|
MRI Wrist w/ Contrast Right
|
Professional
|
Both
|
$4,687.00
|
|
|
Service Code
|
CPT 73222
|
| Hospital Charge Code |
631454
|
| 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 Right
|
Facility
|
IP
|
$4,687.00
|
|
|
Service Code
|
CPT 73222
|
| Hospital Charge Code |
631454
|
| 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 Right
|
Facility
|
OP
|
$4,687.00
|
|
|
Service Code
|
CPT 73222
|
| Hospital Charge Code |
631454
|
| 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 Right
|
Facility
|
IP
|
$5,965.00
|
|
|
Service Code
|
CPT 73222 RT,TC
|
| Hospital Charge Code |
1611397
|
|
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 Right
|
Facility
|
OP
|
$5,965.00
|
|
|
Service Code
|
CPT 73222 RT,TC
|
| Hospital Charge Code |
1611397
|
|
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 Right
|
Professional
|
Both
|
$5,965.00
|
|
|
Service Code
|
CPT 73222 RT,TC
|
| Hospital Charge Code |
1611397
|
|
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 Right
|
Facility
|
OP
|
$5,965.00
|
|
|
Service Code
|
CPT 73222 TC,RT
|
| Hospital Charge Code |
2980046
|
|
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 Right
|
Facility
|
IP
|
$5,965.00
|
|
|
Service Code
|
CPT 73222 TC,RT
|
| Hospital Charge Code |
2980046
|
|
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 Right
|
Professional
|
Both
|
$5,965.00
|
|
|
Service Code
|
CPT 73222 TC,RT
|
| Hospital Charge Code |
2980046
|
|
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/o Contrast Bilateral
|
Facility
|
OP
|
$9,122.00
|
|
|
Service Code
|
CPT 73221
|
| Hospital Charge Code |
631459
|
| Min. Negotiated Rate |
$251.10 |
| Max. Negotiated Rate |
$8,727.93 |
| Rate for Payer: Aetna Commercial |
$8,538.19
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,158.72
|
| Rate for Payer: Aetna Managed Medicare |
$251.10
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,166.47
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,743.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,553.70
|
| Rate for Payer: Anthem Medicare Advantage |
$251.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,028.05
|
| 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 |
$2,736.60
|
| Rate for Payer: Cash Price |
$2,736.60
|
| Rate for Payer: Cigna Commercial |
$8,727.93
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$251.10
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,309.00
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$251.10
|
| Rate for Payer: Health EOS Commercial |
$8,443.32
|
| Rate for Payer: HFN Commercial |
$8,727.93
|
| 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 |
$7,589.50
|
| Rate for Payer: NAPHCARE Commercial |
$376.65
|
| Rate for Payer: Preferred Network Access Commercial |
$8,727.93
|
| Rate for Payer: Quartz Beloit One Network |
$4,648.57
|
| Rate for Payer: Quartz Commercial |
$6,166.47
|
| 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 |
$5,217.78
|
| Rate for Payer: Wellcare Medicare |
$251.10
|
| Rate for Payer: WPS Commercial |
$7,026.68
|
|
|
MRI Wrist w/o Contrast Bilateral
|
Professional
|
Both
|
$5,533.00
|
|
|
Service Code
|
CPT 73221 LT,TC
|
| Hospital Charge Code |
1611399
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$795.00 |
| Max. Negotiated Rate |
$5,466.60 |
| Rate for Payer: Aetna Commercial |
$5,466.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,948.72
|
| Rate for Payer: Cash Price |
$1,659.90
|
| Rate for Payer: Cash Price |
$1,659.90
|
| Rate for Payer: Cash Price |
$1,659.90
|
| Rate for Payer: Cigna Commercial |
