|
XR Bone Survey Infant
|
Facility
|
IP
|
$669.00
|
|
|
Service Code
|
CPT 77076
|
| Hospital Charge Code |
627660
|
| Min. Negotiated Rate |
$340.92 |
| Max. Negotiated Rate |
$640.10 |
| Rate for Payer: Aetna Commercial |
$626.18
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$598.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$368.75
|
| Rate for Payer: Cash Price |
$200.70
|
| Rate for Payer: Cigna Commercial |
$640.10
|
| Rate for Payer: Health EOS Commercial |
$619.23
|
| Rate for Payer: HFN Commercial |
$640.10
|
| Rate for Payer: Multiplan Commercial |
$556.61
|
| Rate for Payer: Preferred Network Access Commercial |
$640.10
|
| Rate for Payer: Quartz Beloit One Network |
$340.92
|
| Rate for Payer: Quartz Commercial |
$417.46
|
| Rate for Payer: WEA Trust Commercial |
$382.67
|
| Rate for Payer: WPS Commercial |
$515.33
|
|
|
XR Bone Survey Infant
|
Facility
|
OP
|
$669.00
|
|
|
Service Code
|
CPT 77076
|
| Hospital Charge Code |
627660
|
| Min. Negotiated Rate |
$110.02 |
| Max. Negotiated Rate |
$640.10 |
| Rate for Payer: Aetna Commercial |
$626.18
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$598.35
|
| Rate for Payer: Aetna Managed Medicare |
$110.02
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$452.24
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$347.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$333.96
|
| Rate for Payer: Anthem Medicare Advantage |
$110.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$368.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$110.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$110.02
|
| Rate for Payer: Cash Price |
$200.70
|
| Rate for Payer: Cash Price |
$200.70
|
| Rate for Payer: Cigna Commercial |
$640.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$110.02
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$389.36
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$110.02
|
| Rate for Payer: Health EOS Commercial |
$619.23
|
| Rate for Payer: HFN Commercial |
$640.10
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$409.28
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$110.02
|
| Rate for Payer: Independent Care Health Plan Medicare |
$110.02
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$110.02
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$110.02
|
| Rate for Payer: Multiplan Commercial |
$556.61
|
| Rate for Payer: NAPHCARE Commercial |
$165.03
|
| Rate for Payer: Preferred Network Access Commercial |
$640.10
|
| Rate for Payer: Quartz Beloit One Network |
$340.92
|
| Rate for Payer: Quartz Commercial |
$452.24
|
| Rate for Payer: Quartz Medicare Advantage |
$110.02
|
| Rate for Payer: The Alliance Commercial |
$440.09
|
| Rate for Payer: United Healthcare Medicare Advantage |
$110.02
|
| Rate for Payer: WEA Trust Commercial |
$382.67
|
| Rate for Payer: Wellcare Medicare |
$110.02
|
| Rate for Payer: WPS Commercial |
$515.33
|
|
|
XR Bone Survey Infant
|
Facility
|
OP
|
$696.00
|
|
|
Service Code
|
CPT 77076 TC
|
| Hospital Charge Code |
1536897
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$202.68 |
| Max. Negotiated Rate |
$665.93 |
| Rate for Payer: Aetna Commercial |
$651.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$622.50
|
| Rate for Payer: Aetna Managed Medicare |
$202.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$423.81
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$339.05
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$322.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$383.64
|
| Rate for Payer: Cash Price |
$208.80
|
| Rate for Payer: Cash Price |
$208.80
|
| Rate for Payer: Cash Price |
$208.80
|
| Rate for Payer: Cigna Commercial |
$665.93
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$405.07
|
| Rate for Payer: Health EOS Commercial |
$644.22
|
| Rate for Payer: HFN Commercial |
$665.93
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$542.88
|
| Rate for Payer: Multiplan Commercial |
$579.07
|
| Rate for Payer: NAPHCARE Commercial |
$434.30
|
| Rate for Payer: Preferred Network Access Commercial |
$665.93
|
| Rate for Payer: Quartz Beloit One Network |
$354.68
|
| Rate for Payer: Quartz Commercial |
$470.50
|
| Rate for Payer: Quartz Medicare Advantage |
$434.30
|
| Rate for Payer: The Alliance Commercial |
