|
XR Foot 2 Views Bilateral
|
Facility
OP
|
$486.00
|
|
|
Service Code
|
CPT 73620 LT,TC
|
| Hospital Charge Code |
1537060
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$136.08 |
| Max. Negotiated Rate |
$1,944.00 |
| Rate for Payer: Aetna Commercial |
$437.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$417.96
|
| Rate for Payer: Aetna Managed Medicare |
$136.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$315.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$243.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$233.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$257.58
|
| Rate for Payer: Cash Price |
$145.80
|
| Rate for Payer: Cash Price |
$145.80
|
| Rate for Payer: Cash Price |
$145.80
|
| Rate for Payer: Cigna Commercial |
$447.12
|
| Rate for Payer: Health EOS Commercial |
$432.54
|
| Rate for Payer: HFN Commercial |
$447.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$364.50
|
| Rate for Payer: Multiplan Commercial |
$388.80
|
| Rate for Payer: NAPHCARE Commercial |
$291.60
|
| Rate for Payer: Preferred Network Access Commercial |
$447.12
|
| Rate for Payer: Quartz Beloit One Network |
$238.14
|
| Rate for Payer: Quartz Commercial |
$315.90
|
| Rate for Payer: Quartz Medicare Advantage |
$291.60
|
| Rate for Payer: The Alliance Commercial |
$1,944.00
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$267.30
|
| Rate for Payer: WPS Commercial |
$359.98
|
|
|
XR Foot 2 Views Bilateral
|
Professional
|
$901.00
|
|
|
Service Code
|
CPT 73620
|
| Hospital Charge Code |
630565
|
| Min. Negotiated Rate |
$27.20 |
| Max. Negotiated Rate |
$855.95 |
| Rate for Payer: Aetna Commercial |
$855.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$774.86
|
| Rate for Payer: Aetna Managed Medicare |
$27.20
|
| Rate for Payer: Anthem Medicare Advantage |
$27.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$27.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$27.20
|
| Rate for Payer: Cash Price |
$270.30
|
| Rate for Payer: Cash Price |
$270.30
|
| Rate for Payer: Cigna Commercial |
$855.95
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$450.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$27.20
|
| Rate for Payer: Health EOS Commercial |
$819.91
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$95.84
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$95.84
|
| Rate for Payer: Independent Care Health Plan Medicare |
$27.20
|
| Rate for Payer: Multiplan Commercial |
$720.80
|
| Rate for Payer: Preferred Network Access Commercial |
$855.95
|
| Rate for Payer: Quartz Beloit One Network |
$396.44
|
| Rate for Payer: Quartz Commercial |
$513.57
|
| Rate for Payer: Quartz Medicare Advantage |
$27.20
|
| Rate for Payer: The Alliance Commercial |
$103.36
|
| Rate for Payer: United Healthcare Medicare Advantage |
$27.20
|
| Rate for Payer: WEA Trust Commercial |
$495.55
|
| Rate for Payer: WPS Commercial |
$136.00
|
|
|
XR Foot 2 Views Bilateral
|
Facility
OP
|
$901.00
|
|
|
Service Code
|
CPT 73620
|
| Hospital Charge Code |
630565
|
| Min. Negotiated Rate |
$89.82 |
| Max. Negotiated Rate |
$828.92 |
| Rate for Payer: Aetna Commercial |
$810.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$774.86
|
| Rate for Payer: Aetna Managed Medicare |
$89.82
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$585.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$450.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$432.48
|
| Rate for Payer: Anthem Medicare Advantage |
$89.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$477.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$89.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$89.82
|
| Rate for Payer: Cash Price |
$270.30
|
| Rate for Payer: Cash Price |
$270.30
|
| Rate for Payer: Cigna Commercial |
$828.92
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$89.82
