|
XR Toes 4th Digit Right
|
Facility
IP
|
$402.00
|
|
|
Service Code
|
CPT 73660 T8,TC
|
| Hospital Charge Code |
1537407
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$196.98 |
| Max. Negotiated Rate |
$369.84 |
| Rate for Payer: Aetna Commercial |
$361.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$213.06
|
| Rate for Payer: Cash Price |
$120.60
|
| Rate for Payer: Cigna Commercial |
$369.84
|
| Rate for Payer: Health EOS Commercial |
$357.78
|
| Rate for Payer: HFN Commercial |
$369.84
|
| Rate for Payer: Multiplan Commercial |
$321.60
|
| Rate for Payer: NAPHCARE Commercial |
$241.20
|
| Rate for Payer: Preferred Network Access Commercial |
$369.84
|
| Rate for Payer: Quartz Beloit One Network |
$196.98
|
| Rate for Payer: Quartz Commercial |
$241.20
|
| Rate for Payer: WEA Trust Commercial |
$221.10
|
| Rate for Payer: WPS Commercial |
$297.76
|
|
|
XR Toes 4th Digit Right
|
Professional
|
$402.00
|
|
|
Service Code
|
CPT 73660 T8,TC
|
| Hospital Charge Code |
1537407
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$176.88 |
| Max. Negotiated Rate |
$381.90 |
| Rate for Payer: Aetna Commercial |
$381.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$345.72
|
| Rate for Payer: Cash Price |
$120.60
|
| Rate for Payer: Cash Price |
$120.60
|
| Rate for Payer: Cigna Commercial |
$381.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$201.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$241.20
|
| Rate for Payer: Health EOS Commercial |
$365.82
|
| Rate for Payer: Multiplan Commercial |
$321.60
|
| Rate for Payer: Preferred Network Access Commercial |
$381.90
|
| Rate for Payer: Quartz Beloit One Network |
$176.88
|
| Rate for Payer: Quartz Commercial |
$229.14
|
| Rate for Payer: The Alliance Commercial |
$201.00
|
| Rate for Payer: WEA Trust Commercial |
$221.10
|
| Rate for Payer: WPS Commercial |
$297.76
|
|
|
XR Toes 4th Digit Right
|
Professional
|
$391.00
|
|
|
Service Code
|
CPT 73660
|
| Hospital Charge Code |
629890
|
| Min. Negotiated Rate |
$28.12 |
| Max. Negotiated Rate |
$371.45 |
| Rate for Payer: Aetna Commercial |
$371.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$336.26
|
| Rate for Payer: Aetna Managed Medicare |
$28.12
|
| Rate for Payer: Anthem Medicare Advantage |
$28.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$28.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$28.12
|
| Rate for Payer: Cash Price |
$117.30
|
| Rate for Payer: Cash Price |
$117.30
|
| Rate for Payer: Cigna Commercial |
$371.45
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$195.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$28.12
|
| Rate for Payer: Health EOS Commercial |
$355.81
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$97.96
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$97.96
|
| Rate for Payer: Independent Care Health Plan Medicare |
$28.12
|
| Rate for Payer: Multiplan Commercial |
$312.80
|
| Rate for Payer: Preferred Network Access Commercial |
$371.45
|
| Rate for Payer: Quartz Beloit One Network |
$172.04
|
| Rate for Payer: Quartz Commercial |
$222.87
|
| Rate for Payer: Quartz Medicare Advantage |
$28.12
|
| Rate for Payer: The Alliance Commercial |
$106.86
|
| Rate for Payer: United Healthcare Medicare Advantage |
$28.12
|
| Rate for Payer: WEA Trust Commercial |
$215.05
|
| Rate for Payer: WPS Commercial |
$140.60
|
|
|
XR Toes 4th Digit Right
|
Facility
OP
|
$402.00
|
|
|
Service Code
|
CPT 73660 T8,TC
|
| Hospital Charge Code |
1537407
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$112.56 |
| Max. Negotiated Rate |
$1,608.00 |
| Rate for Payer: Aetna Commercial |
$361.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$345.72
|
| Rate for Payer: Aetna Managed Medicare |
$112.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$261.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$201.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$192.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$213.06
|
| Rate for Payer: Cash Price |
$120.60
|
