|
XR Fluoroscopy Up to 1 Hour
|
Professional
|
Both
|
$1,060.00
|
|
|
Service Code
|
CPT 76000
|
| Hospital Charge Code |
1537058
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$43.46 |
| Max. Negotiated Rate |
$1,047.28 |
| Rate for Payer: Aetna Commercial |
$1,047.28
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$948.06
|
| Rate for Payer: Aetna Managed Medicare |
$43.46
|
| Rate for Payer: Anthem Medicare Advantage |
$43.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$43.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$43.46
|
| Rate for Payer: Cash Price |
$318.00
|
| Rate for Payer: Cash Price |
$318.00
|
| Rate for Payer: Cash Price |
$318.00
|
| Rate for Payer: Cigna Commercial |
$1,047.28
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$551.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$43.46
|
| Rate for Payer: Health EOS Commercial |
$1,003.18
|
| Rate for Payer: HFN Commercial |
$1,047.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$148.94
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$148.94
|
| Rate for Payer: Independent Care Health Plan Medicare |
$43.46
|
| Rate for Payer: Multiplan Commercial |
$881.92
|
| Rate for Payer: NAPHCARE Commercial |
$65.19
|
| Rate for Payer: Preferred Network Access Commercial |
$1,047.28
|
| Rate for Payer: Quartz Beloit One Network |
$485.06
|
| Rate for Payer: Quartz Commercial |
$628.37
|
| Rate for Payer: Quartz Medicare Advantage |
$43.46
|
| Rate for Payer: The Alliance Commercial |
$165.15
|
| Rate for Payer: United Healthcare Medicare Advantage |
$43.46
|
| Rate for Payer: WEA Trust Commercial |
$606.32
|
| Rate for Payer: WPS Commercial |
$217.31
|
|
|
XR Foot 2 Views Bilateral
|
Facility
|
IP
|
$486.00
|
|
|
Service Code
|
CPT 73620 LT,TC
|
| Hospital Charge Code |
1537060
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$247.67 |
| Max. Negotiated Rate |
$465.00 |
| Rate for Payer: Aetna Commercial |
$454.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$434.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$267.88
|
| Rate for Payer: Cash Price |
$145.80
|
| Rate for Payer: Cigna Commercial |
$465.00
|
| Rate for Payer: Health EOS Commercial |
$449.84
|
| Rate for Payer: HFN Commercial |
$465.00
|
| Rate for Payer: Multiplan Commercial |
$404.35
|
| Rate for Payer: Preferred Network Access Commercial |
$465.00
|
| Rate for Payer: Quartz Beloit One Network |
$247.67
|
| Rate for Payer: Quartz Commercial |
$303.26
|
| Rate for Payer: WEA Trust Commercial |
$277.99
|
| Rate for Payer: WPS Commercial |
$374.37
|
|
|
XR Foot 2 Views Bilateral
|
Facility
|
OP
|
$486.00
|
|
|
Service Code
|
CPT 73620 LT,TC
|
| Hospital Charge Code |
1537060
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$141.52 |
| Max. Negotiated Rate |
$465.00 |
| Rate for Payer: Aetna Commercial |
$454.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$434.68
|
| Rate for Payer: Aetna Managed Medicare |
$141.52
|
| 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 |
$267.88
|
| 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 |
$465.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$282.85
|
| Rate for Payer: Health EOS Commercial |
$449.84
|
| Rate for Payer: HFN Commercial |
$465.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$379.08
|
| Rate for Payer: Multiplan Commercial |
$404.35
|
| Rate for Payer: NAPHCARE Commercial |
$303.26
|
| Rate for Payer: Preferred Network Access Commercial |
$465.00
|
| Rate for Payer: Quartz Beloit One Network |
$247.67
|
| Rate for Payer: Quartz Commercial |
$328.54
|
| Rate for Payer: Quartz Medicare Advantage |
$303.26
|
| Rate for Payer: The Alliance Commercial |
$252.72
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$277.99
|
| Rate for Payer: WPS Commercial |
$374.37
|
|
|
XR Foot 2 Views Bilateral
|
Professional
|
Both
|
$486.00
|
|
|
Service Code
|
CPT 73620 LT,TC
|
| Hospital Charge Code |
1537060
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$99.67 |
| Max. Negotiated Rate |
$480.17 |