$287.04
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$398.11
|
| Rate for Payer: WPS Commercial |
$536.13
|
|
|
XR Bone Survey Infant
|
Facility
|
IP
|
$696.00
|
|
|
Service Code
|
CPT 77076 TC
|
| Hospital Charge Code |
1536897
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$354.68 |
| Max. Negotiated Rate |
$665.93 |
| Rate for Payer: Aetna Commercial |
$651.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$622.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$383.64
|
| Rate for Payer: Cash Price |
$208.80
|
| Rate for Payer: Cigna Commercial |
$665.93
|
| Rate for Payer: Health EOS Commercial |
$644.22
|
| Rate for Payer: HFN Commercial |
$665.93
|
| Rate for Payer: Multiplan Commercial |
$579.07
|
| Rate for Payer: Preferred Network Access Commercial |
$665.93
|
| Rate for Payer: Quartz Beloit One Network |
$354.68
|
| Rate for Payer: Quartz Commercial |
$434.30
|
| Rate for Payer: WEA Trust Commercial |
$398.11
|
| Rate for Payer: WPS Commercial |
$536.13
|
|
|
XR Bone Survey Infant
|
Professional
|
Both
|
$669.00
|
|
|
Service Code
|
CPT 77076
|
| Hospital Charge Code |
627660
|
| Min. Negotiated Rate |
$104.14 |
| Max. Negotiated Rate |
$660.97 |
| Rate for Payer: Aetna Commercial |
$660.97
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$598.35
|
| Rate for Payer: Aetna Managed Medicare |
$104.14
|
| Rate for Payer: Anthem Medicare Advantage |
$104.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$104.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$104.14
|
| Rate for Payer: Cash Price |
$200.70
|
| Rate for Payer: Cash Price |
$200.70
|
| Rate for Payer: Cash Price |
$200.70
|
| Rate for Payer: Cigna Commercial |
$660.97
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$347.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$104.14
|
| Rate for Payer: Health EOS Commercial |
$633.14
|
| Rate for Payer: HFN Commercial |
$660.97
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$376.33
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$376.33
|
| Rate for Payer: Independent Care Health Plan Medicare |
$104.14
|
| Rate for Payer: Multiplan Commercial |
$556.61
|
| Rate for Payer: NAPHCARE Commercial |
$156.20
|
| Rate for Payer: Preferred Network Access Commercial |
$660.97
|
| Rate for Payer: Quartz Beloit One Network |
$306.13
|
| Rate for Payer: Quartz Commercial |
$396.58
|
| Rate for Payer: Quartz Medicare Advantage |
$104.14
|
| Rate for Payer: The Alliance Commercial |
$395.71
|
| Rate for Payer: United Healthcare Medicare Advantage |
$104.14
|
| Rate for Payer: WEA Trust Commercial |
$382.67
|
| Rate for Payer: WPS Commercial |
$520.68
|
|
|
XR Bone Survey Limited (Mets)
|
Facility
|
IP
|
$1,155.00
|
|
|
Service Code
|
CPT 77074 TC
|
| Hospital Charge Code |
1536899
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$588.59 |
| Max. Negotiated Rate |
$1,105.10 |
| Rate for Payer: Aetna Commercial |
$1,081.08
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,033.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$636.64
|
| Rate for Payer: Cash Price |
$346.50
|
| Rate for Payer: Cigna Commercial |
$1,105.10
|
| Rate for Payer: Health EOS Commercial |
$1,069.07
|
| Rate for Payer: HFN Commercial |
$1,105.10
|
| Rate for Payer: Multiplan Commercial |
$960.96
|
| Rate for Payer: Preferred Network Access Commercial |
$1,105.10
|
| Rate for Payer: Quartz Beloit One Network |
$588.59
|
| Rate for Payer: Quartz Commercial |
$720.72
|
| Rate for Payer: WEA Trust Commercial |
$660.66
|
| Rate for Payer: WPS Commercial |
$889.70
|
|
|
XR Bone Survey Limited (Mets)
|
Facility
|
OP
|
$1,070.00
|
|
|
Service Code
|
CPT 77074
|
| Hospital Charge Code |
627662
|
| Min. Negotiated Rate |
$110.02 |
| Max. Negotiated Rate |
$1,023.78 |
| Rate for Payer: Aetna Commercial |
$1,001.52
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$957.01
|
| Rate for Payer: Aetna Managed Medicare |
$110.02
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$723.32
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$556.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$534.14
|
| Rate for Payer: Anthem Medicare Advantage |
$110.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$589.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$110.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$110.02