| Rate for Payer: Cash Price |
$120.60
|
| Rate for Payer: Cash Price |
$120.60
|
| Rate for Payer: Cigna Commercial |
$369.84
|
| Rate for Payer: Health EOS Commercial |
$357.78
|
| Rate for Payer: HFN Commercial |
$369.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$301.50
|
| Rate for Payer: Multiplan Commercial |
$321.60
|
| Rate for Payer: NAPHCARE Commercial |
$241.20
|
| Rate for Payer: Preferred Network Access Commercial |
$369.84
|
| Rate for Payer: Quartz Beloit One Network |
$196.98
|
| Rate for Payer: Quartz Commercial |
$261.30
|
| Rate for Payer: Quartz Medicare Advantage |
$241.20
|
| Rate for Payer: The Alliance Commercial |
$1,608.00
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$221.10
|
| Rate for Payer: WPS Commercial |
$297.76
|
|
|
XR Toes 4th Digit Right
|
Facility
IP
|
$391.00
|
|
|
Service Code
|
CPT 73660
|
| Hospital Charge Code |
629890
|
| Min. Negotiated Rate |
$191.59 |
| Max. Negotiated Rate |
$359.72 |
| Rate for Payer: Aetna Commercial |
$351.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$207.23
|
| Rate for Payer: Cash Price |
$117.30
|
| Rate for Payer: Cigna Commercial |
$359.72
|
| Rate for Payer: Health EOS Commercial |
$347.99
|
| Rate for Payer: HFN Commercial |
$359.72
|
| Rate for Payer: Multiplan Commercial |
$312.80
|
| Rate for Payer: NAPHCARE Commercial |
$234.60
|
| Rate for Payer: Preferred Network Access Commercial |
$359.72
|
| Rate for Payer: Quartz Beloit One Network |
$191.59
|
| Rate for Payer: Quartz Commercial |
$234.60
|
| Rate for Payer: WEA Trust Commercial |
$215.05
|
| Rate for Payer: WPS Commercial |
$289.61
|
|
|
XR Toes 4th Digit Right
|
Facility
OP
|
$391.00
|
|
|
Service Code
|
CPT 73660
|
| Hospital Charge Code |
629890
|
| 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 Toes 5th Digit Left
|
Facility
OP
|
$391.00
|
|
|
Service Code
|
CPT 73660
|
| Hospital Charge Code |
629882
|
| 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 Toes 5th Digit Left
|
Professional
|
$402.00
|
|
|
Service Code
|
CPT 73660 T4,TC
|
| Hospital Charge Code |
1537409
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$176.88 |
| Max. Negotiated Rate |
$381.90 |
| Rate for Payer: Aetna Commercial |
$381.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$345.72
|
| Rate for Payer: Cash Price |
$120.60
|
| Rate for Payer: Cash Price |
$120.60
|
| Rate for Payer: Cigna Commercial |
$381.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$201.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$241.20
|
| Rate for Payer: Health EOS Commercial |
$365.82
|
| Rate for Payer: Multiplan Commercial |
$321.60
|
| Rate for Payer: Preferred Network Access Commercial |
$381.90
|
| Rate for Payer: Quartz Beloit One Network |
$176.88
|
| Rate for Payer: Quartz Commercial |
$229.14
|
| Rate for Payer: The Alliance Commercial |
$201.00
|
| Rate for Payer: WEA Trust Commercial |
$221.10
|
| Rate for Payer: WPS Commercial |
$297.76
|
|
|
XR Toes 5th Digit Left
|
Professional
|
$391.00
|
|
|
Service Code
|
CPT 73660
|
| Hospital Charge Code |
629882
|
| Min. Negotiated Rate |
$28.12 |
| Max. Negotiated Rate |
$371.45 |
| Rate for Payer: Aetna Commercial |
$371.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$336.26
|
| Rate for Payer: Aetna Managed Medicare |
$28.12
|
| Rate for Payer: Anthem Medicare Advantage |
$28.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$28.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$28.12
|
| Rate for Payer: Cash Price |
$117.30
|
| Rate for Payer: Cash Price |
$117.30
|
| Rate for Payer: Cigna Commercial |
$371.45
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$195.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$28.12
|
| Rate for Payer: Health EOS Commercial |
$355.81
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$97.96
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$97.96
|
| Rate for Payer: Independent Care Health Plan Medicare |
$28.12
|
| Rate for Payer: Multiplan Commercial |
$312.80
|
| Rate for Payer: Preferred Network Access Commercial |
