|
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
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
|
Professional
|
$486.00
|
|
|
Service Code
|
CPT 73620 RT
|
| Hospital Charge Code |
2587277
|
|
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 Complete Bilateral
|
Facility
IP
|
$558.00
|
|
|
Service Code
|
CPT 73630 LT
|
| Hospital Charge Code |
2587280
|
|
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 Pod Foot Complete Bilateral
|
Facility
OP
|
$558.00
|
|
|
Service Code
|
CPT 73630 LT
|
| Hospital Charge Code |
2587280
|
|
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 Pod Foot Complete Bilateral
|
Professional
|
$558.00
|
|
|
Service Code
|
CPT 73630 LT
|
| Hospital Charge Code |
2587280
|
|
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 Pod Foot Complete Left
|
Facility
OP
|
$516.00
|
|
|
Service Code
|
CPT 73630
|
| Hospital Charge Code |
2448831
|
| Min. Negotiated Rate |
$47.20 |
| Max. Negotiated Rate |
$474.72 |
| Rate for Payer: Aetna Commercial |
$464.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$443.76
|
| Rate for Payer: Aetna Managed Medicare |
$89.82
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$335.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$258.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$247.68
|
| Rate for Payer: Anthem Medicare Advantage |
$89.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$273.48
|
| 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 |
$154.80
|
| Rate for Payer: Cash Price |
$154.80
|
| Rate for Payer: Cigna Commercial |
$474.72
|
| 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 |
$459.24
|
| Rate for Payer: HFN Commercial |
$474.72
|
| 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 |
$412.80
|
| Rate for Payer: NAPHCARE Commercial |
$134.73
|
| Rate for Payer: Preferred Network Access Commercial |
$474.72
|
| Rate for Payer: Quartz Beloit One Network |
$252.84
|
| Rate for Payer: Quartz Commercial |
$335.40
|
| Rate for Payer: Quartz Medicare Advantage |
$89.82
|
| Rate for Payer: The Alliance Commercial |
$47.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$89.82
|
| Rate for Payer: WEA Trust Commercial |
$283.80
|
| Rate for Payer: Wellcare Medicare |
$89.82
|
| Rate for Payer: WPS Commercial |
$382.20
|
|
|
XR Pod Foot Complete Left
|
Facility
IP
|
$558.00
|
|
|
Service Code
|
CPT 73630 LT
|
| Hospital Charge Code |
2587283
|
|
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 Pod Foot Complete Left
|
Professional
|
$516.00
|
|
|
Service Code
|
CPT 73630
|
| Hospital Charge Code |
2448831
|
| Min. Negotiated Rate |
$33.02 |
| Max. Negotiated Rate |
$490.20 |
| Rate for Payer: Aetna Commercial |
$490.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$443.76
|
| 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 |
$154.80
|
| Rate for Payer: Cash Price |
$154.80
|
| Rate for Payer: Cigna Commercial |
$490.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$258.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$33.02
|
| Rate for Payer: Health EOS Commercial |
$469.56
|
| 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 |
$412.80
|
| Rate for Payer: Preferred Network Access Commercial |
$490.20
|
| Rate for Payer: Quartz Beloit One Network |
$227.04
|
| Rate for Payer: Quartz Commercial |
$294.12
|
| 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 |
$283.80
|
| Rate for Payer: WPS Commercial |
$165.10
|
|
|
XR Pod Foot Complete Left
|
Facility
OP
|
$558.00
|
|
|
Service Code
|
CPT 73630 LT
|
| Hospital Charge Code |
2587283
|
|
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 Pod Foot Complete Left
|
Facility
IP
|
$516.00
|
|
|
Service Code
|
CPT 73630
|
| Hospital Charge Code |
2448831
|
| Min. Negotiated Rate |
$252.84 |
| Max. Negotiated Rate |
$474.72 |
| Rate for Payer: Aetna Commercial |
$464.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$273.48
|
| Rate for Payer: Cash Price |
$154.80
|
| Rate for Payer: Cigna Commercial |
$474.72
|
| Rate for Payer: Health EOS Commercial |
$459.24
|
| Rate for Payer: HFN Commercial |
$474.72
|
| Rate for Payer: Multiplan Commercial |
$412.80
|
| Rate for Payer: NAPHCARE Commercial |
$309.60
|
| Rate for Payer: Preferred Network Access Commercial |
$474.72
|
| Rate for Payer: Quartz Beloit One Network |
$252.84
|
| Rate for Payer: Quartz Commercial |
$309.60
|
| Rate for Payer: WEA Trust Commercial |
$283.80
|
| Rate for Payer: WPS Commercial |
$382.20
|
|
|
XR Pod Foot Complete Left
|
Professional
|
$558.00
|
|
|
Service Code
|
CPT 73630 LT
|
| Hospital Charge Code |
2587283
|
|