|
| Rate for Payer: Cash Price |
$321.00
|
| Rate for Payer: Cash Price |
$321.00
|
| Rate for Payer: Cigna Commercial |
$1,023.78
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$110.02
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$622.74
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$110.02
|
| Rate for Payer: Health EOS Commercial |
$990.39
|
| Rate for Payer: HFN Commercial |
$1,023.78
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$409.28
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$110.02
|
| Rate for Payer: Independent Care Health Plan Medicare |
$110.02
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$110.02
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$110.02
|
| Rate for Payer: Multiplan Commercial |
$890.24
|
| Rate for Payer: NAPHCARE Commercial |
$165.03
|
| Rate for Payer: Preferred Network Access Commercial |
$1,023.78
|
| Rate for Payer: Quartz Beloit One Network |
$545.27
|
| Rate for Payer: Quartz Commercial |
$723.32
|
| Rate for Payer: Quartz Medicare Advantage |
$110.02
|
| Rate for Payer: The Alliance Commercial |
$440.09
|
| Rate for Payer: United Healthcare Medicare Advantage |
$110.02
|
| Rate for Payer: WEA Trust Commercial |
$612.04
|
| Rate for Payer: Wellcare Medicare |
$110.02
|
| Rate for Payer: WPS Commercial |
$824.22
|
|
|
XR Bone Survey Limited (Mets)
|
Professional
|
Both
|
$1,155.00
|
|
|
Service Code
|
CPT 77074 TC
|
| Hospital Charge Code |
1536899
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$43.70 |
| Max. Negotiated Rate |
$1,141.14 |
| Rate for Payer: Aetna Commercial |
$1,141.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,033.03
|
| Rate for Payer: Aetna Managed Medicare |
$43.70
|
| Rate for Payer: Anthem Medicare Advantage |
$43.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$43.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$43.70
|
| Rate for Payer: Cash Price |
$346.50
|
| Rate for Payer: Cash Price |
$346.50
|
| Rate for Payer: Cash Price |
$346.50
|
| Rate for Payer: Cigna Commercial |
$1,141.14
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$600.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$43.70
|
| Rate for Payer: Health EOS Commercial |
$1,093.09
|
| Rate for Payer: HFN Commercial |
$1,141.14
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$153.64
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$153.64
|
| Rate for Payer: Independent Care Health Plan Medicare |
$43.70
|
| Rate for Payer: Multiplan Commercial |
$960.96
|
| Rate for Payer: NAPHCARE Commercial |
$65.55
|
| Rate for Payer: Preferred Network Access Commercial |
$1,141.14
|
| Rate for Payer: Quartz Beloit One Network |
$528.53
|
| Rate for Payer: Quartz Commercial |
$684.68
|
| Rate for Payer: Quartz Medicare Advantage |
$43.70
|
| Rate for Payer: The Alliance Commercial |
$166.06
|
| Rate for Payer: United Healthcare Medicare Advantage |
$43.70
|
| Rate for Payer: WEA Trust Commercial |
$660.66
|
| Rate for Payer: WPS Commercial |
$218.50
|
|
|
XR Bone Survey Limited (Mets)
|
Facility
|
IP
|
$1,070.00
|
|
|
Service Code
|
CPT 77074
|
| Hospital Charge Code |
627662
|
| Min. Negotiated Rate |
$545.27 |
| Max. Negotiated Rate |
$1,023.78 |
| Rate for Payer: Aetna Commercial |
$1,001.52
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$957.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$589.78
|
| Rate for Payer: Cash Price |
$321.00
|
| Rate for Payer: Cigna Commercial |
$1,023.78
|
| Rate for Payer: Health EOS Commercial |
$990.39
|
| Rate for Payer: HFN Commercial |
$1,023.78
|
| Rate for Payer: Multiplan Commercial |
$890.24
|
| Rate for Payer: Preferred Network Access Commercial |
$1,023.78
|
| Rate for Payer: Quartz Beloit One Network |
$545.27
|
| Rate for Payer: Quartz Commercial |
$667.68
|
| Rate for Payer: WEA Trust Commercial |
$612.04
|
| Rate for Payer: WPS Commercial |
$824.22
|
|
|
XR Bone Survey Limited (Mets)
|
Facility
|
OP
|
$1,155.00
|
|
|
Service Code
|
CPT 77074 TC
|
| Hospital Charge Code |
1536899
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$174.80 |
| Max. Negotiated Rate |
$1,105.10 |
| Rate for Payer: Aetna Commercial |
$1,081.08
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,033.03
|
| Rate for Payer: Aetna Managed Medicare |