$371.45
|
| Rate for Payer: Quartz Beloit One Network |
$172.04
|
| Rate for Payer: Quartz Commercial |
$222.87
|
| Rate for Payer: Quartz Medicare Advantage |
$28.12
|
| Rate for Payer: The Alliance Commercial |
$106.86
|
| Rate for Payer: United Healthcare Medicare Advantage |
$28.12
|
| Rate for Payer: WEA Trust Commercial |
$215.05
|
| Rate for Payer: WPS Commercial |
$140.60
|
|
|
XR Toes 5th Digit Left
|
Facility
IP
|
$402.00
|
|
|
Service Code
|
CPT 73660 T4,TC
|
| Hospital Charge Code |
1537409
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$196.98 |
| Max. Negotiated Rate |
$369.84 |
| Rate for Payer: Aetna Commercial |
$361.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$213.06
|
| Rate for Payer: Cash Price |
$120.60
|
| Rate for Payer: Cigna Commercial |
$369.84
|
| Rate for Payer: Health EOS Commercial |
$357.78
|
| Rate for Payer: HFN Commercial |
$369.84
|
| Rate for Payer: Multiplan Commercial |
$321.60
|
| Rate for Payer: NAPHCARE Commercial |
$241.20
|
| Rate for Payer: Preferred Network Access Commercial |
$369.84
|
| Rate for Payer: Quartz Beloit One Network |
$196.98
|
| Rate for Payer: Quartz Commercial |
$241.20
|
| Rate for Payer: WEA Trust Commercial |
$221.10
|
| Rate for Payer: WPS Commercial |
$297.76
|
|
|
XR Toes 5th Digit Left
|
Facility
OP
|
$402.00
|
|
|
Service Code
|
CPT 73660 T4,TC
|
| Hospital Charge Code |
1537409
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$112.56 |
| Max. Negotiated Rate |
$1,608.00 |
| Rate for Payer: Aetna Commercial |
$361.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$345.72
|
| Rate for Payer: Aetna Managed Medicare |
$112.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$261.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$201.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$192.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$213.06
|
| Rate for Payer: Cash Price |
$120.60
|
| Rate for Payer: Cash Price |
$120.60
|
| Rate for Payer: Cash Price |
$120.60
|
| Rate for Payer: Cigna Commercial |
$369.84
|
| Rate for Payer: Health EOS Commercial |
$357.78
|
| Rate for Payer: HFN Commercial |
$369.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$301.50
|
| Rate for Payer: Multiplan Commercial |
$321.60
|
| Rate for Payer: NAPHCARE Commercial |
$241.20
|
| Rate for Payer: Preferred Network Access Commercial |
$369.84
|
| Rate for Payer: Quartz Beloit One Network |
$196.98
|
| Rate for Payer: Quartz Commercial |
$261.30
|
| Rate for Payer: Quartz Medicare Advantage |
$241.20
|
| Rate for Payer: The Alliance Commercial |
$1,608.00
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$221.10
|
| Rate for Payer: WPS Commercial |
$297.76
|
|
|
XR Toes 5th Digit Left
|
Facility
IP
|
$391.00
|
|
|
Service Code
|
CPT 73660
|
| Hospital Charge Code |
629882
|
| Min. Negotiated Rate |
$191.59 |
| Max. Negotiated Rate |
$359.72 |
| Rate for Payer: Aetna Commercial |
$351.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$207.23
|
| Rate for Payer: Cash Price |
$117.30
|
| Rate for Payer: Cigna Commercial |
$359.72
|
| Rate for Payer: Health EOS Commercial |
$347.99
|
| Rate for Payer: HFN Commercial |
$359.72
|
| Rate for Payer: Multiplan Commercial |
$312.80
|
| Rate for Payer: NAPHCARE Commercial |
$234.60
|
| Rate for Payer: Preferred Network Access Commercial |
$359.72
|
| Rate for Payer: Quartz Beloit One Network |
$191.59
|
| Rate for Payer: Quartz Commercial |
$234.60
|
| Rate for Payer: WEA Trust Commercial |
$215.05
|
| Rate for Payer: WPS Commercial |
$289.61
|
|
|
XR Toes 5th Digit Right
|
Professional
|
$391.00
|
|
|
Service Code
|
CPT 73660
|
| Hospital Charge Code |
629876
|
| Min. Negotiated Rate |
$28.12 |
| Max. Negotiated Rate |
$371.45 |
| Rate for Payer: Aetna Commercial |
$371.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$336.26
|
| Rate for Payer: Aetna Managed Medicare |
$28.12
|
| Rate for Payer: Anthem Medicare Advantage |
$28.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$28.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$28.12