$5,466.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,877.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,452.59
|
| Rate for Payer: Health EOS Commercial |
$5,236.43
|
| Rate for Payer: HFN Commercial |
$5,466.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$795.00
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$795.00
|
| Rate for Payer: Multiplan Commercial |
$4,603.46
|
| Rate for Payer: Preferred Network Access Commercial |
$5,466.60
|
| Rate for Payer: Quartz Beloit One Network |
$2,531.90
|
| Rate for Payer: Quartz Commercial |
$3,279.96
|
| Rate for Payer: The Alliance Commercial |
$2,877.16
|
| Rate for Payer: WEA Trust Commercial |
$3,164.88
|
| Rate for Payer: WPS Commercial |
$4,262.07
|
|
|
MRI Wrist w/o Contrast Bilateral
|
Facility
|
IP
|
$9,122.00
|
|
|
Service Code
|
CPT 73221
|
| Hospital Charge Code |
631459
|
| Min. Negotiated Rate |
$4,648.57 |
| Max. Negotiated Rate |
$8,727.93 |
| Rate for Payer: Aetna Commercial |
$8,538.19
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,158.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,028.05
|
| Rate for Payer: Cash Price |
$2,736.60
|
| Rate for Payer: Cigna Commercial |
$8,727.93
|
| Rate for Payer: Health EOS Commercial |
$8,443.32
|
| Rate for Payer: HFN Commercial |
$8,727.93
|
| Rate for Payer: Multiplan Commercial |
$7,589.50
|
| Rate for Payer: Preferred Network Access Commercial |
$8,727.93
|
| Rate for Payer: Quartz Beloit One Network |
$4,648.57
|
| Rate for Payer: Quartz Commercial |
$5,692.13
|
| Rate for Payer: WEA Trust Commercial |
$5,217.78
|
| Rate for Payer: WPS Commercial |
$7,026.68
|
|
|
MRI Wrist w/o Contrast Bilateral
|
Professional
|
Both
|
$9,122.00
|
|
|
Service Code
|
CPT 73221
|
| Hospital Charge Code |
631459
|
| Min. Negotiated Rate |
$204.22 |
| Max. Negotiated Rate |
$9,012.54 |
| Rate for Payer: Aetna Commercial |
$9,012.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,158.72
|
| Rate for Payer: Aetna Managed Medicare |
$204.22
|
| Rate for Payer: Anthem Medicare Advantage |
$204.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$204.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$204.22
|
| Rate for Payer: Cash Price |
$2,736.60
|
| Rate for Payer: Cash Price |
$2,736.60
|
| Rate for Payer: Cash Price |
$2,736.60
|
| Rate for Payer: Cigna Commercial |
$9,012.54
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$4,743.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$204.22
|
| Rate for Payer: Health EOS Commercial |
$8,633.06
|
| Rate for Payer: HFN Commercial |
$9,012.54
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$795.00
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$795.00
|
| Rate for Payer: Independent Care Health Plan Medicare |
$204.22
|
| Rate for Payer: Multiplan Commercial |
$7,589.50
|
| Rate for Payer: NAPHCARE Commercial |
$306.34
|
| Rate for Payer: Preferred Network Access Commercial |
$9,012.54
|
| Rate for Payer: Quartz Beloit One Network |
$4,174.23
|
| Rate for Payer: Quartz Commercial |
$5,407.52
|
| Rate for Payer: Quartz Medicare Advantage |
$204.22
|
| Rate for Payer: The Alliance Commercial |
$776.05
|
| Rate for Payer: United Healthcare Medicare Advantage |
$204.22
|
| Rate for Payer: WEA Trust Commercial |
$5,217.78
|
| Rate for Payer: WPS Commercial |
$1,021.12
|
|
|
MRI Wrist w/o Contrast Bilateral
|
Facility
|
OP
|
$5,533.00
|
|
|
Service Code
|
CPT 73221 LT,TC
|
| Hospital Charge Code |
1611399
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,611.21 |
| Max. Negotiated Rate |
$5,293.97 |
| Rate for Payer: Aetna Commercial |
$5,178.89
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,948.72
|
