|
XR Pod Calcaneous Bilat
|
Facility
IP
|
$868.00
|
|
|
Service Code
|
CPT 73650
|
| Hospital Charge Code |
3242198
|
| Min. Negotiated Rate |
$425.32 |
| Max. Negotiated Rate |
$798.56 |
| Rate for Payer: Aetna Commercial |
$781.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$460.04
|
| Rate for Payer: Cash Price |
$260.40
|
| Rate for Payer: Cigna Commercial |
$798.56
|
| Rate for Payer: Health EOS Commercial |
$772.52
|
| Rate for Payer: HFN Commercial |
$798.56
|
| Rate for Payer: Multiplan Commercial |
$694.40
|
| Rate for Payer: NAPHCARE Commercial |
$520.80
|
| Rate for Payer: Preferred Network Access Commercial |
$798.56
|
| Rate for Payer: Quartz Beloit One Network |
$425.32
|
| Rate for Payer: Quartz Commercial |
$520.80
|
| Rate for Payer: WEA Trust Commercial |
$477.40
|
| Rate for Payer: WPS Commercial |
$642.93
|
|
|
XR Pod Calcaneous Left
|
Professional
|
$434.00
|
|
|
Service Code
|
CPT 73650
|
| Hospital Charge Code |
3242196
|
| Min. Negotiated Rate |
$27.53 |
| Max. Negotiated Rate |
$412.30 |
| Rate for Payer: Aetna Commercial |
$412.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$373.24
|
| Rate for Payer: Aetna Managed Medicare |
$27.53
|
| Rate for Payer: Anthem Medicare Advantage |
$27.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$27.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$27.53
|
| Rate for Payer: Cash Price |
$130.20
|
| Rate for Payer: Cash Price |
$130.20
|
| Rate for Payer: Cigna Commercial |
$412.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$217.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$27.53
|
| Rate for Payer: Health EOS Commercial |
$394.94
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$97.00
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$97.00
|
| Rate for Payer: Independent Care Health Plan Medicare |
$27.53
|
| Rate for Payer: Multiplan Commercial |
$347.20
|
| Rate for Payer: Preferred Network Access Commercial |
$412.30
|
| Rate for Payer: Quartz Beloit One Network |
$190.96
|
| Rate for Payer: Quartz Commercial |
$247.38
|
| Rate for Payer: Quartz Medicare Advantage |
$27.53
|
| Rate for Payer: The Alliance Commercial |
$104.61
|
| Rate for Payer: United Healthcare Medicare Advantage |
$27.53
|
| Rate for Payer: WEA Trust Commercial |
$238.70
|
| Rate for Payer: WPS Commercial |
$137.65
|
|
|
XR Pod Calcaneous Left
|
Facility
OP
|
$434.00
|
|
|
Service Code
|
CPT 73650
|
| Hospital Charge Code |
3242196
|
| Min. Negotiated Rate |
$89.82 |
| Max. Negotiated Rate |
$766.08 |
| Rate for Payer: Aetna Commercial |
$390.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$373.24
|
| Rate for Payer: Aetna Managed Medicare |
$89.82
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$282.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$217.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$208.32
|
| Rate for Payer: Anthem Medicare Advantage |
$89.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$230.02
|
| 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 |
$130.20
|
| Rate for Payer: Cash Price |
$130.20
|
| Rate for Payer: Cigna Commercial |
$399.28
|
| 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 |
$386.26
|
| Rate for Payer: HFN Commercial |
$399.28
|
| 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 |
$347.20
|
| Rate for Payer: NAPHCARE Commercial |
$134.73
|
| Rate for Payer: Preferred Network Access Commercial |
$399.28
|
| Rate for Payer: Quartz Beloit One Network |
$212.66
|
| Rate for Payer: Quartz Commercial |
$282.10
|
| Rate for Payer: Quartz Medicare Advantage |
$89.82
|
| Rate for Payer: The Alliance Commercial |
$766.08
|
| Rate for Payer: United Healthcare Medicare Advantage |
$89.82
|
| Rate for Payer: WEA Trust Commercial |
$238.70
|
| Rate for Payer: Wellcare Medicare |
$89.82
|
| Rate for Payer: WPS Commercial |
$321.46
|
|
|
XR Pod Calcaneous Left
|
Facility
IP
|
$434.00
|
|
|
Service Code
|
CPT 73650
|
| Hospital Charge Code |
3242196
|
| Min. Negotiated Rate |
$212.66 |
| Max. Negotiated Rate |
$399.28 |
| Rate for Payer: Aetna Commercial |