| Rate for Payer: Aetna Commercial |
$480.17
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$434.68
|
| 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 |
$480.17
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$252.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$303.26
|
| Rate for Payer: Health EOS Commercial |
$459.95
|
| Rate for Payer: HFN Commercial |
$480.17
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$99.67
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$99.67
|
| Rate for Payer: Multiplan Commercial |
$404.35
|
| Rate for Payer: Preferred Network Access Commercial |
$480.17
|
| Rate for Payer: Quartz Beloit One Network |
$222.39
|
| Rate for Payer: Quartz Commercial |
$288.10
|
| Rate for Payer: The Alliance Commercial |
$252.72
|
| Rate for Payer: WEA Trust Commercial |
$277.99
|
| Rate for Payer: WPS Commercial |
$374.37
|
|
|
XR Foot 2 Views Bilateral
|
Facility
|
IP
|
$901.00
|
|
|
Service Code
|
CPT 73620
|
| Hospital Charge Code |
630565
|
| Min. Negotiated Rate |
$459.15 |
| Max. Negotiated Rate |
$862.08 |
| Rate for Payer: Aetna Commercial |
$843.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$805.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$496.63
|
| Rate for Payer: Cash Price |
$270.30
|
| Rate for Payer: Cigna Commercial |
$862.08
|
| Rate for Payer: Health EOS Commercial |
$833.97
|
| Rate for Payer: HFN Commercial |
$862.08
|
| Rate for Payer: Multiplan Commercial |
$749.63
|
| Rate for Payer: Preferred Network Access Commercial |
$862.08
|
| Rate for Payer: Quartz Beloit One Network |
$459.15
|
| Rate for Payer: Quartz Commercial |
$562.22
|
| Rate for Payer: WEA Trust Commercial |
$515.37
|
| Rate for Payer: WPS Commercial |
$694.04
|
|
|
XR Foot 2 Views Bilateral
|
Facility
|
OP
|
$901.00
|
|
|
Service Code
|
CPT 73620
|
| Hospital Charge Code |
630565
|
| Min. Negotiated Rate |
$91.58 |
| Max. Negotiated Rate |
$862.08 |
| Rate for Payer: Aetna Commercial |
$843.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$805.85
|
| Rate for Payer: Aetna Managed Medicare |
$91.58
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$609.08
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$468.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$449.78
|
| Rate for Payer: Anthem Medicare Advantage |
$91.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$496.63
|
| 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 |
$270.30
|
| Rate for Payer: Cash Price |
$270.30
|
| Rate for Payer: Cigna Commercial |
$862.08
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$91.58
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$524.38
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$91.58
|
| Rate for Payer: Health EOS Commercial |
$833.97
|
| Rate for Payer: HFN Commercial |
$862.08
|
| 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 |
$749.63
|
| Rate for Payer: NAPHCARE Commercial |
$137.37
|
| Rate for Payer: Preferred Network Access Commercial |
$862.08
|
| Rate for Payer: Quartz Beloit One Network |
$459.15
|
| Rate for Payer: Quartz Commercial |
$609.08
|
| 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 |
$515.37
|
| Rate for Payer: Wellcare Medicare |
$91.58
|
| Rate for Payer: WPS Commercial |
$694.04
|
|
|
XR Foot 2 Views Bilateral
|
Professional
|
Both
|
$901.00
|
|
|
Service Code
|
CPT 73620
|
| Hospital Charge Code |
630565
|
| Min. Negotiated Rate |
$28.40 |
| Max. Negotiated Rate |
$890.19 |
| Rate for Payer: Aetna Commercial |
$890.19
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$805.85
|
| Rate for Payer: Aetna Managed Medicare |
$28.40
|
| Rate for Payer: Anthem Medicare Advantage |
$28.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$28.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$28.40
|
| Rate for Payer: Cash Price |
$270.30
|
| Rate for Payer: Cash Price |
$270.30
|
| Rate for Payer: Cash Price |
$270.30
|
| Rate for Payer: Cigna Commercial |
$890.19