|
| Rate for Payer: Cash Price |
$117.30
|
| Rate for Payer: Cash Price |
$117.30
|
| Rate for Payer: Cigna Commercial |
$371.45
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$195.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$28.12
|
| Rate for Payer: Health EOS Commercial |
$355.81
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$97.96
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$97.96
|
| Rate for Payer: Independent Care Health Plan Medicare |
$28.12
|
| Rate for Payer: Multiplan Commercial |
$312.80
|
| Rate for Payer: Preferred Network Access Commercial |
$371.45
|
| Rate for Payer: Quartz Beloit One Network |
$172.04
|
| Rate for Payer: Quartz Commercial |
$222.87
|
| Rate for Payer: Quartz Medicare Advantage |
$28.12
|
| Rate for Payer: The Alliance Commercial |
$106.86
|
| Rate for Payer: United Healthcare Medicare Advantage |
$28.12
|
| Rate for Payer: WEA Trust Commercial |
$215.05
|
| Rate for Payer: WPS Commercial |
$140.60
|
|
|
XR Toes 5th Digit Right
|
Facility
OP
|
$391.00
|
|
|
Service Code
|
CPT 73660
|
| Hospital Charge Code |
629876
|
| 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 Toes 5th Digit Right
|
Professional
|
$402.00
|
|
|
Service Code
|
CPT 73660 T9,TC
|
| Hospital Charge Code |
1537411
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$176.88 |
| Max. Negotiated Rate |
$381.90 |
| Rate for Payer: Aetna Commercial |
$381.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$345.72
|
| Rate for Payer: Cash Price |
$120.60
|
| Rate for Payer: Cash Price |
$120.60
|
| Rate for Payer: Cigna Commercial |
$381.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$201.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$241.20
|
| Rate for Payer: Health EOS Commercial |
$365.82
|
| Rate for Payer: Multiplan Commercial |
$321.60
|
| Rate for Payer: Preferred Network Access Commercial |
$381.90
|
| Rate for Payer: Quartz Beloit One Network |
$176.88
|
| Rate for Payer: Quartz Commercial |
$229.14
|
| Rate for Payer: The Alliance Commercial |
$201.00
|
| Rate for Payer: WEA Trust Commercial |
$221.10
|
| Rate for Payer: WPS Commercial |
$297.76
|
|
|
XR Toes 5th Digit Right
|
Facility
IP
|
$402.00
|
|
|
Service Code
|
CPT 73660 T9,TC
|
| Hospital Charge Code |
1537411
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$196.98 |
| Max. Negotiated Rate |
$369.84 |
| Rate for Payer: Aetna Commercial |
$361.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$213.06
|
| Rate for Payer: Cash Price |
$120.60
|
| Rate for Payer: Cigna Commercial |
$369.84
|
| Rate for Payer: Health EOS Commercial |
$357.78
|
| Rate for Payer: HFN Commercial |
$369.84
|
| Rate for Payer: Multiplan Commercial |
$321.60
|
| Rate for Payer: NAPHCARE Commercial |
$241.20
|
| Rate for Payer: Preferred Network Access Commercial |
$369.84
|
| Rate for Payer: Quartz Beloit One Network |
$196.98
|
| Rate for Payer: Quartz Commercial |
$241.20
|
| Rate for Payer: WEA Trust Commercial |
$221.10
|
| Rate for Payer: WPS Commercial |
$297.76
|
|
|
XR Toes 5th Digit Right
|
Facility
OP
|
$402.00
|
|
|
Service Code
|
CPT 73660 T9,TC
|
| Hospital Charge Code |
1537411
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$112.56 |
| Max. Negotiated Rate |
$1,608.00 |
| Rate for Payer: Aetna Commercial |
$361.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$345.72
|
| Rate for Payer: Aetna Managed Medicare |
$112.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$261.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$201.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$192.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$213.06
|
| Rate for Payer: Cash Price |
$120.60
|
| Rate for Payer: Cash Price |
$120.60
|
| Rate for Payer: Cash Price |
$120.60
|
| Rate for Payer: Cigna Commercial |
$369.84
|
| Rate for Payer: Health EOS Commercial |
$357.78
|
| Rate for Payer: HFN Commercial |
$369.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$301.50
|
| Rate for Payer: Multiplan Commercial |