$390.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$230.02
|
| Rate for Payer: Cash Price |
$130.20
|
| Rate for Payer: Cigna Commercial |
$399.28
|
| Rate for Payer: Health EOS Commercial |
$386.26
|
| Rate for Payer: HFN Commercial |
$399.28
|
| Rate for Payer: Multiplan Commercial |
$347.20
|
| Rate for Payer: NAPHCARE Commercial |
$260.40
|
| Rate for Payer: Preferred Network Access Commercial |
$399.28
|
| Rate for Payer: Quartz Beloit One Network |
$212.66
|
| Rate for Payer: Quartz Commercial |
$260.40
|
| Rate for Payer: WEA Trust Commercial |
$238.70
|
| Rate for Payer: WPS Commercial |
$321.46
|
|
|
XR Pod Calcaneous Right
|
Facility
OP
|
$434.00
|
|
|
Service Code
|
CPT 73650
|
| Hospital Charge Code |
3242197
|
| Min. Negotiated Rate |
$89.82 |
| Max. Negotiated Rate |
$766.08 |
| Rate for Payer: Aetna Commercial |
$390.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$373.24
|
| Rate for Payer: Aetna Managed Medicare |
$89.82
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$282.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$217.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$208.32
|
| Rate for Payer: Anthem Medicare Advantage |
$89.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$230.02
|
| 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 |
$130.20
|
| Rate for Payer: Cash Price |
$130.20
|
| Rate for Payer: Cigna Commercial |
$399.28
|
| 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 |
$386.26
|
| Rate for Payer: HFN Commercial |
$399.28
|
| 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 |
$347.20
|
| Rate for Payer: NAPHCARE Commercial |
$134.73
|
| Rate for Payer: Preferred Network Access Commercial |
$399.28
|
| Rate for Payer: Quartz Beloit One Network |
$212.66
|
| Rate for Payer: Quartz Commercial |
$282.10
|
| Rate for Payer: Quartz Medicare Advantage |
$89.82
|
| Rate for Payer: The Alliance Commercial |
$766.08
|
| Rate for Payer: United Healthcare Medicare Advantage |
$89.82
|
| Rate for Payer: WEA Trust Commercial |
$238.70
|
| Rate for Payer: Wellcare Medicare |
$89.82
|
| Rate for Payer: WPS Commercial |
$321.46
|
|
|
XR Pod Calcaneous Right
|
Facility
IP
|
$434.00
|
|
|
Service Code
|
CPT 73650
|
| Hospital Charge Code |
3242197
|
| Min. Negotiated Rate |
$212.66 |
| Max. Negotiated Rate |
$399.28 |
| Rate for Payer: Aetna Commercial |
$390.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$230.02
|
| Rate for Payer: Cash Price |
$130.20
|
| Rate for Payer: Cigna Commercial |
$399.28
|
| Rate for Payer: Health EOS Commercial |
$386.26
|
| Rate for Payer: HFN Commercial |
$399.28
|
| Rate for Payer: Multiplan Commercial |
$347.20
|
| Rate for Payer: NAPHCARE Commercial |
$260.40
|
| Rate for Payer: Preferred Network Access Commercial |
$399.28
|
| Rate for Payer: Quartz Beloit One Network |
$212.66
|
| Rate for Payer: Quartz Commercial |
$260.40
|
| Rate for Payer: WEA Trust Commercial |
$238.70
|
| Rate for Payer: WPS Commercial |
$321.46
|
|
|
XR Pod Calcaneous Right
|
Professional
|
$434.00
|
|
|
Service Code
|
CPT 73650
|
| Hospital Charge Code |
3242197
|
| Min. Negotiated Rate |
$27.53 |
| Max. Negotiated Rate |
$412.30 |
| Rate for Payer: Aetna Commercial |
$412.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$373.24
|
| Rate for Payer: Aetna Managed Medicare |
$27.53
|
| Rate for Payer: Anthem Medicare Advantage |
$27.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$27.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$27.53
|
| Rate for Payer: Cash Price |
$130.20
|
| Rate for Payer: Cash Price |
$130.20
|
| Rate for Payer: Cigna Commercial |
$412.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$217.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$27.53
|
| Rate for Payer: Health EOS Commercial |
$394.94
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$97.00
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$97.00
|
| Rate for Payer: Independent Care Health Plan Medicare |
$27.53
|
| Rate for Payer: Multiplan Commercial |
$347.20
|
| Rate for Payer: Preferred Network Access Commercial |
$412.30
|
| Rate for Payer: Quartz Beloit One Network |