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$468.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$28.40
|
| Rate for Payer: Health EOS Commercial |
$852.71
|
| Rate for Payer: HFN Commercial |
$890.19
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$99.67
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$99.67
|
| Rate for Payer: Independent Care Health Plan Medicare |
$28.40
|
| Rate for Payer: Multiplan Commercial |
$749.63
|
| Rate for Payer: NAPHCARE Commercial |
$42.60
|
| Rate for Payer: Preferred Network Access Commercial |
$890.19
|
| Rate for Payer: Quartz Beloit One Network |
$412.30
|
| Rate for Payer: Quartz Commercial |
$534.11
|
| Rate for Payer: Quartz Medicare Advantage |
$28.40
|
| Rate for Payer: The Alliance Commercial |
$107.93
|
| Rate for Payer: United Healthcare Medicare Advantage |
$28.40
|
| Rate for Payer: WEA Trust Commercial |
$515.37
|
| Rate for Payer: WPS Commercial |
$142.01
|
|
|
XR Foot 2 Views Left
|
Facility
|
IP
|
$486.00
|
|
|
Service Code
|
CPT 73620 LT,TC
|
| Hospital Charge Code |
1537062
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$247.67 |
| Max. Negotiated Rate |
$465.00 |
| Rate for Payer: Aetna Commercial |
$454.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$434.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$267.88
|
| Rate for Payer: Cash Price |
$145.80
|
| Rate for Payer: Cigna Commercial |
$465.00
|
| Rate for Payer: Health EOS Commercial |
$449.84
|
| Rate for Payer: HFN Commercial |
$465.00
|
| Rate for Payer: Multiplan Commercial |
$404.35
|
| Rate for Payer: Preferred Network Access Commercial |
$465.00
|
| Rate for Payer: Quartz Beloit One Network |
$247.67
|
| Rate for Payer: Quartz Commercial |
$303.26
|
| Rate for Payer: WEA Trust Commercial |
$277.99
|
| Rate for Payer: WPS Commercial |
$374.37
|
|
|
XR Foot 2 Views Left
|
Facility
|
OP
|
$486.00
|
|
|
Service Code
|
CPT 73620 LT,TC
|
| Hospital Charge Code |
1537062
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$141.52 |
| Max. Negotiated Rate |
$465.00 |
| Rate for Payer: Aetna Commercial |
$454.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$434.68
|
| Rate for Payer: Aetna Managed Medicare |
$141.52
|
| 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 |
$267.88
|
| 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 |
$465.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$282.85
|
| Rate for Payer: Health EOS Commercial |
$449.84
|
| Rate for Payer: HFN Commercial |
$465.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$379.08
|
| Rate for Payer: Multiplan Commercial |
$404.35
|
| Rate for Payer: NAPHCARE Commercial |
$303.26
|
| Rate for Payer: Preferred Network Access Commercial |
$465.00
|
| Rate for Payer: Quartz Beloit One Network |
$247.67
|
| Rate for Payer: Quartz Commercial |
$328.54
|
| Rate for Payer: Quartz Medicare Advantage |
$303.26
|
| Rate for Payer: The Alliance Commercial |
$252.72
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$277.99
|
| Rate for Payer: WPS Commercial |
$374.37
|
|
|
XR Foot 2 Views Left
|
Facility
|
IP
|
$450.00
|
|
|
Service Code
|
CPT 73620
|
| Hospital Charge Code |
630559
|
| Min. Negotiated Rate |
$229.32 |
| Max. Negotiated Rate |
$430.56 |
| Rate for Payer: Aetna Commercial |
$421.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$402.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$248.04
|
| Rate for Payer: Cash Price |
$135.00
|
| 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: 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 |
$346.63
|
|
|
XR Foot 2 Views Left
|
Professional
|
Both
|
$450.00
|
|
|
Service Code
|
CPT 73620
|
| Hospital Charge Code |
630559
|
| Min. Negotiated Rate |
$28.40 |
| Max. Negotiated Rate |
$444.60 |
| Rate for Payer: Aetna Commercial |
$444.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$402.48
|
| Rate for Payer: Aetna Managed Medicare |
$28.40
|
| Rate for Payer: Anthem Medicare Advantage |
$28.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$28.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$28.40