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 Pod Foot Complete Right
|
Facility
IP
|
$516.00
|
|
|
Service Code
|
CPT 73630
|
| Hospital Charge Code |
2448832
|
| Min. Negotiated Rate |
$252.84 |
| Max. Negotiated Rate |
$474.72 |
| Rate for Payer: Aetna Commercial |
$464.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$273.48
|
| Rate for Payer: Cash Price |
$154.80
|
| Rate for Payer: Cigna Commercial |
$474.72
|
| Rate for Payer: Health EOS Commercial |
$459.24
|
| Rate for Payer: HFN Commercial |
$474.72
|
| Rate for Payer: Multiplan Commercial |
$412.80
|
| Rate for Payer: NAPHCARE Commercial |
$309.60
|
| Rate for Payer: Preferred Network Access Commercial |
$474.72
|
| Rate for Payer: Quartz Beloit One Network |
$252.84
|
| Rate for Payer: Quartz Commercial |
$309.60
|
| Rate for Payer: WEA Trust Commercial |
$283.80
|
| Rate for Payer: WPS Commercial |
$382.20
|
|
|
XR Pod Foot Complete Right
|
Professional
|
$558.00
|
|
|
Service Code
|
CPT 73630 RT
|
| Hospital Charge Code |
2587286
|
|
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 Pod Foot Complete Right
|
Facility
OP
|
$516.00
|
|
|
Service Code
|
CPT 73630
|
| Hospital Charge Code |
2448832
|
| Min. Negotiated Rate |
$47.20 |
| Max. Negotiated Rate |
$474.72 |
| Rate for Payer: Aetna Commercial |
$464.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$443.76
|
| Rate for Payer: Aetna Managed Medicare |
$89.82
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$335.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$258.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$247.68
|
| Rate for Payer: Anthem Medicare Advantage |
$89.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$273.48
|
| 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 |
$154.80
|
| Rate for Payer: Cash Price |
$154.80
|
| Rate for Payer: Cigna Commercial |
$474.72
|
| 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 |
$459.24
|
| Rate for Payer: HFN Commercial |
$474.72
|
| 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 |
$412.80
|
| Rate for Payer: NAPHCARE Commercial |
$134.73
|
| Rate for Payer: Preferred Network Access Commercial |
$474.72
|
| Rate for Payer: Quartz Beloit One Network |
$252.84
|
| Rate for Payer: Quartz Commercial |
$335.40
|
| Rate for Payer: Quartz Medicare Advantage |
$89.82
|
| Rate for Payer: The Alliance Commercial |
$47.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$89.82
|
| Rate for Payer: WEA Trust Commercial |
$283.80
|
| Rate for Payer: Wellcare Medicare |
$89.82
|
| Rate for Payer: WPS Commercial |
$382.20
|
|
|
XR Pod Foot Complete Right
|
Facility
IP
|
$558.00
|
|
|
Service Code
|
CPT 73630 TC,RT
|
| Hospital Charge Code |
3100297
|
|
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 Pod Foot Complete Right
|
Professional
|
$558.00
|
|
|
Service Code
|
CPT 73630 TC,RT
|
| Hospital Charge Code |
3100297
|
|
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 Pod Foot Complete Right
|
Professional
|
$516.00
|
|
|
Service Code
|
CPT 73630
|
| Hospital Charge Code |
2448832
|
| Min. Negotiated Rate |
$33.02 |
| Max. Negotiated Rate |
$490.20 |
| Rate for Payer: Aetna Commercial |
$490.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$443.76
|
| 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 |
$154.80
|
| Rate for Payer: Cash Price |
$154.80
|
| Rate for Payer: Cigna Commercial |
$490.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$258.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$33.02
|
| Rate for Payer: Health EOS Commercial |
$469.56
|
| 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 |
$412.80
|
| Rate for Payer: Preferred Network Access Commercial |
$490.20
|
| Rate for Payer: Quartz Beloit One Network |
$227.04
|
| Rate for Payer: Quartz Commercial |
$294.12
|
| 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 |
$283.80
|
| Rate for Payer: WPS Commercial |
$165.10
|
|
|
XR Pod Foot Complete Right
|
Facility
OP
|
$558.00
|
|
|
Service Code
|
CPT 73630 RT
|
| Hospital Charge Code |
2587286
|
|
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 Pod Foot Complete Right
|
Facility
OP
|
$558.00
|
|
|
Service Code
|
CPT 73630 TC,RT
|
| Hospital Charge Code |
3100297
|
|
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 Pod Foot Complete Right
|
Facility
IP
|
$558.00
|
|
|
Service Code
|
CPT 73630 RT
|
| Hospital Charge Code |
2587286
|
|
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 Pod Toes 2nd Digit Left
|
Facility
IP
|
$407.00
|
|
|
Service Code
|
CPT 73660 T1
|
| Hospital Charge Code |
2587289
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$199.43 |
| Max. Negotiated Rate |