| Rate for Payer: Aetna Managed Medicare |
$1,611.21
|
| 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 |
$3,049.79
|
| Rate for Payer: Cash Price |
$1,659.90
|
| Rate for Payer: Cash Price |
$1,659.90
|
| Rate for Payer: Cash Price |
$1,659.90
|
| Rate for Payer: Cigna Commercial |
$5,293.97
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,220.21
|
| Rate for Payer: Health EOS Commercial |
$5,121.34
|
| Rate for Payer: HFN Commercial |
$5,293.97
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,315.74
|
| Rate for Payer: Multiplan Commercial |
$4,603.46
|
| Rate for Payer: NAPHCARE Commercial |
$3,452.59
|
| Rate for Payer: Preferred Network Access Commercial |
$5,293.97
|
| Rate for Payer: Quartz Beloit One Network |
$2,819.62
|
| Rate for Payer: Quartz Commercial |
$3,740.31
|
| Rate for Payer: Quartz Medicare Advantage |
$3,452.59
|
| Rate for Payer: The Alliance Commercial |
$2,877.16
|
| Rate for Payer: United Healthcare PPO |
$3,142.88
|
| Rate for Payer: WEA Trust Commercial |
$3,164.88
|
| Rate for Payer: WPS Commercial |
$4,262.07
|
|
|
MRI Wrist w/o Contrast Bilateral
|
Facility
|
IP
|
$5,533.00
|
|
|
Service Code
|
CPT 73221 LT,TC
|
| Hospital Charge Code |
1611399
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$2,819.62 |
| Max. Negotiated Rate |
$5,293.97 |
| Rate for Payer: Aetna Commercial |
$5,178.89
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,948.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,049.79
|
| Rate for Payer: Cash Price |
$1,659.90
|
| Rate for Payer: Cigna Commercial |
$5,293.97
|
| Rate for Payer: Health EOS Commercial |
$5,121.34
|
| Rate for Payer: HFN Commercial |
$5,293.97
|
| Rate for Payer: Multiplan Commercial |
$4,603.46
|
| Rate for Payer: Preferred Network Access Commercial |
$5,293.97
|
| Rate for Payer: Quartz Beloit One Network |
$2,819.62
|
| Rate for Payer: Quartz Commercial |
$3,452.59
|
| Rate for Payer: WEA Trust Commercial |
$3,164.88
|
| Rate for Payer: WPS Commercial |
$4,262.07
|
|
|
MRI Wrist w/o Contrast Left
|
Professional
|
Both
|
$4,561.00
|
|
|
Service Code
|
CPT 73221
|
| Hospital Charge Code |
631465
|
| Min. Negotiated Rate |
$204.22 |
| Max. Negotiated Rate |
$4,506.27 |
| Rate for Payer: Aetna Commercial |
$4,506.27
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,079.36
|
| Rate for Payer: Aetna Managed Medicare |
$204.22
|
| Rate for Payer: Anthem Medicare Advantage |
$204.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$204.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$204.22
|
| Rate for Payer: Cash Price |
$1,368.30
|
| Rate for Payer: Cash Price |
$1,368.30
|
| Rate for Payer: Cash Price |
$1,368.30
|
| Rate for Payer: Cigna Commercial |
$4,506.27
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,371.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$204.22
|
| Rate for Payer: Health EOS Commercial |
$4,316.53
|
| Rate for Payer: HFN Commercial |
$4,506.27
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$795.00
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$795.00
|
| Rate for Payer: Independent Care Health Plan Medicare |
$204.22
|
| Rate for Payer: Multiplan Commercial |
$3,794.75
|
| Rate for Payer: NAPHCARE Commercial |
$306.34
|
| Rate for Payer: Preferred Network Access Commercial |
$4,506.27
|
| Rate for Payer: Quartz Beloit One Network |
$2,087.11
|
| Rate for Payer: Quartz Commercial |
$2,703.76
|
| Rate for Payer: Quartz Medicare Advantage |
$204.22
|
| Rate for Payer: The Alliance Commercial |
$776.05
|
| Rate for Payer: United Healthcare Medicare Advantage |
$204.22
|
| Rate for Payer: WEA Trust Commercial |