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$89.82
|
| Rate for Payer: Health EOS Commercial |
$801.89
|
| Rate for Payer: HFN Commercial |
$828.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$334.13
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$89.82
|
| Rate for Payer: Independent Care Health Plan Medicare |
$89.82
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$89.82
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$89.82
|
| Rate for Payer: Multiplan Commercial |
$720.80
|
| Rate for Payer: NAPHCARE Commercial |
$134.73
|
| Rate for Payer: Preferred Network Access Commercial |
$828.92
|
| Rate for Payer: Quartz Beloit One Network |
$441.49
|
| Rate for Payer: Quartz Commercial |
$585.65
|
| Rate for Payer: Quartz Medicare Advantage |
$89.82
|
| Rate for Payer: The Alliance Commercial |
$658.24
|
| Rate for Payer: United Healthcare Medicare Advantage |
$89.82
|
| Rate for Payer: WEA Trust Commercial |
$495.55
|
| Rate for Payer: Wellcare Medicare |
$89.82
|
| Rate for Payer: WPS Commercial |
$667.37
|
|
|
XR Foot 2 Views Bilateral
|
Facility
IP
|
$901.00
|
|
|
Service Code
|
CPT 73620
|
| Hospital Charge Code |
630565
|
| Min. Negotiated Rate |
$441.49 |
| Max. Negotiated Rate |
$828.92 |
| Rate for Payer: Aetna Commercial |
$810.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$477.53
|
| Rate for Payer: Cash Price |
$270.30
|
| Rate for Payer: Cigna Commercial |
$828.92
|
| Rate for Payer: Health EOS Commercial |
$801.89
|
| Rate for Payer: HFN Commercial |
$828.92
|
| Rate for Payer: Multiplan Commercial |
$720.80
|
| Rate for Payer: NAPHCARE Commercial |
$540.60
|
| Rate for Payer: Preferred Network Access Commercial |
$828.92
|
| Rate for Payer: Quartz Beloit One Network |
$441.49
|
| Rate for Payer: Quartz Commercial |
$540.60
|
| Rate for Payer: WEA Trust Commercial |
$495.55
|
| Rate for Payer: WPS Commercial |
$667.37
|
|
|
XR Foot 2 Views Bilateral
|
Facility
IP
|
$486.00
|
|
|
Service Code
|
CPT 73620 LT,TC
|
| Hospital Charge Code |
1537060
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$238.14 |
| Max. Negotiated Rate |
$447.12 |
| Rate for Payer: Aetna Commercial |
$437.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$257.58
|
| Rate for Payer: Cash Price |
$145.80
|
| Rate for Payer: Cigna Commercial |
$447.12
|
| Rate for Payer: Health EOS Commercial |
$432.54
|
| Rate for Payer: HFN Commercial |
$447.12
|
| Rate for Payer: Multiplan Commercial |
$388.80
|
| Rate for Payer: NAPHCARE Commercial |
$291.60
|
| Rate for Payer: Preferred Network Access Commercial |
$447.12
|
| Rate for Payer: Quartz Beloit One Network |
$238.14
|
| Rate for Payer: Quartz Commercial |
$291.60
|
| Rate for Payer: WEA Trust Commercial |
$267.30
|
| Rate for Payer: WPS Commercial |
$359.98
|
|
|
XR Foot 2 Views Left
|
Facility
IP
|
$486.00
|
|
|
Service Code
|
CPT 73620 LT,TC
|
| Hospital Charge Code |
1537062
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$238.14 |
| Max. Negotiated Rate |
$447.12 |
| Rate for Payer: Aetna Commercial |
$437.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$257.58
|
| Rate for Payer: Cash Price |
$145.80
|
| Rate for Payer: Cigna Commercial |
$447.12
|
| Rate for Payer: Health EOS Commercial |
$432.54
|
| Rate for Payer: HFN Commercial |
$447.12
|
| Rate for Payer: Multiplan Commercial |
$388.80
|
| Rate for Payer: NAPHCARE Commercial |
$291.60
|
| Rate for Payer: Preferred Network Access Commercial |
$447.12
|
| Rate for Payer: Quartz Beloit One Network |
$238.14
|
| Rate for Payer: Quartz Commercial |
$291.60
|
| Rate for Payer: WEA Trust Commercial |
$267.30
|
| Rate for Payer: WPS Commercial |
$359.98
|
|
|
XR Foot 2 Views Left
|
Facility
IP
|
$450.00
|
|
|
Service Code
|
CPT 73620
|
| Hospital Charge Code |
630559
|
| Min. Negotiated Rate |
$220.50 |
| Max. Negotiated Rate |
$414.00 |