$336.34
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$423.81
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$339.05
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$322.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$636.64
|
| Rate for Payer: Cash Price |
$346.50
|
| Rate for Payer: Cash Price |
$346.50
|
| Rate for Payer: Cash Price |
$346.50
|
| Rate for Payer: Cigna Commercial |
$1,105.10
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$672.21
|
| Rate for Payer: Health EOS Commercial |
$1,069.07
|
| Rate for Payer: HFN Commercial |
$1,105.10
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$900.90
|
| Rate for Payer: Multiplan Commercial |
$960.96
|
| Rate for Payer: NAPHCARE Commercial |
$720.72
|
| Rate for Payer: Preferred Network Access Commercial |
$1,105.10
|
| Rate for Payer: Quartz Beloit One Network |
$588.59
|
| Rate for Payer: Quartz Commercial |
$780.78
|
| Rate for Payer: Quartz Medicare Advantage |
$720.72
|
| Rate for Payer: The Alliance Commercial |
$174.80
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$660.66
|
| Rate for Payer: WPS Commercial |
$889.70
|
|
|
XR Bone Survey Limited (Mets)
|
Professional
|
Both
|
$1,070.00
|
|
|
Service Code
|
CPT 77074
|
| Hospital Charge Code |
627662
|
| Min. Negotiated Rate |
$64.28 |
| Max. Negotiated Rate |
$1,057.16 |
| Rate for Payer: Aetna Commercial |
$1,057.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$957.01
|
| Rate for Payer: Aetna Managed Medicare |
$64.28
|
| Rate for Payer: Anthem Medicare Advantage |
$64.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$64.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$64.28
|
| Rate for Payer: Cash Price |
$321.00
|
| Rate for Payer: Cash Price |
$321.00
|
| Rate for Payer: Cash Price |
$321.00
|
| Rate for Payer: Cigna Commercial |
$1,057.16
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$556.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$64.28
|
| Rate for Payer: Health EOS Commercial |
$1,012.65
|
| Rate for Payer: HFN Commercial |
$1,057.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$230.08
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$230.08
|
| Rate for Payer: Independent Care Health Plan Medicare |
$64.28
|
| Rate for Payer: Multiplan Commercial |
$890.24
|
| Rate for Payer: NAPHCARE Commercial |
$96.42
|
| Rate for Payer: Preferred Network Access Commercial |
$1,057.16
|
| Rate for Payer: Quartz Beloit One Network |
$489.63
|
| Rate for Payer: Quartz Commercial |
$634.30
|
| Rate for Payer: Quartz Medicare Advantage |
$64.28
|
| Rate for Payer: The Alliance Commercial |
$244.27
|
| Rate for Payer: United Healthcare Medicare Advantage |
$64.28
|
| Rate for Payer: WEA Trust Commercial |
$612.04
|
| Rate for Payer: WPS Commercial |
$321.41
|
|
|
XR Calcaneous Bilateral
|
Facility
|
IP
|
$316.00
|
|
|
Service Code
|
CPT 73650 LT,TC
|
| Hospital Charge Code |
1536907
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$161.03 |
| Max. Negotiated Rate |
$302.35 |
| Rate for Payer: Aetna Commercial |
$295.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$282.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$174.18
|
| Rate for Payer: Cash Price |
$94.80
|
| Rate for Payer: Cigna Commercial |
$302.35
|
| Rate for Payer: Health EOS Commercial |
$292.49
|
| Rate for Payer: HFN Commercial |
$302.35
|
| Rate for Payer: Multiplan Commercial |
$262.91
|
| Rate for Payer: Preferred Network Access Commercial |
$302.35
|
| Rate for Payer: Quartz Beloit One Network |
$161.03
|
| Rate for Payer: Quartz Commercial |
$197.18
|
| Rate for Payer: WEA Trust Commercial |
$180.75
|
| Rate for Payer: WPS Commercial |
$243.41
|
|
|
XR Calcaneous Bilateral
|
Professional
|
Both
|
$316.00
|
|
|
Service Code
|
CPT 73650 LT,TC
|
| Hospital Charge Code |
1536907
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$100.88 |
| Max. Negotiated Rate |
$312.21 |
| Rate for Payer: Aetna Commercial |
$312.21
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$282.63
|
| Rate for Payer: Cash Price |
$94.80
|
| Rate for Payer: Cash Price |
$94.80
|
| Rate for Payer: Cash Price |
$94.80
|
| Rate for Payer: Cigna Commercial |
$312.21
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$164.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$197.18
