit One Network |
$3,096.84
|
| Rate for Payer: Quartz Commercial |
$4,108.05
|
| Rate for Payer: Quartz Medicare Advantage |
$3,792.05
|
| Rate for Payer: The Alliance Commercial |
$3,160.04
|
| Rate for Payer: United Healthcare PPO |
$3,142.88
|
| Rate for Payer: WEA Trust Commercial |
$3,476.04
|
| Rate for Payer: WPS Commercial |
$4,681.11
|
|
|
MRI UE Non Joint w/ + w/o Contrast Left
|
Facility
|
OP
|
$5,479.00
|
|
|
Service Code
|
CPT 73220
|
| Hospital Charge Code |
631355
|
| Min. Negotiated Rate |
$367.15 |
| Max. Negotiated Rate |
$5,242.31 |
| Rate for Payer: Aetna Commercial |
$5,128.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,900.42
|
| Rate for Payer: Aetna Managed Medicare |
$367.15
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,703.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,849.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,735.12
|
| Rate for Payer: Anthem Medicare Advantage |
$367.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,020.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$367.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$367.15
|
| Rate for Payer: Cash Price |
$1,643.70
|
| Rate for Payer: Cash Price |
$1,643.70
|
| Rate for Payer: Cigna Commercial |
$5,242.31
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$367.15
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,188.78
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$367.15
|
| Rate for Payer: Health EOS Commercial |
$5,071.36
|
| Rate for Payer: HFN Commercial |
$5,242.31
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,365.80
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$367.15
|
| Rate for Payer: Independent Care Health Plan Medicare |
$367.15
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$367.15
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$367.15
|
| Rate for Payer: Multiplan Commercial |
$4,558.53
|
| Rate for Payer: NAPHCARE Commercial |
$550.73
|
| Rate for Payer: Preferred Network Access Commercial |
$5,242.31
|
| Rate for Payer: Quartz Beloit One Network |
$2,792.10
|
| Rate for Payer: Quartz Commercial |
$3,703.80
|
| Rate for Payer: Quartz Medicare Advantage |
$367.15
|
| Rate for Payer: The Alliance Commercial |
$1,468.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$367.15
|
| Rate for Payer: WEA Trust Commercial |
$3,133.99
|
| Rate for Payer: Wellcare Medicare |
$367.15
|
| Rate for Payer: WPS Commercial |
$4,220.47
|
|
|
MRI UE Non Joint w/ + w/o Contrast Left
|
Professional
|
Both
|
$5,479.00
|
|
|
Service Code
|
CPT 73220
|
| Hospital Charge Code |
631355
|
| Min. Negotiated Rate |
$404.78 |
| Max. Negotiated Rate |
$5,413.25 |
| Rate for Payer: Aetna Commercial |
$5,413.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,900.42
|
| Rate for Payer: Aetna Managed Medicare |
$404.78
|
| Rate for Payer: Anthem Medicare Advantage |
$404.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$404.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$404.78
|
| Rate for Payer: Cash Price |
$1,643.70
|
| Rate for Payer: Cash Price |
$1,643.70
|
| Rate for Payer: Cash Price |
$1,643.70
|
| Rate for Payer: Cigna Commercial |
$5,413.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,849.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$404.78
|
| Rate for Payer: Health EOS Commercial |
$5,185.33
|
| Rate for Payer: HFN Commercial |
$5,413.25
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,659.96
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,659.96
|
| Rate for Payer: Independent Care Health Plan Medicare |
$404.78
|
| Rate for Payer: Multiplan Commercial |
$4,558.53
|
| Rate for Payer: NAPHCARE Commercial |
$607.17
|
| Rate for Payer: Preferred Network Access Commercial |
$5,413.25
|
| Rate for Payer: Quartz Beloit One Network |
$2,507.19
|