| Rate for Payer: Aetna Commercial |
$405.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$238.50
|
| Rate for Payer: Cash Price |
$135.00
|
| Rate for Payer: Cigna Commercial |
$414.00
|
| Rate for Payer: Health EOS Commercial |
$400.50
|
| Rate for Payer: HFN Commercial |
$414.00
|
| Rate for Payer: Multiplan Commercial |
$360.00
|
| Rate for Payer: NAPHCARE Commercial |
$270.00
|
| Rate for Payer: Preferred Network Access Commercial |
$414.00
|
| Rate for Payer: Quartz Beloit One Network |
$220.50
|
| Rate for Payer: Quartz Commercial |
$270.00
|
| Rate for Payer: WEA Trust Commercial |
$247.50
|
| Rate for Payer: WPS Commercial |
$333.32
|
|
|
XR Foot 2 Views Left
|
Professional
|
$486.00
|
|
|
Service Code
|
CPT 73620 LT,TC
|
| Hospital Charge Code |
1537062
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$213.84 |
| Max. Negotiated Rate |
$461.70 |
| Rate for Payer: Aetna Commercial |
$461.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$417.96
|
| Rate for Payer: Cash Price |
$145.80
|
| Rate for Payer: Cash Price |
$145.80
|
| Rate for Payer: Cigna Commercial |
$461.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$243.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$291.60
|
| Rate for Payer: Health EOS Commercial |
$442.26
|
| Rate for Payer: Multiplan Commercial |
$388.80
|
| Rate for Payer: Preferred Network Access Commercial |
$461.70
|
| Rate for Payer: Quartz Beloit One Network |
$213.84
|
| Rate for Payer: Quartz Commercial |
$277.02
|
| Rate for Payer: The Alliance Commercial |
$243.00
|
| Rate for Payer: WEA Trust Commercial |
$267.30
|
| Rate for Payer: WPS Commercial |
$359.98
|
|
|
XR Foot 2 Views Left
|
Facility
OP
|
$450.00
|
|
|
Service Code
|
CPT 73620
|
| Hospital Charge Code |
630559
|
| Min. Negotiated Rate |
$89.82 |
| Max. Negotiated Rate |
$658.24 |
| Rate for Payer: Aetna Commercial |
$405.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$387.00
|
| Rate for Payer: Aetna Managed Medicare |
$89.82
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$292.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$225.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$216.00
|
| Rate for Payer: Anthem Medicare Advantage |
$89.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$238.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$89.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$89.82
|
| Rate for Payer: Cash Price |
$135.00
|
| Rate for Payer: Cash Price |
$135.00
|
| Rate for Payer: Cigna Commercial |
$414.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$89.82
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$89.82
|
| Rate for Payer: Health EOS Commercial |
$400.50
|
| Rate for Payer: HFN Commercial |
$414.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$334.13
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$89.82
|
| Rate for Payer: Independent Care Health Plan Medicare |
$89.82
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$89.82
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$89.82
|
| Rate for Payer: Multiplan Commercial |
$360.00
|
| Rate for Payer: NAPHCARE Commercial |
$134.73
|
| Rate for Payer: Preferred Network Access Commercial |
$414.00
|
| Rate for Payer: Quartz Beloit One Network |
$220.50
|
| Rate for Payer: Quartz Commercial |
$292.50
|
| Rate for Payer: Quartz Medicare Advantage |
$89.82
|
| Rate for Payer: The Alliance Commercial |
$658.24
|
| Rate for Payer: United Healthcare Medicare Advantage |
$89.82
|
| Rate for Payer: WEA Trust Commercial |
$247.50
|
| Rate for Payer: Wellcare Medicare |
$89.82
|
| Rate for Payer: WPS Commercial |
$333.32
|
|
|
XR Foot 2 Views Left
|
Professional
|
$450.00
|
|
|
Service Code
|
CPT 73620
|
| Hospital Charge Code |
630559
|
| Min. Negotiated Rate |
$27.20 |
| Max. Negotiated Rate |
$427.50 |
| Rate for Payer: Aetna Commercial |