$2,608.89
|
| Rate for Payer: WPS Commercial |
$1,021.12
|
|
|
MRI Wrist w/o Contrast Left
|
Facility
|
IP
|
$4,561.00
|
|
|
Service Code
|
CPT 73221
|
| Hospital Charge Code |
631465
|
| Min. Negotiated Rate |
$2,324.29 |
| Max. Negotiated Rate |
$4,363.96 |
| Rate for Payer: Aetna Commercial |
$4,269.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,079.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,514.02
|
| Rate for Payer: Cash Price |
$1,368.30
|
| Rate for Payer: Cigna Commercial |
$4,363.96
|
| Rate for Payer: Health EOS Commercial |
$4,221.66
|
| Rate for Payer: HFN Commercial |
$4,363.96
|
| Rate for Payer: Multiplan Commercial |
$3,794.75
|
| Rate for Payer: Preferred Network Access Commercial |
$4,363.96
|
| Rate for Payer: Quartz Beloit One Network |
$2,324.29
|
| Rate for Payer: Quartz Commercial |
$2,846.06
|
| Rate for Payer: WEA Trust Commercial |
$2,608.89
|
| Rate for Payer: WPS Commercial |
$3,513.34
|
|
|
MRI Wrist w/o Contrast Left
|
Facility
|
OP
|
$4,561.00
|
|
|
Service Code
|
CPT 73221
|
| Hospital Charge Code |
631465
|
| Min. Negotiated Rate |
$251.10 |
| Max. Negotiated Rate |
$4,363.96 |
| Rate for Payer: Aetna Commercial |
$4,269.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,079.36
|
| Rate for Payer: Aetna Managed Medicare |
$251.10
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,083.24
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,371.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,276.85
|
| Rate for Payer: Anthem Medicare Advantage |
$251.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,514.02
|
| 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 |
$1,368.30
|
| Rate for Payer: Cash Price |
$1,368.30
|
| Rate for Payer: Cigna Commercial |
$4,363.96
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$251.10
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,654.50
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$251.10
|
| Rate for Payer: Health EOS Commercial |
$4,221.66
|
| Rate for Payer: HFN Commercial |
$4,363.96
|
| 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 |
$3,794.75
|
| Rate for Payer: NAPHCARE Commercial |
$376.65
|
| Rate for Payer: Preferred Network Access Commercial |
$4,363.96
|
| Rate for Payer: Quartz Beloit One Network |
$2,324.29
|
| Rate for Payer: Quartz Commercial |
$3,083.24
|
| 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 |
$2,608.89
|
| Rate for Payer: Wellcare Medicare |
$251.10
|
| Rate for Payer: WPS Commercial |
$3,513.34
|
|
|
MRI Wrist w/o Contrast Left
|
Facility
|
OP
|
$5,085.00
|
|
|
Service Code
|
CPT 73221 LT,TC
|
| Hospital Charge Code |
1611401
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,480.75 |
| Max. Negotiated Rate |
$4,865.33 |
| Rate for Payer: Aetna Commercial |
$4,759.56
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,548.02
|
| Rate for Payer: Aetna Managed Medicare |
$1,480.75
|
| 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 |
$2,802.85
|
| Rate for Payer: Cash Price |
$1,525.50
|
| Rate for Payer: Cash Price |
$1,525.50
|
| Rate for Payer: Cash Price |
$1,525.50
|
| Rate for Payer: Cigna Commercial |
$4,865.33
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,959.47
|
| Rate for Payer: Health EOS Commercial |
$4,706.68
|
| Rate for Payer: HFN Commercial |
$4,865.33
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,966.30
|
| Rate for Payer: Multiplan Commercial |
$4,230.72
|
| Rate for Payer: NAPHCARE Commercial |
$3,173.04
|
| Rate for Payer: Preferred Network Access Commercial |
$4,865.33
|
| Rate for Payer: Quartz Beloit One Network |
$2,591.32
|