|
| Rate for Payer: Health EOS Commercial |
$299.06
|
| Rate for Payer: HFN Commercial |
$312.21
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$100.88
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$100.88
|
| Rate for Payer: Multiplan Commercial |
$262.91
|
| Rate for Payer: Preferred Network Access Commercial |
$312.21
|
| Rate for Payer: Quartz Beloit One Network |
$144.60
|
| Rate for Payer: Quartz Commercial |
$187.32
|
| Rate for Payer: The Alliance Commercial |
$164.32
|
| Rate for Payer: WEA Trust Commercial |
$180.75
|
| Rate for Payer: WPS Commercial |
$243.41
|
|
|
XR Calcaneous Bilateral
|
Facility
|
IP
|
$868.00
|
|
|
Service Code
|
CPT 73650
|
| Hospital Charge Code |
629616
|
| Min. Negotiated Rate |
$442.33 |
| Max. Negotiated Rate |
$830.50 |
| Rate for Payer: Aetna Commercial |
$812.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$776.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$478.44
|
| Rate for Payer: Cash Price |
$260.40
|
| Rate for Payer: Cigna Commercial |
$830.50
|
| Rate for Payer: Health EOS Commercial |
$803.42
|
| Rate for Payer: HFN Commercial |
$830.50
|
| Rate for Payer: Multiplan Commercial |
$722.18
|
| Rate for Payer: Preferred Network Access Commercial |
$830.50
|
| Rate for Payer: Quartz Beloit One Network |
$442.33
|
| Rate for Payer: Quartz Commercial |
$541.63
|
| Rate for Payer: WEA Trust Commercial |
$496.50
|
| Rate for Payer: WPS Commercial |
$668.62
|
|
|
XR Calcaneous Bilateral
|
Facility
|
OP
|
$868.00
|
|
|
Service Code
|
CPT 73650
|
| Hospital Charge Code |
629616
|
| Min. Negotiated Rate |
$91.58 |
| Max. Negotiated Rate |
$830.50 |
| Rate for Payer: Aetna Commercial |
$812.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$776.34
|
| Rate for Payer: Aetna Managed Medicare |
$91.58
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$586.77
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$451.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$433.31
|
| Rate for Payer: Anthem Medicare Advantage |
$91.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$478.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$91.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$91.58
|
| Rate for Payer: Cash Price |
$260.40
|
| Rate for Payer: Cash Price |
$260.40
|
| Rate for Payer: Cigna Commercial |
$830.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$91.58
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$505.18
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$91.58
|
| Rate for Payer: Health EOS Commercial |
$803.42
|
| Rate for Payer: HFN Commercial |
$830.50
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$340.69
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$91.58
|
| Rate for Payer: Independent Care Health Plan Medicare |
$91.58
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$91.58
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$91.58
|
| Rate for Payer: Multiplan Commercial |
$722.18
|
| Rate for Payer: NAPHCARE Commercial |
$137.37
|
| Rate for Payer: Preferred Network Access Commercial |
$830.50
|
| Rate for Payer: Quartz Beloit One Network |
$442.33
|
| Rate for Payer: Quartz Commercial |
$586.77
|
| Rate for Payer: Quartz Medicare Advantage |
$91.58
|
| Rate for Payer: The Alliance Commercial |
$366.33
|
| Rate for Payer: United Healthcare Medicare Advantage |
$91.58
|
| Rate for Payer: WEA Trust Commercial |
$496.50
|
| Rate for Payer: Wellcare Medicare |
$91.58
|
| Rate for Payer: WPS Commercial |
$668.62
|
|
|
XR Calcaneous Bilateral
|
Professional
|
Both
|
$868.00
|
|
|
Service Code
|
CPT 73650
|
| Hospital Charge Code |
629616
|
| Min. Negotiated Rate |
$28.07 |
| Max. Negotiated Rate |
$857.58 |
| Rate for Payer: Aetna Commercial |
$857.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$776.34
|
| Rate for Payer: Aetna Managed Medicare |
$28.07
|
| Rate for Payer: Anthem Medicare Advantage |
$28.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$28.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$28.07
|
| Rate for Payer: Cash Price |
$260.40
|
| Rate for Payer: Cash Price |
$260.40
|
| Rate for Payer: Cash Price |
$260.40
|
| Rate for Payer: Cigna Commercial |
$857.58
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$451.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$28.07