$427.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$387.00
|
| Rate for Payer: Aetna Managed Medicare |
$27.20
|
| Rate for Payer: Anthem Medicare Advantage |
$27.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$27.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$27.20
|
| Rate for Payer: Cash Price |
$135.00
|
| Rate for Payer: Cash Price |
$135.00
|
| Rate for Payer: Cigna Commercial |
$427.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$225.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$27.20
|
| Rate for Payer: Health EOS Commercial |
$409.50
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$95.84
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$95.84
|
| Rate for Payer: Independent Care Health Plan Medicare |
$27.20
|
| Rate for Payer: Multiplan Commercial |
$360.00
|
| Rate for Payer: Preferred Network Access Commercial |
$427.50
|
| Rate for Payer: Quartz Beloit One Network |
$198.00
|
| Rate for Payer: Quartz Commercial |
$256.50
|
| Rate for Payer: Quartz Medicare Advantage |
$27.20
|
| Rate for Payer: The Alliance Commercial |
$103.36
|
| Rate for Payer: United Healthcare Medicare Advantage |
$27.20
|
| Rate for Payer: WEA Trust Commercial |
$247.50
|
| Rate for Payer: WPS Commercial |
$136.00
|
|
|
XR Foot 2 Views Left
|
Facility
OP
|
$486.00
|
|
|
Service Code
|
CPT 73620 LT,TC
|
| Hospital Charge Code |
1537062
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$136.08 |
| Max. Negotiated Rate |
$1,944.00 |
| Rate for Payer: Aetna Commercial |
$437.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$417.96
|
| Rate for Payer: Aetna Managed Medicare |
$136.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$315.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$243.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$233.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$257.58
|
| Rate for Payer: Cash Price |
$145.80
|
| Rate for Payer: Cash Price |
$145.80
|
| Rate for Payer: Cash Price |
$145.80
|
| Rate for Payer: Cigna Commercial |
$447.12
|
| Rate for Payer: Health EOS Commercial |
$432.54
|
| Rate for Payer: HFN Commercial |
$447.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$364.50
|
| Rate for Payer: Multiplan Commercial |
$388.80
|
| Rate for Payer: NAPHCARE Commercial |
$291.60
|
| Rate for Payer: Preferred Network Access Commercial |
$447.12
|
| Rate for Payer: Quartz Beloit One Network |
$238.14
|
| Rate for Payer: Quartz Commercial |
$315.90
|
| Rate for Payer: Quartz Medicare Advantage |
$291.60
|
| Rate for Payer: The Alliance Commercial |
$1,944.00
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$267.30
|
| Rate for Payer: WPS Commercial |
$359.98
|
|
|
XR Foot 2 Views Right
|
Facility
IP
|
$486.00
|
|
|
Service Code
|
CPT 73620 TC,RT
|
| Hospital Charge Code |
2980065
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$238.14 |
| Max. Negotiated Rate |
$447.12 |
| Rate for Payer: Aetna Commercial |
$437.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$257.58
|
| Rate for Payer: Cash Price |
$145.80
|
| Rate for Payer: Cigna Commercial |
$447.12
|
| Rate for Payer: Health EOS Commercial |
$432.54
|
| Rate for Payer: HFN Commercial |
$447.12
|
| Rate for Payer: Multiplan Commercial |
$388.80
|
| Rate for Payer: NAPHCARE Commercial |
$291.60
|
| Rate for Payer: Preferred Network Access Commercial |
$447.12
|
| Rate for Payer: Quartz Beloit One Network |
$238.14
|
| Rate for Payer: Quartz Commercial |
$291.60
|
| Rate for Payer: WEA Trust Commercial |
$267.30
|
| Rate for Payer: WPS Commercial |
$359.98
|
|
|
XR Foot 2 Views Right
|
Facility
IP
|
$486.00
|
|
|
Service Code
|
CPT 73620 RT,TC
|
| Hospital Charge Code |
1537064
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$238.14 |
| Max. Negotiated Rate |
$447.12 |
| Rate for Payer: Aetna Commercial |