|
| Rate for Payer: Cash Price |
$135.00
|
| Rate for Payer: Cash Price |
$135.00
|
| Rate for Payer: Cash Price |
$135.00
|
| 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 |
$28.40
|
| Rate for Payer: Health EOS Commercial |
$425.88
|
| Rate for Payer: HFN Commercial |
$444.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$99.67
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$99.67
|
| Rate for Payer: Independent Care Health Plan Medicare |
$28.40
|
| Rate for Payer: Multiplan Commercial |
$374.40
|
| Rate for Payer: NAPHCARE Commercial |
$42.60
|
| 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: Quartz Medicare Advantage |
$28.40
|
| Rate for Payer: The Alliance Commercial |
$107.93
|
| Rate for Payer: United Healthcare Medicare Advantage |
$28.40
|
| Rate for Payer: WEA Trust Commercial |
$257.40
|
| Rate for Payer: WPS Commercial |
$142.01
|
|
|
XR Foot 2 Views Left
|
Professional
|
Both
|
$486.00
|
|
|
Service Code
|
CPT 73620 LT,TC
|
| Hospital Charge Code |
1537062
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$99.67 |
| Max. Negotiated Rate |
$480.17 |
| Rate for Payer: Aetna Commercial |
$480.17
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$434.68
|
| 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 |
$480.17
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$252.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$303.26
|
| Rate for Payer: Health EOS Commercial |
$459.95
|
| Rate for Payer: HFN Commercial |
$480.17
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$99.67
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$99.67
|
| Rate for Payer: Multiplan Commercial |
$404.35
|
| Rate for Payer: Preferred Network Access Commercial |
$480.17
|
| Rate for Payer: Quartz Beloit One Network |
$222.39
|
| Rate for Payer: Quartz Commercial |
$288.10
|
| Rate for Payer: The Alliance Commercial |
$252.72
|
| Rate for Payer: WEA Trust Commercial |
$277.99
|
| Rate for Payer: WPS Commercial |
$374.37
|
|
|
XR Foot 2 Views Left
|
Facility
|
OP
|
$450.00
|
|
|
Service Code
|
CPT 73620
|
| Hospital Charge Code |
630559
|
| Min. Negotiated Rate |
$91.58 |
| Max. Negotiated Rate |
$430.56 |
| Rate for Payer: Aetna Commercial |
$421.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$402.48
|
| Rate for Payer: Aetna Managed Medicare |
$91.58
|
| 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: Anthem Medicare Advantage |
$91.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$248.04
|
| 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 |
$135.00
|
| Rate for Payer: Cash Price |
$135.00
|
| Rate for Payer: Cigna Commercial |
$430.56
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$91.58
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$261.90
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$91.58
|
| Rate for Payer: Health EOS Commercial |
$416.52
|
| Rate for Payer: HFN Commercial |
$430.56
|
| 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 |
$374.40
|
| Rate for Payer: NAPHCARE Commercial |
$137.37
|
| 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 |
$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 |
$257.40
|
| Rate for Payer: Wellcare Medicare |
$91.58
|
| Rate for Payer: WPS Commercial |
$346.63
|
|
|
XR Foot 2 Views Right
|
Facility
|
IP
|
$486.00
|
|
|
Service Code
|
CPT 73620 RT,TC
|
| Hospital Charge Code |
1537064
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$247.67 |
| Max. Negotiated Rate |
$465.00 |
| Rate for Payer: Aetna Commercial |
$454.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$434.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$267.88
|
| Rate for Payer: Cash Price |
$145.80
|
| Rate for Payer: Cigna Commercial |
$465.00
|
| Rate for Payer: Health EOS Commercial |
$449.84
|
| Rate for Payer: HFN Commercial |
$465.00
|
| Rate for Payer: Multiplan Commercial |
$404.35
|
| Rate for Payer: Preferred Network Access Commercial |
$465.00
|
| Rate for Payer: Quartz Beloit One Network |
$247.67
|