| Rate for Payer: Quartz Commercial |
$3,437.46
|
| Rate for Payer: Quartz Medicare Advantage |
$3,173.04
|
| Rate for Payer: The Alliance Commercial |
$2,644.20
|
| Rate for Payer: United Healthcare PPO |
$3,142.88
|
| Rate for Payer: WEA Trust Commercial |
$2,908.62
|
| Rate for Payer: WPS Commercial |
$3,916.98
|
|
|
MRI Wrist w/o Contrast Left
|
Professional
|
Both
|
$5,085.00
|
|
|
Service Code
|
CPT 73221 LT,TC
|
| Hospital Charge Code |
1611401
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$795.00 |
| Max. Negotiated Rate |
$5,023.98 |
| Rate for Payer: Aetna Commercial |
$5,023.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,548.02
|
| Rate for Payer: Cash Price |
$1,525.50
|
| Rate for Payer: Cash Price |
$1,525.50
|
| Rate for Payer: Cash Price |
$1,525.50
|
| Rate for Payer: Cigna Commercial |
$5,023.98
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,644.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,173.04
|
| Rate for Payer: Health EOS Commercial |
$4,812.44
|
| Rate for Payer: HFN Commercial |
$5,023.98
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$795.00
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$795.00
|
| Rate for Payer: Multiplan Commercial |
$4,230.72
|
| Rate for Payer: Preferred Network Access Commercial |
$5,023.98
|
| Rate for Payer: Quartz Beloit One Network |
$2,326.90
|
| Rate for Payer: Quartz Commercial |
$3,014.39
|
| Rate for Payer: The Alliance Commercial |
$2,644.20
|
| Rate for Payer: WEA Trust Commercial |
$2,908.62
|
| Rate for Payer: WPS Commercial |
$3,916.98
|
|
|
MRI Wrist w/o Contrast Left
|
Facility
|
IP
|
$5,085.00
|
|
|
Service Code
|
CPT 73221 LT,TC
|
| Hospital Charge Code |
1611401
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$2,591.32 |
| Max. Negotiated Rate |
$4,865.33 |
| Rate for Payer: Aetna Commercial |
$4,759.56
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,548.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,802.85
|
| Rate for Payer: Cash Price |
$1,525.50
|
| Rate for Payer: Cigna Commercial |
$4,865.33
|
| Rate for Payer: Health EOS Commercial |
$4,706.68
|
| Rate for Payer: HFN Commercial |
$4,865.33
|
| Rate for Payer: Multiplan Commercial |
$4,230.72
|
| Rate for Payer: Preferred Network Access Commercial |
$4,865.33
|
| Rate for Payer: Quartz Beloit One Network |
$2,591.32
|
| Rate for Payer: Quartz Commercial |
$3,173.04
|
| Rate for Payer: WEA Trust Commercial |
$2,908.62
|
| Rate for Payer: WPS Commercial |
$3,916.98
|
|
|
MRI Wrist w/o Contrast Right
|
Professional
|
Both
|
$5,085.00
|
|
|
Service Code
|
CPT 73221 RT,TC
|
| Hospital Charge Code |
1611403
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$795.00 |
| Max. Negotiated Rate |
$5,023.98 |
| Rate for Payer: Aetna Commercial |
$5,023.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,548.02
|
| Rate for Payer: Cash Price |
$1,525.50
|
| Rate for Payer: Cash Price |
$1,525.50
|
| Rate for Payer: Cash Price |
$1,525.50
|
| Rate for Payer: Cigna Commercial |
$5,023.98
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,644.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,173.04
|
| Rate for Payer: Health EOS Commercial |
$4,812.44
|
| Rate for Payer: HFN Commercial |
$5,023.98
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$795.00
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$795.00
|
| Rate for Payer: Multiplan Commercial |
$4,230.72
|
| Rate for Payer: Preferred Network Access Commercial |
$5,023.98
|
| Rate for Payer: Quartz Beloit One Network |
$2,326.90
|
| Rate for Payer: Quartz Commercial |
$3,014.39
|
| Rate for Payer: The Alliance Commercial |