$437.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$257.58
|
| Rate for Payer: Cash Price |
$145.80
|
| Rate for Payer: Cigna Commercial |
$447.12
|
| Rate for Payer: Health EOS Commercial |
$432.54
|
| Rate for Payer: HFN Commercial |
$447.12
|
| Rate for Payer: Multiplan Commercial |
$388.80
|
| Rate for Payer: NAPHCARE Commercial |
$291.60
|
| Rate for Payer: Preferred Network Access Commercial |
$447.12
|
| Rate for Payer: Quartz Beloit One Network |
$238.14
|
| Rate for Payer: Quartz Commercial |
$291.60
|
| Rate for Payer: WEA Trust Commercial |
$267.30
|
| Rate for Payer: WPS Commercial |
$359.98
|
|
|
XR Foot 2 Views Right
|
Professional
|
$450.00
|
|
|
Service Code
|
CPT 73620
|
| Hospital Charge Code |
630555
|
| Min. Negotiated Rate |
$27.20 |
| Max. Negotiated Rate |
$427.50 |
| Rate for Payer: Aetna Commercial |
$427.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$387.00
|
| Rate for Payer: Aetna Managed Medicare |
$27.20
|
| Rate for Payer: Anthem Medicare Advantage |
$27.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$27.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$27.20
|
| Rate for Payer: Cash Price |
$135.00
|
| Rate for Payer: Cash Price |
$135.00
|
| Rate for Payer: Cigna Commercial |
$427.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$225.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$27.20
|
| Rate for Payer: Health EOS Commercial |
$409.50
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$95.84
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$95.84
|
| Rate for Payer: Independent Care Health Plan Medicare |
$27.20
|
| Rate for Payer: Multiplan Commercial |
$360.00
|
| Rate for Payer: Preferred Network Access Commercial |
$427.50
|
| Rate for Payer: Quartz Beloit One Network |
$198.00
|
| Rate for Payer: Quartz Commercial |
$256.50
|
| Rate for Payer: Quartz Medicare Advantage |
$27.20
|
| Rate for Payer: The Alliance Commercial |
$103.36
|
| Rate for Payer: United Healthcare Medicare Advantage |
$27.20
|
| Rate for Payer: WEA Trust Commercial |
$247.50
|
| Rate for Payer: WPS Commercial |
$136.00
|
|
|
XR Foot 2 Views Right
|
Professional
|
$486.00
|
|
|
Service Code
|
CPT 73620 TC,RT
|
| Hospital Charge Code |
2980065
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$213.84 |
| Max. Negotiated Rate |
$461.70 |
| Rate for Payer: Aetna Commercial |
$461.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$417.96
|
| Rate for Payer: Cash Price |
$145.80
|
| Rate for Payer: Cash Price |
$145.80
|
| Rate for Payer: Cigna Commercial |
$461.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$243.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$291.60
|
| Rate for Payer: Health EOS Commercial |
$442.26
|
| Rate for Payer: Multiplan Commercial |
$388.80
|
| Rate for Payer: Preferred Network Access Commercial |
$461.70
|
| Rate for Payer: Quartz Beloit One Network |
$213.84
|
| Rate for Payer: Quartz Commercial |
$277.02
|
| Rate for Payer: The Alliance Commercial |
$243.00
|
| Rate for Payer: WEA Trust Commercial |
$267.30
|
| Rate for Payer: WPS Commercial |
$359.98
|
|
|
XR Foot 2 Views Right
|
Facility
OP
|
$486.00
|
|
|
Service Code
|
CPT 73620 TC,RT
|
| Hospital Charge Code |
2980065
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$136.08 |
| Max. Negotiated Rate |
$1,944.00 |
| Rate for Payer: Aetna Commercial |
$437.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$417.96
|
| Rate for Payer: Aetna Managed Medicare |
$136.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$315.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$243.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$233.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$257.58
|
| Rate for Payer: Cash Price |
$145.80
|
| Rate for Payer: Cash Price |
$145.80
|
| Rate for Payer: Cash Price |
$145.80
|
| Rate for Payer: Cigna Commercial |