|
| Rate for Payer: Health EOS Commercial |
$821.48
|
| Rate for Payer: HFN Commercial |
$857.58
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$100.88
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$100.88
|
| Rate for Payer: Independent Care Health Plan Medicare |
$28.07
|
| Rate for Payer: Multiplan Commercial |
$722.18
|
| Rate for Payer: NAPHCARE Commercial |
$42.10
|
| Rate for Payer: Preferred Network Access Commercial |
$857.58
|
| Rate for Payer: Quartz Beloit One Network |
$397.20
|
| Rate for Payer: Quartz Commercial |
$514.55
|
| Rate for Payer: Quartz Medicare Advantage |
$28.07
|
| Rate for Payer: The Alliance Commercial |
$106.66
|
| Rate for Payer: United Healthcare Medicare Advantage |
$28.07
|
| Rate for Payer: WEA Trust Commercial |
$496.50
|
| Rate for Payer: WPS Commercial |
$140.35
|
|
|
XR Calcaneous Bilateral
|
Facility
|
OP
|
$316.00
|
|
|
Service Code
|
CPT 73650 LT,TC
|
| Hospital Charge Code |
1536907
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$92.02 |
| Max. Negotiated Rate |
$350.30 |
| Rate for Payer: Aetna Commercial |
$295.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$282.63
|
| Rate for Payer: Aetna Managed Medicare |
$92.02
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$350.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$280.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$266.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$174.18
|
| Rate for Payer: Cash Price |
$94.80
|
| Rate for Payer: Cash Price |
$94.80
|
| Rate for Payer: Cash Price |
$94.80
|
| Rate for Payer: Cigna Commercial |
$302.35
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$183.91
|
| Rate for Payer: Health EOS Commercial |
$292.49
|
| Rate for Payer: HFN Commercial |
$302.35
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$246.48
|
| Rate for Payer: Multiplan Commercial |
$262.91
|
| Rate for Payer: NAPHCARE Commercial |
$197.18
|
| Rate for Payer: Preferred Network Access Commercial |
$302.35
|
| Rate for Payer: Quartz Beloit One Network |
$161.03
|
| Rate for Payer: Quartz Commercial |
$213.62
|
| Rate for Payer: Quartz Medicare Advantage |
$197.18
|
| Rate for Payer: The Alliance Commercial |
$164.32
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$180.75
|
| Rate for Payer: WPS Commercial |
$243.41
|
|
|
XR Calcaneous Left
|
Facility
|
IP
|
$316.00
|
|
|
Service Code
|
CPT 73650 LT,TC
|
| Hospital Charge Code |
1536909
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$161.03 |
| Max. Negotiated Rate |
$302.35 |
| Rate for Payer: Aetna Commercial |
$295.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$282.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$174.18
|
| Rate for Payer: Cash Price |
$94.80
|
| Rate for Payer: Cigna Commercial |
$302.35
|
| Rate for Payer: Health EOS Commercial |
$292.49
|
| Rate for Payer: HFN Commercial |
$302.35
|
| Rate for Payer: Multiplan Commercial |
$262.91
|
| Rate for Payer: Preferred Network Access Commercial |
$302.35
|
| Rate for Payer: Quartz Beloit One Network |
$161.03
|
| Rate for Payer: Quartz Commercial |
$197.18
|
| Rate for Payer: WEA Trust Commercial |
$180.75
|
| Rate for Payer: WPS Commercial |
$243.41
|
|
|
XR Calcaneous Left
|
Facility
|
OP
|
$434.00
|
|
|
Service Code
|
CPT 73650
|
| Hospital Charge Code |
629618
|
| Min. Negotiated Rate |
$91.58 |
| Max. Negotiated Rate |
$415.25 |
| Rate for Payer: Aetna Commercial |
$406.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$388.17
|
| Rate for Payer: Aetna Managed Medicare |
$91.58
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$293.38
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$225.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$216.65
|
| Rate for Payer: Anthem Medicare Advantage |
$91.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$239.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$91.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$91.58
|
| Rate for Payer: Cash Price |
$130.20
|
| Rate for Payer: Cash Price |
$130.20
|
| Rate for Payer: Cigna Commercial |
$415.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$91.58
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$252.59
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$91.58
|