| Rate for Payer: Quartz Commercial |
$3,247.95
|
| Rate for Payer: Quartz Medicare Advantage |
$404.78
|
| Rate for Payer: The Alliance Commercial |
$1,538.16
|
| Rate for Payer: United Healthcare Medicare Advantage |
$404.78
|
| Rate for Payer: WEA Trust Commercial |
$3,133.99
|
| Rate for Payer: WPS Commercial |
$2,023.89
|
|
|
MRI 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 |
$1,659.96 |
| Max. Negotiated Rate |
$6,004.08 |
| Rate for Payer: Aetna Commercial |
$6,004.08
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,435.27
|
| Rate for Payer: Cash Price |
$1,823.10
|
| Rate for Payer: Cash Price |
$1,823.10
|
| Rate for Payer: Cash Price |
$1,823.10
|
| Rate for Payer: Cigna Commercial |
$6,004.08
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$3,160.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,792.05
|
| Rate for Payer: Health EOS Commercial |
$5,751.27
|
| Rate for Payer: HFN Commercial |
$6,004.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,659.96
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,659.96
|
| Rate for Payer: Multiplan Commercial |
$5,056.06
|
| Rate for Payer: Preferred Network Access Commercial |
$6,004.08
|
| Rate for Payer: Quartz Beloit One Network |
$2,780.84
|
| Rate for Payer: Quartz Commercial |
$3,602.45
|
| Rate for Payer: The Alliance Commercial |
$3,160.04
|
| Rate for Payer: WEA Trust Commercial |
$3,476.04
|
| Rate for Payer: WPS Commercial |
$4,681.11
|
|
|
MRI 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 |
$1,769.62 |
| Max. Negotiated Rate |
$5,814.47 |
| Rate for Payer: Aetna Commercial |
$5,688.07
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,435.27
|
| Rate for Payer: Aetna Managed Medicare |
$1,769.62
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,635.84
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,985.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,835.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,349.64
|
| Rate for Payer: Cash Price |
$1,823.10
|
| Rate for Payer: Cash Price |
$1,823.10
|
| Rate for Payer: Cash Price |
$1,823.10
|
| Rate for Payer: Cigna Commercial |
$5,814.47
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,536.81
|
| Rate for Payer: Health EOS Commercial |
$5,624.87
|
| Rate for Payer: HFN Commercial |
$5,814.47
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,740.06
|
| Rate for Payer: Multiplan Commercial |
$5,056.06
|
| Rate for Payer: NAPHCARE Commercial |
$3,792.05
|
| Rate for Payer: Preferred Network Access Commercial |
$5,814.47
|
| Rate for Payer: Quartz Beloit One Network |
$3,096.84
|
| Rate for Payer: Quartz Commercial |
$4,108.05
|
| Rate for Payer: Quartz Medicare Advantage |
$3,792.05
|
| Rate for Payer: The Alliance Commercial |
$3,160.04
|
| Rate for Payer: United Healthcare PPO |
$3,142.88
|
| Rate for Payer: WEA Trust Commercial |
$3,476.04
|
| Rate for Payer: WPS Commercial |
$4,681.11
|
|
|
MRI UE Non Joint w/ + w/o Contrast Right
|
Professional
|
Both
|
$5,479.00
|
|
|
Service Code
|
CPT 73220
|
| Hospital Charge Code |
631359
|
| Min. Negotiated Rate |
$404.78 |
| Max. Negotiated Rate |
$5,413.25 |
| Rate for Payer: Aetna Commercial |
$5,413.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,900.42
|
| Rate for Payer: Aetna Managed Medicare |
$404.78
|
| Rate for Payer: Anthem Medicare Advantage |
$404.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$404.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$404.78
|
| Rate for Payer: Cash Price |
$1,643.70
|
| Rate for Payer: Cash Price |
$1,643.70
|
| Rate for Payer: Cash Price |
$1,643.70
|
| Rate for Payer: Cigna Commercial |
$5,413.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,849.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$404.78
|
| Rate for Payer: Health EOS Commercial |
$5,185.33
|