$447.12
|
| Rate for Payer: Health EOS Commercial |
$432.54
|
| Rate for Payer: HFN Commercial |
$447.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$364.50
|
| Rate for Payer: Multiplan Commercial |
$388.80
|
| Rate for Payer: NAPHCARE Commercial |
$291.60
|
| Rate for Payer: Preferred Network Access Commercial |
$447.12
|
| Rate for Payer: Quartz Beloit One Network |
$238.14
|
| Rate for Payer: Quartz Commercial |
$315.90
|
| Rate for Payer: Quartz Medicare Advantage |
$291.60
|
| Rate for Payer: The Alliance Commercial |
$1,944.00
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$267.30
|
| Rate for Payer: WPS Commercial |
$359.98
|
|
|
XR Foot 2 Views Right
|
Professional
|
$486.00
|
|
|
Service Code
|
CPT 73620 RT,TC
|
| Hospital Charge Code |
1537064
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$213.84 |
| Max. Negotiated Rate |
$461.70 |
| Rate for Payer: Aetna Commercial |
$461.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$417.96
|
| Rate for Payer: Cash Price |
$145.80
|
| Rate for Payer: Cash Price |
$145.80
|
| Rate for Payer: Cigna Commercial |
$461.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$243.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$291.60
|
| Rate for Payer: Health EOS Commercial |
$442.26
|
| Rate for Payer: Multiplan Commercial |
$388.80
|
| Rate for Payer: Preferred Network Access Commercial |
$461.70
|
| Rate for Payer: Quartz Beloit One Network |
$213.84
|
| Rate for Payer: Quartz Commercial |
$277.02
|
| Rate for Payer: The Alliance Commercial |
$243.00
|
| Rate for Payer: WEA Trust Commercial |
$267.30
|
| Rate for Payer: WPS Commercial |
$359.98
|
|
|
XR Foot 2 Views Right
|
Facility
IP
|
$450.00
|
|
|
Service Code
|
CPT 73620
|
| Hospital Charge Code |
630555
|
| Min. Negotiated Rate |
$220.50 |
| Max. Negotiated Rate |
$414.00 |
| Rate for Payer: Aetna Commercial |
$405.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$238.50
|
| Rate for Payer: Cash Price |
$135.00
|
| Rate for Payer: Cigna Commercial |
$414.00
|
| Rate for Payer: Health EOS Commercial |
$400.50
|
| Rate for Payer: HFN Commercial |
$414.00
|
| Rate for Payer: Multiplan Commercial |
$360.00
|
| Rate for Payer: NAPHCARE Commercial |
$270.00
|
| Rate for Payer: Preferred Network Access Commercial |
$414.00
|
| Rate for Payer: Quartz Beloit One Network |
$220.50
|
| Rate for Payer: Quartz Commercial |
$270.00
|
| Rate for Payer: WEA Trust Commercial |
$247.50
|
| Rate for Payer: WPS Commercial |
$333.32
|
|
|
XR Foot 2 Views Right
|
Facility
OP
|
$450.00
|
|
|
Service Code
|
CPT 73620
|
| Hospital Charge Code |
630555
|
| Min. Negotiated Rate |
$89.82 |
| Max. Negotiated Rate |
$658.24 |
| Rate for Payer: Aetna Commercial |
$405.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$387.00
|
| Rate for Payer: Aetna Managed Medicare |
$89.82
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$292.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$225.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$216.00
|
| Rate for Payer: Anthem Medicare Advantage |
$89.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$238.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$89.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$89.82
|
| Rate for Payer: Cash Price |
$135.00
|
| Rate for Payer: Cash Price |
$135.00
|
| Rate for Payer: Cigna Commercial |
$414.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$89.82
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$89.82
|
| Rate for Payer: Health EOS Commercial |
$400.50
|
| Rate for Payer: HFN Commercial |
$414.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$334.13
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$89.82
|
| Rate for Payer: Independent Care Health Plan Medicare |
$89.82
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$89.82
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$89.82