| Rate for Payer: Quartz Commercial |
$303.26
|
| Rate for Payer: WEA Trust Commercial |
$277.99
|
| Rate for Payer: WPS Commercial |
$374.37
|
|
|
XR Foot 2 Views Right
|
Professional
|
Both
|
$450.00
|
|
|
Service Code
|
CPT 73620
|
| Hospital Charge Code |
630555
|
| Min. Negotiated Rate |
$28.40 |
| Max. Negotiated Rate |
$444.60 |
| Rate for Payer: Aetna Commercial |
$444.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$402.48
|
| Rate for Payer: Aetna Managed Medicare |
$28.40
|
| Rate for Payer: Anthem Medicare Advantage |
$28.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$28.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$28.40
|
| Rate for Payer: Cash Price |
$135.00
|
| Rate for Payer: Cash Price |
$135.00
|
| Rate for Payer: Cash Price |
$135.00
|
| 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 |
$28.40
|
| Rate for Payer: Health EOS Commercial |
$425.88
|
| Rate for Payer: HFN Commercial |
$444.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$99.67
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$99.67
|
| Rate for Payer: Independent Care Health Plan Medicare |
$28.40
|
| Rate for Payer: Multiplan Commercial |
$374.40
|
| Rate for Payer: NAPHCARE Commercial |
$42.60
|
| 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: Quartz Medicare Advantage |
$28.40
|
| Rate for Payer: The Alliance Commercial |
$107.93
|
| Rate for Payer: United Healthcare Medicare Advantage |
$28.40
|
| Rate for Payer: WEA Trust Commercial |
$257.40
|
| Rate for Payer: WPS Commercial |
$142.01
|
|
|
XR Foot 2 Views Right
|
Facility
|
OP
|
$486.00
|
|
|
Service Code
|
CPT 73620 RT,TC
|
| Hospital Charge Code |
1537064
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$141.52 |
| Max. Negotiated Rate |
$465.00 |
| Rate for Payer: Aetna Commercial |
$454.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$434.68
|
| Rate for Payer: Aetna Managed Medicare |
$141.52
|
| 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 |
$267.88
|
| 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 |
$465.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$282.85
|
| Rate for Payer: Health EOS Commercial |
$449.84
|
| Rate for Payer: HFN Commercial |
$465.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$379.08
|
| Rate for Payer: Multiplan Commercial |
$404.35
|
| Rate for Payer: NAPHCARE Commercial |
$303.26
|
| Rate for Payer: Preferred Network Access Commercial |
$465.00
|
| Rate for Payer: Quartz Beloit One Network |
$247.67
|
| Rate for Payer: Quartz Commercial |
$328.54
|
| Rate for Payer: Quartz Medicare Advantage |
$303.26
|
| Rate for Payer: The Alliance Commercial |
$252.72
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$277.99
|
| Rate for Payer: WPS Commercial |
$374.37
|
|
|
XR Foot 2 Views Right
|
Professional
|
Both
|
$486.00
|
|
|
Service Code
|
CPT 73620 RT,TC
|
| Hospital Charge Code |
1537064
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$99.67 |
| Max. Negotiated Rate |
$480.17 |
| Rate for Payer: Aetna Commercial |
$480.17
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$434.68
|
| 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 |
$480.17
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$252.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$303.26
|
| Rate for Payer: Health EOS Commercial |
$459.95
|
| Rate for Payer: HFN Commercial |
$480.17
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$99.67
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$99.67
|
| Rate for Payer: Multiplan Commercial |
$404.35
|
| Rate for Payer: Preferred Network Access Commercial |
$480.17
|
| Rate for Payer: Quartz Beloit One Network |
$222.39
|
| Rate for Payer: Quartz Commercial |
$288.10
|
| Rate for Payer: The Alliance Commercial |
$252.72
|
| Rate for Payer: WEA Trust Commercial |
$277.99
|
| Rate for Payer: WPS Commercial |
$374.37
|
|
|
XR Foot 2 Views Right
|
Facility
|
IP
|
$486.00
|
|
|
Service Code
|
CPT 73620 TC,RT
|
| Hospital Charge Code |
2980065
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$247.67 |