$321.60
|
| Rate for Payer: NAPHCARE Commercial |
$241.20
|
| Rate for Payer: Preferred Network Access Commercial |
$369.84
|
| Rate for Payer: Quartz Beloit One Network |
$196.98
|
| Rate for Payer: Quartz Commercial |
$261.30
|
| Rate for Payer: Quartz Medicare Advantage |
$241.20
|
| Rate for Payer: The Alliance Commercial |
$1,608.00
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$221.10
|
| Rate for Payer: WPS Commercial |
$297.76
|
|
|
XR Toes 5th Digit Right
|
Facility
IP
|
$391.00
|
|
|
Service Code
|
CPT 73660
|
| Hospital Charge Code |
629876
|
| Min. Negotiated Rate |
$191.59 |
| Max. Negotiated Rate |
$359.72 |
| Rate for Payer: Aetna Commercial |
$351.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$207.23
|
| Rate for Payer: Cash Price |
$117.30
|
| Rate for Payer: Cigna Commercial |
$359.72
|
| Rate for Payer: Health EOS Commercial |
$347.99
|
| Rate for Payer: HFN Commercial |
$359.72
|
| Rate for Payer: Multiplan Commercial |
$312.80
|
| Rate for Payer: NAPHCARE Commercial |
$234.60
|
| Rate for Payer: Preferred Network Access Commercial |
$359.72
|
| Rate for Payer: Quartz Beloit One Network |
$191.59
|
| Rate for Payer: Quartz Commercial |
$234.60
|
| Rate for Payer: WEA Trust Commercial |
$215.05
|
| Rate for Payer: WPS Commercial |
$289.61
|
|
|
XR Toes Great Left
|
Facility
IP
|
$402.00
|
|
|
Service Code
|
CPT 73660 TA,TC
|
| Hospital Charge Code |
1537413
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$196.98 |
| Max. Negotiated Rate |
$369.84 |
| Rate for Payer: Aetna Commercial |
$361.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$213.06
|
| Rate for Payer: Cash Price |
$120.60
|
| Rate for Payer: Cigna Commercial |
$369.84
|
| Rate for Payer: Health EOS Commercial |
$357.78
|
| Rate for Payer: HFN Commercial |
$369.84
|
| Rate for Payer: Multiplan Commercial |
$321.60
|
| Rate for Payer: NAPHCARE Commercial |
$241.20
|
| Rate for Payer: Preferred Network Access Commercial |
$369.84
|
| Rate for Payer: Quartz Beloit One Network |
$196.98
|
| Rate for Payer: Quartz Commercial |
$241.20
|
| Rate for Payer: WEA Trust Commercial |
$221.10
|
| Rate for Payer: WPS Commercial |
$297.76
|
|
|
XR Toes Great Left
|
Professional
|
$391.00
|
|
|
Service Code
|
CPT 73660
|
| Hospital Charge Code |
629866
|
| Min. Negotiated Rate |
$28.12 |
| Max. Negotiated Rate |
$371.45 |
| Rate for Payer: Aetna Commercial |
$371.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$336.26
|
| Rate for Payer: Aetna Managed Medicare |
$28.12
|
| Rate for Payer: Anthem Medicare Advantage |
$28.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$28.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$28.12
|
| Rate for Payer: Cash Price |
$117.30
|
| Rate for Payer: Cash Price |
$117.30
|
| Rate for Payer: Cigna Commercial |
$371.45
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$195.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$28.12
|
| Rate for Payer: Health EOS Commercial |
$355.81
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$97.96
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$97.96
|
| Rate for Payer: Independent Care Health Plan Medicare |
$28.12
|
| Rate for Payer: Multiplan Commercial |
$312.80
|
| Rate for Payer: Preferred Network Access Commercial |
$371.45
|
| Rate for Payer: Quartz Beloit One Network |
$172.04
|
| Rate for Payer: Quartz Commercial |
$222.87
|
| Rate for Payer: Quartz Medicare Advantage |
$28.12
|
| Rate for Payer: The Alliance Commercial |
$106.86
|
| Rate for Payer: United Healthcare Medicare Advantage |
$28.12
|
| Rate for Payer: WEA Trust Commercial |
$215.05
|
| Rate for Payer: WPS Commercial |
$140.60
|
|
|
XR Toes Great Left
|
Facility
OP
|
$402.00
|
|
|
Service Code
|
CPT 73660 TA,TC
|
| Hospital Charge Code |
1537413
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$112.56 |
| Max. Negotiated Rate |
$1,608.00 |
| Rate for Payer: Aetna Commercial |
$361.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$345.72
|
| Rate for Payer: Aetna Managed Medicare |