$190.96
|
| Rate for Payer: Quartz Commercial |
$247.38
|
| Rate for Payer: Quartz Medicare Advantage |
$27.53
|
| Rate for Payer: The Alliance Commercial |
$104.61
|
| Rate for Payer: United Healthcare Medicare Advantage |
$27.53
|
| Rate for Payer: WEA Trust Commercial |
$238.70
|
| Rate for Payer: WPS Commercial |
$137.65
|
|
|
XR Pod Foot 2 Views Bilateral
|
Facility
OP
|
$468.00
|
|
|
Service Code
|
CPT 73620 LT
|
| Hospital Charge Code |
2587271
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$131.04 |
| Max. Negotiated Rate |
$1,872.00 |
| Rate for Payer: Aetna Commercial |
$421.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$402.48
|
| Rate for Payer: Aetna Managed Medicare |
$131.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$304.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$234.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$224.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$248.04
|
| Rate for Payer: Cash Price |
$140.40
|
| Rate for Payer: Cash Price |
$140.40
|
| Rate for Payer: Cash Price |
$140.40
|
| Rate for Payer: Cigna Commercial |
$430.56
|
| Rate for Payer: Health EOS Commercial |
$416.52
|
| Rate for Payer: HFN Commercial |
$430.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$351.00
|
| Rate for Payer: Multiplan Commercial |
$374.40
|
| Rate for Payer: NAPHCARE Commercial |
$280.80
|
| Rate for Payer: Preferred Network Access Commercial |
$430.56
|
| Rate for Payer: Quartz Beloit One Network |
$229.32
|
| Rate for Payer: Quartz Commercial |
$304.20
|
| Rate for Payer: Quartz Medicare Advantage |
$280.80
|
| Rate for Payer: The Alliance Commercial |
$1,872.00
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$257.40
|
| Rate for Payer: WPS Commercial |
$346.65
|
|
|
XR Pod Foot 2 Views Bilateral
|
Professional
|
$468.00
|
|
|
Service Code
|
CPT 73620 LT
|
| Hospital Charge Code |
2587271
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$205.92 |
| Max. Negotiated Rate |
$444.60 |
| Rate for Payer: Aetna Commercial |
$444.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$402.48
|
| Rate for Payer: Cash Price |
$140.40
|
| Rate for Payer: Cash Price |
$140.40
|
| Rate for Payer: Cigna Commercial |
$444.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$234.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$280.80
|
| Rate for Payer: Health EOS Commercial |
$425.88
|
| Rate for Payer: Multiplan Commercial |
$374.40
|
| Rate for Payer: Preferred Network Access Commercial |
$444.60
|
| Rate for Payer: Quartz Beloit One Network |
$205.92
|
| Rate for Payer: Quartz Commercial |
$266.76
|
| Rate for Payer: The Alliance Commercial |
$234.00
|
| Rate for Payer: WEA Trust Commercial |
$257.40
|
| Rate for Payer: WPS Commercial |
$346.65
|
|
|
XR Pod Foot 2 Views Bilateral
|
Professional
|
$901.00
|
|
|
Service Code
|
CPT 73620
|
| Hospital Charge Code |
2448827
|
| 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 Pod Foot 2 Views Bilateral
|
Facility
OP
|
$901.00
|
|
|
Service Code
|
CPT 73620
|
| Hospital Charge Code |
2448827
|
| 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 Pod Foot 2 Views Bilateral
|
Facility
IP
|
$901.00
|
|
|
Service Code
|
CPT 73620
|
| Hospital Charge Code |
2448827
|
| 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 Pod Foot 2 Views Bilateral
|
Facility
IP
|
$468.00
|
|
|
Service Code
|
CPT 73620 LT
|
| Hospital Charge Code |
2587271
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$229.32 |
| Max. Negotiated Rate |
$430.56 |
| Rate for Payer: Aetna Commercial |
$421.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$248.04
|
| Rate for Payer: Cash Price |
$140.40
|
| Rate for Payer: Cigna Commercial |
$430.56
|
| Rate for Payer: Health EOS Commercial |
$416.52
|
| Rate for Payer: HFN Commercial |
$430.56
|
| Rate for Payer: Multiplan Commercial |
$374.40
|
| Rate for Payer: NAPHCARE Commercial |
$280.80
|
| Rate for Payer: Preferred Network Access Commercial |
$430.56
|
| Rate for Payer: Quartz Beloit One Network |
$229.32
|
| Rate for Payer: Quartz Commercial |
$280.80
|
| Rate for Payer: WEA Trust Commercial |