| Max. Negotiated Rate |
$465.00 |
| Rate for Payer: Aetna Commercial |
$454.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$434.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$267.88
|
| Rate for Payer: Cash Price |
$145.80
|
| Rate for Payer: Cigna Commercial |
$465.00
|
| Rate for Payer: Health EOS Commercial |
$449.84
|
| Rate for Payer: HFN Commercial |
$465.00
|
| Rate for Payer: Multiplan Commercial |
$404.35
|
| Rate for Payer: Preferred Network Access Commercial |
$465.00
|
| Rate for Payer: Quartz Beloit One Network |
$247.67
|
| Rate for Payer: Quartz Commercial |
$303.26
|
| Rate for Payer: WEA Trust Commercial |
$277.99
|
| Rate for Payer: WPS Commercial |
$374.37
|
|
|
XR Foot 2 Views Right
|
Facility
|
IP
|
$450.00
|
|
|
Service Code
|
CPT 73620
|
| Hospital Charge Code |
630555
|
| Min. Negotiated Rate |
$229.32 |
| Max. Negotiated Rate |
$430.56 |
| Rate for Payer: Aetna Commercial |
$421.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$402.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$248.04
|
| Rate for Payer: Cash Price |
$135.00
|
| 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: 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 |
$346.63
|
|
|
XR Foot 2 Views Right
|
Professional
|
Both
|
$486.00
|
|
|
Service Code
|
CPT 73620 TC,RT
|
| Hospital Charge Code |
2980065
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$99.67 |
| Max. Negotiated Rate |
$480.17 |
| Rate for Payer: Aetna Commercial |
$480.17
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$434.68
|
| 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 |
$480.17
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$252.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$303.26
|
| Rate for Payer: Health EOS Commercial |
$459.95
|
| Rate for Payer: HFN Commercial |
$480.17
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$99.67
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$99.67
|
| Rate for Payer: Multiplan Commercial |
$404.35
|
| Rate for Payer: Preferred Network Access Commercial |
$480.17
|
| Rate for Payer: Quartz Beloit One Network |
$222.39
|
| Rate for Payer: Quartz Commercial |
$288.10
|
| Rate for Payer: The Alliance Commercial |
$252.72
|
| Rate for Payer: WEA Trust Commercial |
$277.99
|
| Rate for Payer: WPS Commercial |
$374.37
|
|
|
XR Foot 2 Views Right
|
Facility
|
OP
|
$486.00
|
|
|
Service Code
|
CPT 73620 TC,RT
|
| Hospital Charge Code |
2980065
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$141.52 |
| Max. Negotiated Rate |
$465.00 |
| Rate for Payer: Aetna Commercial |
$454.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$434.68
|
| Rate for Payer: Aetna Managed Medicare |
$141.52
|
| 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 |
$267.88
|
| 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 |
$465.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$282.85
|
| Rate for Payer: Health EOS Commercial |
$449.84
|
| Rate for Payer: HFN Commercial |
$465.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$379.08
|
| Rate for Payer: Multiplan Commercial |
$404.35
|
| Rate for Payer: NAPHCARE Commercial |
$303.26
|
| Rate for Payer: Preferred Network Access Commercial |
$465.00
|
| Rate for Payer: Quartz Beloit One Network |
$247.67
|
| Rate for Payer: Quartz Commercial |
$328.54
|
| Rate for Payer: Quartz Medicare Advantage |
$303.26
|
| Rate for Payer: The Alliance Commercial |
$252.72
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$277.99
|
| Rate for Payer: WPS Commercial |
$374.37
|
|
|
XR Foot 2 Views Right
|
Facility
|
OP
|
$450.00
|
|
|
Service Code
|
CPT 73620
|
| Hospital Charge Code |
630555
|
| Min. Negotiated Rate |
$91.58 |
| Max. Negotiated Rate |
$430.56 |
| Rate for Payer: Aetna Commercial |
$421.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$402.48
|
| Rate for Payer: Aetna Managed Medicare |
$91.58
|
| 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: Anthem Medicare Advantage |