$112.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$261.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$201.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$192.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$213.06
|
| Rate for Payer: Cash Price |
$120.60
|
| Rate for Payer: Cash Price |
$120.60
|
| Rate for Payer: Cash Price |
$120.60
|
| Rate for Payer: Cigna Commercial |
$369.84
|
| Rate for Payer: Health EOS Commercial |
$357.78
|
| Rate for Payer: HFN Commercial |
$369.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$301.50
|
| Rate for Payer: Multiplan Commercial |
$321.60
|
| Rate for Payer: NAPHCARE Commercial |
$241.20
|
| Rate for Payer: Preferred Network Access Commercial |
$369.84
|
| Rate for Payer: Quartz Beloit One Network |
$196.98
|
| Rate for Payer: Quartz Commercial |
$261.30
|
| Rate for Payer: Quartz Medicare Advantage |
$241.20
|
| Rate for Payer: The Alliance Commercial |
$1,608.00
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$221.10
|
| Rate for Payer: WPS Commercial |
$297.76
|
|
|
XR Toes Great Left
|
Professional
|
$402.00
|
|
|
Service Code
|
CPT 73660 TA,TC
|
| Hospital Charge Code |
1537413
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$176.88 |
| Max. Negotiated Rate |
$381.90 |
| Rate for Payer: Aetna Commercial |
$381.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$345.72
|
| Rate for Payer: Cash Price |
$120.60
|
| Rate for Payer: Cash Price |
$120.60
|
| Rate for Payer: Cigna Commercial |
$381.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$201.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$241.20
|
| Rate for Payer: Health EOS Commercial |
$365.82
|
| Rate for Payer: Multiplan Commercial |
$321.60
|
| Rate for Payer: Preferred Network Access Commercial |
$381.90
|
| Rate for Payer: Quartz Beloit One Network |
$176.88
|
| Rate for Payer: Quartz Commercial |
$229.14
|
| Rate for Payer: The Alliance Commercial |
$201.00
|
| Rate for Payer: WEA Trust Commercial |
$221.10
|
| Rate for Payer: WPS Commercial |
$297.76
|
|
|
XR Toes Great Left
|
Facility
OP
|
$391.00
|
|
|
Service Code
|
CPT 73660
|
| Hospital Charge Code |
629866
|
| 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 Toes Great Left
|
Facility
IP
|
$391.00
|
|
|
Service Code
|
CPT 73660
|
| Hospital Charge Code |
629866
|
| Min. Negotiated Rate |
$191.59 |
| Max. Negotiated Rate |
$359.72 |
| Rate for Payer: Aetna Commercial |
$351.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$207.23
|
| Rate for Payer: Cash Price |
$117.30
|
| Rate for Payer: Cigna Commercial |
$359.72
|
| Rate for Payer: Health EOS Commercial |
$347.99
|
| Rate for Payer: HFN Commercial |
$359.72
|
| Rate for Payer: Multiplan Commercial |
$312.80
|
| Rate for Payer: NAPHCARE Commercial |
$234.60
|
| Rate for Payer: Preferred Network Access Commercial |
$359.72
|
| Rate for Payer: Quartz Beloit One Network |
$191.59
|
| Rate for Payer: Quartz Commercial |
$234.60
|
| Rate for Payer: WEA Trust Commercial |
$215.05
|
| Rate for Payer: WPS Commercial |
$289.61
|
|
|
XR Toes Great Right
|
Professional
|
$402.00
|
|
|
Service Code
|
CPT 73660 TC,T5
|
| Hospital Charge Code |
1537415
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$176.88 |
| Max. Negotiated Rate |
$381.90 |
| Rate for Payer: Aetna Commercial |
$381.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$345.72
|
| Rate for Payer: Cash Price |
$120.60
|
| Rate for Payer: Cash Price |
$120.60
|
| Rate for Payer: Cigna Commercial |
$381.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$201.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$241.20
|
| Rate for Payer: Health EOS Commercial |
$365.82
|
| Rate for Payer: Multiplan Commercial |
$321.60
|
| Rate for Payer: Preferred Network Access Commercial |
$381.90
|
| Rate for Payer: Quartz Beloit One Network |
$176.88
|
| Rate for Payer: Quartz Commercial |
$229.14
|
| Rate for Payer: The Alliance Commercial |
$201.00
|
| Rate for Payer: WEA Trust Commercial |
$221.10
|
| Rate for Payer: WPS Commercial |
$297.76
|
|