|
| Rate for Payer: Multiplan Commercial |
$360.00
|
| Rate for Payer: NAPHCARE Commercial |
$134.73
|
| Rate for Payer: Preferred Network Access Commercial |
$414.00
|
| Rate for Payer: Quartz Beloit One Network |
$220.50
|
| Rate for Payer: Quartz Commercial |
$292.50
|
| Rate for Payer: Quartz Medicare Advantage |
$89.82
|
| Rate for Payer: The Alliance Commercial |
$658.24
|
| Rate for Payer: United Healthcare Medicare Advantage |
$89.82
|
| Rate for Payer: WEA Trust Commercial |
$247.50
|
| Rate for Payer: Wellcare Medicare |
$89.82
|
| Rate for Payer: WPS Commercial |
$333.32
|
|
|
XR Foot 2 Views Right
|
Facility
OP
|
$486.00
|
|
|
Service Code
|
CPT 73620 RT,TC
|
| Hospital Charge Code |
1537064
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$136.08 |
| Max. Negotiated Rate |
$1,944.00 |
| Rate for Payer: Aetna Commercial |
$437.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$417.96
|
| Rate for Payer: Aetna Managed Medicare |
$136.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$315.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$243.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$233.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$257.58
|
| Rate for Payer: Cash Price |
$145.80
|
| Rate for Payer: Cash Price |
$145.80
|
| Rate for Payer: Cash Price |
$145.80
|
| Rate for Payer: Cigna Commercial |
$447.12
|
| Rate for Payer: Health EOS Commercial |
$432.54
|
| Rate for Payer: HFN Commercial |
$447.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$364.50
|
| Rate for Payer: Multiplan Commercial |
$388.80
|
| Rate for Payer: NAPHCARE Commercial |
$291.60
|
| Rate for Payer: Preferred Network Access Commercial |
$447.12
|
| Rate for Payer: Quartz Beloit One Network |
$238.14
|
| Rate for Payer: Quartz Commercial |
$315.90
|
| Rate for Payer: Quartz Medicare Advantage |
$291.60
|
| Rate for Payer: The Alliance Commercial |
$1,944.00
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$267.30
|
| Rate for Payer: WPS Commercial |
$359.98
|
|
|
XR Foot Complete Bilateral
|
Professional
|
$1,032.00
|
|
|
Service Code
|
CPT 73630
|
| Hospital Charge Code |
630552
|
| Min. Negotiated Rate |
$33.02 |
| Max. Negotiated Rate |
$980.40 |
| Rate for Payer: Aetna Commercial |
$980.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$887.52
|
| Rate for Payer: Aetna Managed Medicare |
$33.02
|
| Rate for Payer: Anthem Medicare Advantage |
$33.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$33.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$33.02
|
| Rate for Payer: Cash Price |
$309.60
|
| Rate for Payer: Cash Price |
$309.60
|
| Rate for Payer: Cigna Commercial |
$980.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$516.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$33.02
|
| Rate for Payer: Health EOS Commercial |
$939.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$115.64
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$115.64
|
| Rate for Payer: Independent Care Health Plan Medicare |
$33.02
|
| Rate for Payer: Multiplan Commercial |
$825.60
|
| Rate for Payer: Preferred Network Access Commercial |
$980.40
|
| Rate for Payer: Quartz Beloit One Network |
$454.08
|
| Rate for Payer: Quartz Commercial |
$588.24
|
| Rate for Payer: Quartz Medicare Advantage |
$33.02
|
| Rate for Payer: The Alliance Commercial |
$125.48
|
| Rate for Payer: United Healthcare Medicare Advantage |
$33.02
|
| Rate for Payer: WEA Trust Commercial |
$567.60
|
| Rate for Payer: WPS Commercial |
$165.10
|
|
|
XR Foot Complete Bilateral
|
Professional
|
$558.00
|
|
|
Service Code
|
CPT 73630 LT,TC
|
| Hospital Charge Code |
1537066
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$245.52 |
| Max. Negotiated Rate |
$530.10 |
| Rate for Payer: Aetna Commercial |
$530.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$479.88