| Rate for Payer: HFN Commercial |
$5,413.25
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,659.96
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,659.96
|
| Rate for Payer: Independent Care Health Plan Medicare |
$404.78
|
| Rate for Payer: Multiplan Commercial |
$4,558.53
|
| Rate for Payer: NAPHCARE Commercial |
$607.17
|
| Rate for Payer: Preferred Network Access Commercial |
$5,413.25
|
| Rate for Payer: Quartz Beloit One Network |
$2,507.19
|
| Rate for Payer: Quartz Commercial |
$3,247.95
|
| Rate for Payer: Quartz Medicare Advantage |
$404.78
|
| Rate for Payer: The Alliance Commercial |
$1,538.16
|
| Rate for Payer: United Healthcare Medicare Advantage |
$404.78
|
| Rate for Payer: WEA Trust Commercial |
$3,133.99
|
| Rate for Payer: WPS Commercial |
$2,023.89
|
|
|
MRI UE Non Joint w/ + w/o Contrast Right
|
Facility
|
OP
|
$5,479.00
|
|
|
Service Code
|
CPT 73220
|
| Hospital Charge Code |
631359
|
| Min. Negotiated Rate |
$367.15 |
| Max. Negotiated Rate |
$5,242.31 |
| Rate for Payer: Aetna Commercial |
$5,128.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,900.42
|
| Rate for Payer: Aetna Managed Medicare |
$367.15
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,703.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,849.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,735.12
|
| Rate for Payer: Anthem Medicare Advantage |
$367.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,020.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$367.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$367.15
|
| Rate for Payer: Cash Price |
$1,643.70
|
| Rate for Payer: Cash Price |
$1,643.70
|
| Rate for Payer: Cigna Commercial |
$5,242.31
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$367.15
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,188.78
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$367.15
|
| Rate for Payer: Health EOS Commercial |
$5,071.36
|
| Rate for Payer: HFN Commercial |
$5,242.31
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,365.80
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$367.15
|
| Rate for Payer: Independent Care Health Plan Medicare |
$367.15
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$367.15
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$367.15
|
| Rate for Payer: Multiplan Commercial |
$4,558.53
|
| Rate for Payer: NAPHCARE Commercial |
$550.73
|
| Rate for Payer: Preferred Network Access Commercial |
$5,242.31
|
| Rate for Payer: Quartz Beloit One Network |
$2,792.10
|
| Rate for Payer: Quartz Commercial |
$3,703.80
|
| Rate for Payer: Quartz Medicare Advantage |
$367.15
|
| Rate for Payer: The Alliance Commercial |
$1,468.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$367.15
|
| Rate for Payer: WEA Trust Commercial |
$3,133.99
|
| Rate for Payer: Wellcare Medicare |
$367.15
|
| Rate for Payer: WPS Commercial |
$4,220.47
|
|
|
MRI 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 |
$1,769.62 |
| Max. Negotiated Rate |
$5,814.47 |
| Rate for Payer: Aetna Commercial |
$5,688.07
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,435.27
|
| Rate for Payer: Aetna Managed Medicare |
$1,769.62
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,635.84
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,985.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,835.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,349.64
|
| Rate for Payer: Cash Price |
$1,823.10
|
| Rate for Payer: Cash Price |
$1,823.10
|
| Rate for Payer: Cash Price |
$1,823.10
|
| Rate for Payer: Cigna Commercial |
$5,814.47
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,536.81
|
| Rate for Payer: Health EOS Commercial |
$5,624.87
|
| Rate for Payer: HFN Commercial |
$5,814.47
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,740.06
|