$257.40
|
| Rate for Payer: WPS Commercial |
$346.65
|
|
|
XR Pod Foot 2 Views Left
|
Professional
|
$450.00
|
|
|
Service Code
|
CPT 73620
|
| Hospital Charge Code |
2448828
|
| 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 Pod Foot 2 Views Left
|
Facility
OP
|
$450.00
|
|
|
Service Code
|
CPT 73620
|
| Hospital Charge Code |
2448828
|
| 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 Pod Foot 2 Views Left
|
Facility
IP
|
$450.00
|
|
|
Service Code
|
CPT 73620
|
| Hospital Charge Code |
2448828
|
| 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 Pod Foot 2 Views Left
|
Professional
|
$486.00
|
|
|
Service Code
|
CPT 73620 LT
|
| Hospital Charge Code |
2587274
|
|
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 Pod Foot 2 Views Left
|
Facility
OP
|
$486.00
|
|
|
Service Code
|
CPT 73620 LT
|
| Hospital Charge Code |
2587274
|
|
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 Pod Foot 2 Views Left
|
Facility
IP
|
$486.00
|
|
|
Service Code
|
CPT 73620 LT
|
| Hospital Charge Code |
2587274
|
|
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 Pod Foot 2 Views Right
|
Professional
|
$450.00
|
|
|
Service Code
|
CPT 73620
|
| Hospital Charge Code |
2448829
|
| 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 Pod Foot 2 Views Right
|
Facility
IP
|
$486.00
|
|
|
Service Code
|
CPT 73620 RT
|
| Hospital Charge Code |
2587277
|
|
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 Pod Foot 2 Views Right
|
Facility
OP
|
$450.00
|
|
|
Service Code
|
CPT 73620
|
| Hospital Charge Code |
2448829
|
| 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 Pod Foot 2 Views Right
|
Facility
IP
|
$450.00
|
|
|
Service Code
|
CPT 73620
|
| Hospital Charge Code |
2448829
|
| 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 Pod Foot 2 Views Right
|
Facility
OP
|
$468.00
|
|
|
Service Code
|
CPT 73620 TC,RT
|
| Hospital Charge Code |
2980066
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$131.04 |
| Max. Negotiated Rate |
$1,872.00 |
| Rate for Payer: Aetna Commercial |
$421.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$402.48
|
| Rate for Payer: Aetna Managed Medicare |
$131.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$304.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$234.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$224.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$248.04
|
| Rate for Payer: Cash Price |
$140.40
|
| Rate for Payer: Cash Price |
$140.40
|
| Rate for Payer: Cash Price |
$140.40
|
| Rate for Payer: Cigna Commercial |
$430.56
|
| Rate for Payer: Health EOS Commercial |
$416.52
|
| Rate for Payer: HFN Commercial |
$430.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$351.00
|
| Rate for Payer: Multiplan Commercial |
$374.40
|
| Rate for Payer: NAPHCARE Commercial |
$280.80
|
| Rate for Payer: Preferred Network Access Commercial |
$430.56
|
| Rate for Payer: Quartz Beloit One Network |
$229.32
|
| Rate for Payer: Quartz Commercial |
$304.20
|
| Rate for Payer: Quartz Medicare Advantage |
$280.80
|
| Rate for Payer: The Alliance Commercial |
$1,872.00
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$257.40
|
| Rate for Payer: WPS Commercial |
$346.65
|
|
|
XR Pod Foot 2 Views Right
|
Facility
IP
|
$468.00
|
|
|
Service Code
|
CPT 73620 TC,RT
|
| Hospital Charge Code |
2980066
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$229.32 |
| Max. Negotiated Rate |
$430.56 |
| Rate for Payer: Aetna Commercial |
$421.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$248.04
|
| Rate for Payer: Cash Price |
$140.40
|
| Rate for Payer: Cigna Commercial |
$430.56
|
| Rate for Payer: Health EOS Commercial |
$416.52
|
| Rate for Payer: HFN Commercial |
$430.56
|
| Rate for Payer: Multiplan Commercial |
$374.40
|
| Rate for Payer: NAPHCARE Commercial |
$280.80
|
| Rate for Payer: Preferred Network Access Commercial |
$430.56
|
| Rate for Payer: Quartz Beloit One Network |
$229.32
|
| Rate for Payer: Quartz Commercial |
$280.80
|
| Rate for Payer: WEA Trust Commercial |
$257.40
|
| Rate for Payer: WPS Commercial |
$346.65
|
|