| Rate for Payer: Health EOS Commercial |
$401.71
|
| Rate for Payer: HFN Commercial |
$415.25
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$340.69
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$91.58
|
| Rate for Payer: Independent Care Health Plan Medicare |
$91.58
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$91.58
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$91.58
|
| Rate for Payer: Multiplan Commercial |
$361.09
|
| Rate for Payer: NAPHCARE Commercial |
$137.37
|
| Rate for Payer: Preferred Network Access Commercial |
$415.25
|
| Rate for Payer: Quartz Beloit One Network |
$221.17
|
| Rate for Payer: Quartz Commercial |
$293.38
|
| Rate for Payer: Quartz Medicare Advantage |
$91.58
|
| Rate for Payer: The Alliance Commercial |
$366.33
|
| Rate for Payer: United Healthcare Medicare Advantage |
$91.58
|
| Rate for Payer: WEA Trust Commercial |
$248.25
|
| Rate for Payer: Wellcare Medicare |
$91.58
|
| Rate for Payer: WPS Commercial |
$334.31
|
|
|
XR Calcaneous Left
|
Facility
|
OP
|
$316.00
|
|
|
Service Code
|
CPT 73650 LT,TC
|
| Hospital Charge Code |
1536909
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$92.02 |
| Max. Negotiated Rate |
$350.30 |
| Rate for Payer: Aetna Commercial |
$295.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$282.63
|
| Rate for Payer: Aetna Managed Medicare |
$92.02
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$350.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$280.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$266.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$174.18
|
| Rate for Payer: Cash Price |
$94.80
|
| Rate for Payer: Cash Price |
$94.80
|
| Rate for Payer: Cash Price |
$94.80
|
| Rate for Payer: Cigna Commercial |
$302.35
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$183.91
|
| Rate for Payer: Health EOS Commercial |
$292.49
|
| Rate for Payer: HFN Commercial |
$302.35
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$246.48
|
| Rate for Payer: Multiplan Commercial |
$262.91
|
| Rate for Payer: NAPHCARE Commercial |
$197.18
|
| Rate for Payer: Preferred Network Access Commercial |
$302.35
|
| Rate for Payer: Quartz Beloit One Network |
$161.03
|
| Rate for Payer: Quartz Commercial |
$213.62
|
| Rate for Payer: Quartz Medicare Advantage |
$197.18
|
| Rate for Payer: The Alliance Commercial |
$164.32
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$180.75
|
| Rate for Payer: WPS Commercial |
$243.41
|
|
|
XR Calcaneous Left
|
Professional
|
Both
|
$434.00
|
|
|
Service Code
|
CPT 73650
|
| Hospital Charge Code |
629618
|
| Min. Negotiated Rate |
$28.07 |
| Max. Negotiated Rate |
$428.79 |
| Rate for Payer: Aetna Commercial |
$428.79
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$388.17
|
| Rate for Payer: Aetna Managed Medicare |
$28.07
|
| Rate for Payer: Anthem Medicare Advantage |
$28.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$28.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$28.07
|
| Rate for Payer: Cash Price |
$130.20
|
| Rate for Payer: Cash Price |
$130.20
|
| Rate for Payer: Cash Price |
$130.20
|
| Rate for Payer: Cigna Commercial |
$428.79
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$225.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$28.07
|
| Rate for Payer: Health EOS Commercial |
$410.74
|
| Rate for Payer: HFN Commercial |
$428.79
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$100.88
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$100.88
|
| Rate for Payer: Independent Care Health Plan Medicare |
$28.07
|
| Rate for Payer: Multiplan Commercial |
$361.09
|
| Rate for Payer: NAPHCARE Commercial |
$42.10
|
| Rate for Payer: Preferred Network Access Commercial |
$428.79
|
| Rate for Payer: Quartz Beloit One Network |
$198.60
|
| Rate for Payer: Quartz Commercial |
$257.28
|
| Rate for Payer: Quartz Medicare Advantage |
$28.07
|
| Rate for Payer: The Alliance Commercial |
$106.66
|
| Rate for Payer: United Healthcare Medicare Advantage |
$28.07
|
| Rate for Payer: WEA Trust Commercial |
$248.25
|
| Rate for Payer: WPS Commercial |
$140.35
|
|
|
XR Calcaneous Left
|
Professional
|
Both
|
$316.00
|
|
|
Service Code
|
CPT 73650 LT,TC
|
| Hospital Charge Code |
1536909
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$100.88 |