| Rate for Payer: Multiplan Commercial |
$5,056.06
|
| Rate for Payer: NAPHCARE Commercial |
$3,792.05
|
| Rate for Payer: Preferred Network Access Commercial |
$5,814.47
|
| Rate for Payer: Quartz Beloit One Network |
$3,096.84
|
| Rate for Payer: Quartz Commercial |
$4,108.05
|
| Rate for Payer: Quartz Medicare Advantage |
$3,792.05
|
| Rate for Payer: The Alliance Commercial |
$3,160.04
|
| Rate for Payer: United Healthcare PPO |
$3,142.88
|
| Rate for Payer: WEA Trust Commercial |
$3,476.04
|
| Rate for Payer: WPS Commercial |
$4,681.11
|
|
|
MRI 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 |
$1,659.96 |
| Max. Negotiated Rate |
$6,004.08 |
| Rate for Payer: Aetna Commercial |
$6,004.08
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,435.27
|
| Rate for Payer: Cash Price |
$1,823.10
|
| Rate for Payer: Cash Price |
$1,823.10
|
| Rate for Payer: Cash Price |
$1,823.10
|
| Rate for Payer: Cigna Commercial |
$6,004.08
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$3,160.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,792.05
|
| Rate for Payer: Health EOS Commercial |
$5,751.27
|
| Rate for Payer: HFN Commercial |
$6,004.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,659.96
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,659.96
|
| Rate for Payer: Multiplan Commercial |
$5,056.06
|
| Rate for Payer: Preferred Network Access Commercial |
$6,004.08
|
| Rate for Payer: Quartz Beloit One Network |
$2,780.84
|
| Rate for Payer: Quartz Commercial |
$3,602.45
|
| Rate for Payer: The Alliance Commercial |
$3,160.04
|
| Rate for Payer: WEA Trust Commercial |
$3,476.04
|
| Rate for Payer: WPS Commercial |
$4,681.11
|
|
|
MRI UE Non Joint w/ + w/o Contrast Right
|
Facility
|
IP
|
$5,479.00
|
|
|
Service Code
|
CPT 73220
|
| Hospital Charge Code |
631359
|
| Min. Negotiated Rate |
$2,792.10 |
| Max. Negotiated Rate |
$5,242.31 |
| Rate for Payer: Aetna Commercial |
$5,128.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,900.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,020.02
|
| Rate for Payer: Cash Price |
$1,643.70
|
| Rate for Payer: Cigna Commercial |
$5,242.31
|
| Rate for Payer: Health EOS Commercial |
$5,071.36
|
| Rate for Payer: HFN Commercial |
$5,242.31
|
| Rate for Payer: Multiplan Commercial |
$4,558.53
|
| Rate for Payer: Preferred Network Access Commercial |
$5,242.31
|
| Rate for Payer: Quartz Beloit One Network |
$2,792.10
|
| Rate for Payer: Quartz Commercial |
$3,418.90
|
| Rate for Payer: WEA Trust Commercial |
$3,133.99
|
| Rate for Payer: WPS Commercial |
$4,220.47
|
|
|
MRI 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 |
$1,659.96 |
| Max. Negotiated Rate |
$6,004.08 |
| Rate for Payer: Aetna Commercial |
$6,004.08
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,435.27
|
| Rate for Payer: Cash Price |
$1,823.10
|
| Rate for Payer: Cash Price |
$1,823.10
|
| Rate for Payer: Cash Price |
$1,823.10
|
| Rate for Payer: Cigna Commercial |
$6,004.08
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$3,160.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,792.05
|
| Rate for Payer: Health EOS Commercial |
$5,751.27
|
| Rate for Payer: HFN Commercial |
$6,004.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,659.96
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,659.96
|
| Rate for Payer: Multiplan Commercial |
$5,056.06
|
| Rate for Payer: Preferred Network Access Commercial |
$6,004.08
|
| Rate for Payer: Quartz Beloit One Network |
$2,780.84
|
| Rate for Payer: Quartz Commercial |
$3,602.45
|
| Rate for Payer: The Alliance Commercial |
$3,160.04
|
| Rate for Payer: WEA Trust Commercial |
$3,476.04
|
| Rate for Payer: WPS Commercial |
$4,681.11
|
|
|
MRI 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 |
$3,096.84 |
| Max. Negotiated Rate |
$5,814.47 |