$374.44 |
| Rate for Payer: Aetna Commercial |
$366.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$215.71
|
| Rate for Payer: Cash Price |
$122.10
|
| Rate for Payer: Cigna Commercial |
$374.44
|
| Rate for Payer: Health EOS Commercial |
$362.23
|
| Rate for Payer: HFN Commercial |
$374.44
|
| Rate for Payer: Multiplan Commercial |
$325.60
|
| Rate for Payer: NAPHCARE Commercial |
$244.20
|
| Rate for Payer: Preferred Network Access Commercial |
$374.44
|
| Rate for Payer: Quartz Beloit One Network |
$199.43
|
| Rate for Payer: Quartz Commercial |
$244.20
|
| Rate for Payer: WEA Trust Commercial |
$223.85
|
| Rate for Payer: WPS Commercial |
$301.46
|
|
|
XR Pod Toes 2nd Digit Left
|
Facility
OP
|
$407.00
|
|
|
Service Code
|
CPT 73660 T1
|
| Hospital Charge Code |
2587289
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$113.96 |
| Max. Negotiated Rate |
$1,628.00 |
| Rate for Payer: Aetna Commercial |
$366.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$350.02
|
| Rate for Payer: Aetna Managed Medicare |
$113.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$264.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$203.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$195.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$215.71
|
| Rate for Payer: Cash Price |
$122.10
|
| Rate for Payer: Cash Price |
$122.10
|
| Rate for Payer: Cash Price |
$122.10
|
| Rate for Payer: Cigna Commercial |
$374.44
|
| Rate for Payer: Health EOS Commercial |
$362.23
|
| Rate for Payer: HFN Commercial |
$374.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$305.25
|
| Rate for Payer: Multiplan Commercial |
$325.60
|
| Rate for Payer: NAPHCARE Commercial |
$244.20
|
| Rate for Payer: Preferred Network Access Commercial |
$374.44
|
| Rate for Payer: Quartz Beloit One Network |
$199.43
|
| Rate for Payer: Quartz Commercial |
$264.55
|
| Rate for Payer: Quartz Medicare Advantage |
$244.20
|
| Rate for Payer: The Alliance Commercial |
$1,628.00
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$223.85
|
| Rate for Payer: WPS Commercial |
$301.46
|
|
|
XR Pod Toes 2nd Digit Left
|
Facility
OP
|
$391.00
|
|
|
Service Code
|
CPT 73660
|
| Hospital Charge Code |
2448833
|
| Min. Negotiated Rate |
$89.82 |
| Max. Negotiated Rate |
$515.52 |
| Rate for Payer: Aetna Commercial |
$351.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$336.26
|
| Rate for Payer: Aetna Managed Medicare |
$89.82
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$254.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$195.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$187.68
|
| Rate for Payer: Anthem Medicare Advantage |
$89.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$207.23
|
| 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 |
$117.30
|
| Rate for Payer: Cash Price |
$117.30
|
| Rate for Payer: Cigna Commercial |
$359.72
|
| 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 |
$347.99
|
| Rate for Payer: HFN Commercial |
$359.72
|
| 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 |
$312.80
|
| Rate for Payer: NAPHCARE Commercial |
$134.73
|
| Rate for Payer: Preferred Network Access Commercial |
$359.72
|
| Rate for Payer: Quartz Beloit One Network |
$191.59
|
| Rate for Payer: Quartz Commercial |
$254.15
|
| Rate for Payer: Quartz Medicare Advantage |
$89.82
|
| Rate for Payer: The Alliance Commercial |
$515.52
|
| Rate for Payer: United Healthcare Medicare Advantage |
$89.82
|
| Rate for Payer: WEA Trust Commercial |
$215.05
|
| Rate for Payer: Wellcare Medicare |
$89.82
|
| Rate for Payer: WPS Commercial |
$289.61
|
|
|
XR Pod Toes 2nd Digit Left
|
Professional
|
$407.00
|
|
|
Service Code
|
CPT 73660 T1
|
| Hospital Charge Code |
2587289
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$179.08 |
| Max. Negotiated Rate |
$386.65 |
| Rate for Payer: Aetna Commercial |
$386.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$350.02
|
| Rate for Payer: Cash Price |
$122.10
|
| Rate for Payer: Cash Price |
$122.10
|
| Rate for Payer: Cigna Commercial |
$386.65
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$203.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$244.20
|
| Rate for Payer: Health EOS Commercial |
$370.37
|
| Rate for Payer: Multiplan Commercial |
$325.60
|
| Rate for Payer: Preferred Network Access Commercial |
$386.65
|
| Rate for Payer: Quartz Beloit One Network |
$179.08
|
| Rate for Payer: Quartz Commercial |
$231.99
|
| Rate for Payer: The Alliance Commercial |
$203.50
|
| Rate for Payer: WEA Trust Commercial |
$223.85
|
| Rate for Payer: WPS Commercial |
$301.46
|
|