$2,644.20
|
| Rate for Payer: WEA Trust Commercial |
$2,908.62
|
| Rate for Payer: WPS Commercial |
$3,916.98
|
|
|
MRI Wrist w/o Contrast Right
|
Facility
|
IP
|
$4,561.00
|
|
|
Service Code
|
CPT 73221
|
| Hospital Charge Code |
631482
|
| Min. Negotiated Rate |
$2,324.29 |
| Max. Negotiated Rate |
$4,363.96 |
| Rate for Payer: Aetna Commercial |
$4,269.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,079.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,514.02
|
| Rate for Payer: Cash Price |
$1,368.30
|
| Rate for Payer: Cigna Commercial |
$4,363.96
|
| Rate for Payer: Health EOS Commercial |
$4,221.66
|
| Rate for Payer: HFN Commercial |
$4,363.96
|
| Rate for Payer: Multiplan Commercial |
$3,794.75
|
| Rate for Payer: Preferred Network Access Commercial |
$4,363.96
|
| Rate for Payer: Quartz Beloit One Network |
$2,324.29
|
| Rate for Payer: Quartz Commercial |
$2,846.06
|
| Rate for Payer: WEA Trust Commercial |
$2,608.89
|
| Rate for Payer: WPS Commercial |
$3,513.34
|
|
|
MRI Wrist w/o Contrast Right
|
Professional
|
Both
|
$4,561.00
|
|
|
Service Code
|
CPT 73221
|
| Hospital Charge Code |
631482
|
| Min. Negotiated Rate |
$204.22 |
| Max. Negotiated Rate |
$4,506.27 |
| Rate for Payer: Aetna Commercial |
$4,506.27
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,079.36
|
| Rate for Payer: Aetna Managed Medicare |
$204.22
|
| Rate for Payer: Anthem Medicare Advantage |
$204.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$204.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$204.22
|
| Rate for Payer: Cash Price |
$1,368.30
|
| Rate for Payer: Cash Price |
$1,368.30
|
| Rate for Payer: Cash Price |
$1,368.30
|
| Rate for Payer: Cigna Commercial |
$4,506.27
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,371.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$204.22
|
| Rate for Payer: Health EOS Commercial |
$4,316.53
|
| Rate for Payer: HFN Commercial |
$4,506.27
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$795.00
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$795.00
|
| Rate for Payer: Independent Care Health Plan Medicare |
$204.22
|
| Rate for Payer: Multiplan Commercial |
$3,794.75
|
| Rate for Payer: NAPHCARE Commercial |
$306.34
|
| Rate for Payer: Preferred Network Access Commercial |
$4,506.27
|
| Rate for Payer: Quartz Beloit One Network |
$2,087.11
|
| Rate for Payer: Quartz Commercial |
$2,703.76
|
| Rate for Payer: Quartz Medicare Advantage |
$204.22
|
| Rate for Payer: The Alliance Commercial |
$776.05
|
| Rate for Payer: United Healthcare Medicare Advantage |
$204.22
|
| Rate for Payer: WEA Trust Commercial |
$2,608.89
|
| Rate for Payer: WPS Commercial |
$1,021.12
|
|
|
MRI Wrist w/o Contrast Right
|
Facility
|
IP
|
$5,085.00
|
|
|
Service Code
|
CPT 73221 RT,TC
|
| Hospital Charge Code |
1611403
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$2,591.32 |
| Max. Negotiated Rate |
$4,865.33 |
| Rate for Payer: Aetna Commercial |
$4,759.56
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,548.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,802.85
|
| Rate for Payer: Cash Price |
$1,525.50
|
| Rate for Payer: Cigna Commercial |
$4,865.33
|
| Rate for Payer: Health EOS Commercial |
$4,706.68
|
| Rate for Payer: HFN Commercial |
$4,865.33
|
| Rate for Payer: Multiplan Commercial |
$4,230.72
|
| Rate for Payer: Preferred Network Access Commercial |
$4,865.33
|
| Rate for Payer: Quartz Beloit One Network |
$2,591.32
|
| Rate for Payer: Quartz Commercial |
$3,173.04
|
| Rate for Payer: WEA Trust Commercial |
$2,908.62
|
| Rate for Payer: WPS Commercial |
$3,916.98
|
|