$91.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$248.04
|
| 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 |
$135.00
|
| Rate for Payer: Cash Price |
$135.00
|
| Rate for Payer: Cigna Commercial |
$430.56
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$91.58
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$261.90
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$91.58
|
| Rate for Payer: Health EOS Commercial |
$416.52
|
| Rate for Payer: HFN Commercial |
$430.56
|
| 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 |
$374.40
|
| Rate for Payer: NAPHCARE Commercial |
$137.37
|
| 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 |
$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 |
$257.40
|
| Rate for Payer: Wellcare Medicare |
$91.58
|
| Rate for Payer: WPS Commercial |
$346.63
|
|
|
XR Foot Complete Bilateral
|
Professional
|
Both
|
$558.00
|
|
|
Service Code
|
CPT 73630 LT,TC
|
| Hospital Charge Code |
1537066
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$120.27 |
| Max. Negotiated Rate |
$551.30 |
| Rate for Payer: Aetna Commercial |
$551.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$499.08
|
| 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 |
$551.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$290.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$348.19
|
| Rate for Payer: Health EOS Commercial |
$528.09
|
| Rate for Payer: HFN Commercial |
$551.30
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$120.27
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$120.27
|
| Rate for Payer: Multiplan Commercial |
$464.26
|
| Rate for Payer: Preferred Network Access Commercial |
$551.30
|
| Rate for Payer: Quartz Beloit One Network |
$255.34
|
| Rate for Payer: Quartz Commercial |
$330.78
|
| Rate for Payer: The Alliance Commercial |
$290.16
|
| Rate for Payer: WEA Trust Commercial |
$319.18
|
| Rate for Payer: WPS Commercial |
$429.83
|
|
|
XR Foot Complete Bilateral
|
Facility
|
OP
|
$558.00
|
|
|
Service Code
|
CPT 73630 LT,TC
|
| Hospital Charge Code |
1537066
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$162.49 |
| Max. Negotiated Rate |
$533.89 |
| Rate for Payer: Aetna Commercial |
$522.29
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$499.08
|
| Rate for Payer: Aetna Managed Medicare |
$162.49
|
| 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 |
$307.57
|
| 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 |
$533.89
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$324.76
|
| Rate for Payer: Health EOS Commercial |
$516.48
|
| Rate for Payer: HFN Commercial |
$533.89
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$435.24
|
| Rate for Payer: Multiplan Commercial |
$464.26
|
| Rate for Payer: NAPHCARE Commercial |
$348.19
|
| Rate for Payer: Preferred Network Access Commercial |
$533.89
|
| Rate for Payer: Quartz Beloit One Network |
$284.36
|
| Rate for Payer: Quartz Commercial |
$377.21
|
| Rate for Payer: Quartz Medicare Advantage |
$348.19
|
| Rate for Payer: The Alliance Commercial |
$290.16
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$319.18
|
| Rate for Payer: WPS Commercial |
$429.83
|
|
|
XR Foot Complete Bilateral
|
Facility
|
IP
|
$1,032.00
|
|
|
Service Code
|
CPT 73630
|
| Hospital Charge Code |
630552
|
| Min. Negotiated Rate |
$525.91 |
| Max. Negotiated Rate |
$987.42 |
| Rate for Payer: Aetna Commercial |
$965.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$923.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$568.84
|
| Rate for Payer: Cash Price |
$309.60
|
| Rate for Payer: Cigna Commercial |
$987.42
|
| Rate for Payer: Health EOS Commercial |
$955.22
|
| Rate for Payer: HFN Commercial |
$987.42
|
| Rate for Payer: Multiplan Commercial |
$858.62
|
| Rate for Payer: Preferred Network Access Commercial |
$987.42
|
| Rate for Payer: Quartz Beloit One Network |
$525.91
|
| Rate for Payer: Quartz Commercial |
$643.97
|
| Rate for Payer: WEA Trust Commercial |
$590.30
|
| Rate for Payer: WPS Commercial |
$794.95
|
|