| Max. Negotiated Rate |
$312.21 |
| Rate for Payer: Aetna Commercial |
$312.21
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$282.63
|
| Rate for Payer: Cash Price |
$94.80
|
| Rate for Payer: Cash Price |
$94.80
|
| Rate for Payer: Cash Price |
$94.80
|
| Rate for Payer: Cigna Commercial |
$312.21
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$164.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$197.18
|
| Rate for Payer: Health EOS Commercial |
$299.06
|
| Rate for Payer: HFN Commercial |
$312.21
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$100.88
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$100.88
|
| Rate for Payer: Multiplan Commercial |
$262.91
|
| Rate for Payer: Preferred Network Access Commercial |
$312.21
|
| Rate for Payer: Quartz Beloit One Network |
$144.60
|
| Rate for Payer: Quartz Commercial |
$187.32
|
| Rate for Payer: The Alliance Commercial |
$164.32
|
| Rate for Payer: WEA Trust Commercial |
$180.75
|
| Rate for Payer: WPS Commercial |
$243.41
|
|
|
XR Calcaneous Left
|
Facility
|
IP
|
$434.00
|
|
|
Service Code
|
CPT 73650
|
| Hospital Charge Code |
629618
|
| Min. Negotiated Rate |
$221.17 |
| Max. Negotiated Rate |
$415.25 |
| Rate for Payer: Aetna Commercial |
$406.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$388.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$239.22
|
| Rate for Payer: Cash Price |
$130.20
|
| Rate for Payer: Cigna Commercial |
$415.25
|
| Rate for Payer: Health EOS Commercial |
$401.71
|
| Rate for Payer: HFN Commercial |
$415.25
|
| Rate for Payer: Multiplan Commercial |
$361.09
|
| Rate for Payer: Preferred Network Access Commercial |
$415.25
|
| Rate for Payer: Quartz Beloit One Network |
$221.17
|
| Rate for Payer: Quartz Commercial |
$270.82
|
| Rate for Payer: WEA Trust Commercial |
$248.25
|
| Rate for Payer: WPS Commercial |
$334.31
|
|
|
XR Calcaneous Right
|
Professional
|
Both
|
$316.00
|
|
|
Service Code
|
CPT 73650 TC,RT
|
| Hospital Charge Code |
2980068
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$100.88 |
| Max. Negotiated Rate |
$312.21 |
| Rate for Payer: Aetna Commercial |
$312.21
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$282.63
|
| Rate for Payer: Cash Price |
$94.80
|
| Rate for Payer: Cash Price |
$94.80
|
| Rate for Payer: Cash Price |
$94.80
|
| Rate for Payer: Cigna Commercial |
$312.21
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$164.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$197.18
|
| Rate for Payer: Health EOS Commercial |
$299.06
|
| Rate for Payer: HFN Commercial |
$312.21
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$100.88
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$100.88
|
| Rate for Payer: Multiplan Commercial |
$262.91
|
| Rate for Payer: Preferred Network Access Commercial |
$312.21
|
| Rate for Payer: Quartz Beloit One Network |
$144.60
|
| Rate for Payer: Quartz Commercial |
$187.32
|
| Rate for Payer: The Alliance Commercial |
$164.32
|
| Rate for Payer: WEA Trust Commercial |
$180.75
|
| Rate for Payer: WPS Commercial |
$243.41
|
|
|
XR Calcaneous Right
|
Professional
|
Both
|
$316.00
|
|
|
Service Code
|
CPT 73650 RT,TC
|
| Hospital Charge Code |
1536911
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$100.88 |
| Max. Negotiated Rate |
$312.21 |
| Rate for Payer: Aetna Commercial |
$312.21
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$282.63
|
| Rate for Payer: Cash Price |
$94.80
|
| Rate for Payer: Cash Price |
$94.80
|
| Rate for Payer: Cash Price |
$94.80
|
| Rate for Payer: Cigna Commercial |
$312.21
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$164.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$197.18
|
| Rate for Payer: Health EOS Commercial |
$299.06
|
| Rate for Payer: HFN Commercial |
$312.21
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$100.88
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$100.88
|
| Rate for Payer: Multiplan Commercial |
$262.91
|
| Rate for Payer: Preferred Network Access Commercial |
$312.21
|
| Rate for Payer: Quartz Beloit One Network |
$144.60
|
| Rate for Payer: Quartz Commercial |
$187.32
|
| Rate for Payer: The Alliance Commercial |
$164.32
|
| Rate for Payer: WEA Trust Commercial |
$180.75
|
| Rate for Payer: WPS Commercial |
$243.41
|
|