| Rate for Payer: Aetna Commercial |
$5,688.07
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,435.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,349.64
|
| Rate for Payer: Cash Price |
$1,823.10
|
| Rate for Payer: Cigna Commercial |
$5,814.47
|
| Rate for Payer: Health EOS Commercial |
$5,624.87
|
| Rate for Payer: HFN Commercial |
$5,814.47
|
| Rate for Payer: Multiplan Commercial |
$5,056.06
|
| Rate for Payer: Preferred Network Access Commercial |
$5,814.47
|
| Rate for Payer: Quartz Beloit One Network |
$3,096.84
|
| Rate for Payer: Quartz Commercial |
$3,792.05
|
| Rate for Payer: WEA Trust Commercial |
$3,476.04
|
| Rate for Payer: WPS Commercial |
$4,681.11
|
|
|
MRI UE Non Joint w/ + w/o Contrast Right
|
Facility
|
IP
|
$6,077.00
|
|
|
Service Code
|
CPT 73220 RT,TC
|
| Hospital Charge Code |
1611371
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$3,096.84 |
| Max. Negotiated Rate |
$5,814.47 |
| Rate for Payer: Aetna Commercial |
$5,688.07
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,435.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,349.64
|
| Rate for Payer: Cash Price |
$1,823.10
|
| Rate for Payer: Cigna Commercial |
$5,814.47
|
| Rate for Payer: Health EOS Commercial |
$5,624.87
|
| Rate for Payer: HFN Commercial |
$5,814.47
|
| Rate for Payer: Multiplan Commercial |
$5,056.06
|
| Rate for Payer: Preferred Network Access Commercial |
$5,814.47
|
| Rate for Payer: Quartz Beloit One Network |
$3,096.84
|
| Rate for Payer: Quartz Commercial |
$3,792.05
|
| Rate for Payer: WEA Trust Commercial |
$3,476.04
|
| Rate for Payer: WPS Commercial |
$4,681.11
|
|
|
MRI Wrist w/ Contrast Bilateral
|
Facility
|
IP
|
$9,376.00
|
|
|
Service Code
|
CPT 73222
|
| Hospital Charge Code |
631441
|
| 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 Wrist w/ Contrast Bilateral
|
Facility
|
OP
|
$5,965.00
|
|
|
Service Code
|
CPT 73222 LT,TC
|
| Hospital Charge Code |
1611393
|
|
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 Wrist w/ Contrast Bilateral
|
Facility
|
IP
|
$5,965.00
|
|
|
Service Code
|
CPT 73222 LT,TC
|
| Hospital Charge Code |
1611393
|
|
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 Wrist w/ Contrast Bilateral
|
Professional
|
Both
|
$9,376.00
|
|
|
Service Code
|
CPT 73222
|
| Hospital Charge Code |
631441
|
| 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 Wrist w/ Contrast Bilateral
|
Facility
|
OP
|
$9,376.00
|
|
|
Service Code
|
CPT 73222
|
| Hospital Charge Code |
631441
|
| 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 Wrist w/ Contrast Bilateral
|
Professional
|
Both
|
$5,965.00
|
|
|
Service Code
|
CPT 73222 LT,TC
|
| Hospital Charge Code |
1611393
|
|
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 Wrist w/ Contrast Left
|
Professional
|
Both
|
$5,965.00
|
|
|
Service Code
|
CPT 73222 LT,TC
|
| Hospital Charge Code |
1611395
|
|
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 Wrist w/ Contrast Left
|
Facility
|
IP
|
$5,965.00
|
|
|
Service Code
|
CPT 73222 LT,TC
|
| Hospital Charge Code |
1611395
|
|
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 Wrist w/ Contrast Left
|
Facility
|
OP
|
$4,687.00
|
|
|
Service Code
|
CPT 73222
|
| Hospital Charge Code |
631449
|
| 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
|
|
|
MRI Wrist w/ Contrast Left
|
Professional
|
Both
|
$4,687.00
|
|
|
Service Code
|
CPT 73222
|
| Hospital Charge Code |
631449
|
| 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 Wrist w/ Contrast Left
|
Facility
|
IP
|
$4,687.00
|
|
|
Service Code
|
CPT 73222
|
| Hospital Charge Code |
631449
|
| 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 Wrist w/ Contrast Left
|
Facility
|
OP
|
$5,965.00
|
|
|
Service Code
|
CPT 73222 LT,TC
|
| Hospital Charge Code |
1611395
|
|
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
|
|