|
| Rate for Payer: Cash Price |
$167.40
|
| Rate for Payer: Cash Price |
$167.40
|
| Rate for Payer: Cigna Commercial |
$530.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$279.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$334.80
|
| Rate for Payer: Health EOS Commercial |
$507.78
|
| Rate for Payer: Multiplan Commercial |
$446.40
|
| Rate for Payer: Preferred Network Access Commercial |
$530.10
|
| Rate for Payer: Quartz Beloit One Network |
$245.52
|
| Rate for Payer: Quartz Commercial |
$318.06
|
| Rate for Payer: The Alliance Commercial |
$279.00
|
| Rate for Payer: WEA Trust Commercial |
$306.90
|
| Rate for Payer: WPS Commercial |
$413.31
|
|
|
XR Foot Complete Bilateral
|
Facility
OP
|
$558.00
|
|
|
Service Code
|
CPT 73630 LT,TC
|
| Hospital Charge Code |
1537066
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$156.24 |
| Max. Negotiated Rate |
$2,232.00 |
| Rate for Payer: Aetna Commercial |
$502.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$479.88
|
| Rate for Payer: Aetna Managed Medicare |
$156.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$362.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$279.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$267.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$295.74
|
| Rate for Payer: Cash Price |
$167.40
|
| Rate for Payer: Cash Price |
$167.40
|
| Rate for Payer: Cash Price |
$167.40
|
| Rate for Payer: Cigna Commercial |
$513.36
|
| Rate for Payer: Health EOS Commercial |
$496.62
|
| Rate for Payer: HFN Commercial |
$513.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$418.50
|
| Rate for Payer: Multiplan Commercial |
$446.40
|
| Rate for Payer: NAPHCARE Commercial |
$334.80
|
| Rate for Payer: Preferred Network Access Commercial |
$513.36
|
| Rate for Payer: Quartz Beloit One Network |
$273.42
|
| Rate for Payer: Quartz Commercial |
$362.70
|
| Rate for Payer: Quartz Medicare Advantage |
$334.80
|
| Rate for Payer: The Alliance Commercial |
$2,232.00
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$306.90
|
| Rate for Payer: WPS Commercial |
$413.31
|
|
|
XR Foot Complete Bilateral
|
Facility
IP
|
$558.00
|
|
|
Service Code
|
CPT 73630 LT,TC
|
| Hospital Charge Code |
1537066
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$273.42 |
| Max. Negotiated Rate |
$513.36 |
| Rate for Payer: Aetna Commercial |
$502.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$295.74
|
| Rate for Payer: Cash Price |
$167.40
|
| Rate for Payer: Cigna Commercial |
$513.36
|
| Rate for Payer: Health EOS Commercial |
$496.62
|
| Rate for Payer: HFN Commercial |
$513.36
|
| Rate for Payer: Multiplan Commercial |
$446.40
|
| Rate for Payer: NAPHCARE Commercial |
$334.80
|
| Rate for Payer: Preferred Network Access Commercial |
$513.36
|
| Rate for Payer: Quartz Beloit One Network |
$273.42
|
| Rate for Payer: Quartz Commercial |
$334.80
|
| Rate for Payer: WEA Trust Commercial |
$306.90
|
| Rate for Payer: WPS Commercial |
$413.31
|
|
|
XR Foot Complete Bilateral
|
Facility
IP
|
$1,032.00
|
|
|
Service Code
|
CPT 73630
|
| Hospital Charge Code |
630552
|
| Min. Negotiated Rate |
$505.68 |
| Max. Negotiated Rate |
$949.44 |
| Rate for Payer: Aetna Commercial |
$928.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$546.96
|
| Rate for Payer: Cash Price |
$309.60
|
| Rate for Payer: Cigna Commercial |
$949.44
|
| Rate for Payer: Health EOS Commercial |
$918.48
|
| Rate for Payer: HFN Commercial |
$949.44
|
| Rate for Payer: Multiplan Commercial |
$825.60
|
| Rate for Payer: NAPHCARE Commercial |
$619.20
|
| Rate for Payer: Preferred Network Access Commercial |
$949.44
|
| Rate for Payer: Quartz Beloit One Network |
$505.68
|
| Rate for Payer: Quartz Commercial |
$619.20
|
| Rate for Payer: WEA Trust Commercial |
$567.60
|
| Rate for Payer: WPS Commercial |
$764.40
|
|
