|
XR Pod Toes 4th Digit Left
|
Professional
|
Both
|
$407.00
|
|
|
Service Code
|
CPT 73660 T3
|
| Hospital Charge Code |
2587301
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$101.88 |
| Max. Negotiated Rate |
$402.12 |
| Rate for Payer: Aetna Commercial |
$402.12
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$364.02
|
| 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 |
$402.12
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$211.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$253.97
|
| Rate for Payer: Health EOS Commercial |
$385.18
|
| Rate for Payer: HFN Commercial |
$402.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$101.88
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$101.88
|
| Rate for Payer: Multiplan Commercial |
$338.62
|
| Rate for Payer: Preferred Network Access Commercial |
$402.12
|
| Rate for Payer: Quartz Beloit One Network |
$186.24
|
| Rate for Payer: Quartz Commercial |
$241.27
|
| Rate for Payer: The Alliance Commercial |
$211.64
|
| Rate for Payer: WEA Trust Commercial |
$232.80
|
| Rate for Payer: WPS Commercial |
$313.51
|
|
|
XR Pod Toes 4th Digit Left
|
Professional
|
Both
|
$391.00
|
|
|
Service Code
|
CPT 73660
|
| Hospital Charge Code |
2448835
|
| Min. Negotiated Rate |
$28.36 |
| Max. Negotiated Rate |
$386.31 |
| Rate for Payer: Aetna Commercial |
$386.31
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$349.71
|
| Rate for Payer: Aetna Managed Medicare |
$28.36
|
| Rate for Payer: Anthem Medicare Advantage |
$28.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$28.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$28.36
|
| Rate for Payer: Cash Price |
$117.30
|
| Rate for Payer: Cash Price |
$117.30
|
| Rate for Payer: Cash Price |
$117.30
|
| Rate for Payer: Cigna Commercial |
$386.31
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$203.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$28.36
|
| Rate for Payer: Health EOS Commercial |
$370.04
|
| Rate for Payer: HFN Commercial |
$386.31
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$101.88
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$101.88
|
| Rate for Payer: Independent Care Health Plan Medicare |
$28.36
|
| Rate for Payer: Multiplan Commercial |
$325.31
|
| Rate for Payer: NAPHCARE Commercial |
$42.54
|
| Rate for Payer: Preferred Network Access Commercial |
$386.31
|
| Rate for Payer: Quartz Beloit One Network |
$178.92
|
| Rate for Payer: Quartz Commercial |
$231.78
|
| Rate for Payer: Quartz Medicare Advantage |
$28.36
|
| Rate for Payer: The Alliance Commercial |
$107.77
|
| Rate for Payer: United Healthcare Medicare Advantage |
$28.36
|
| Rate for Payer: WEA Trust Commercial |
$223.65
|
| Rate for Payer: WPS Commercial |
$141.80
|
|
|
XR Pod Toes 4th Digit Left
|
Facility
|
IP
|
$407.00
|
|
|
Service Code
|
CPT 73660 T3
|
| Hospital Charge Code |
2587301
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$207.41 |
| Max. Negotiated Rate |
$389.42 |
| Rate for Payer: Aetna Commercial |
$380.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$364.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$224.34
|
| Rate for Payer: Cash Price |
$122.10
|
| Rate for Payer: Cigna Commercial |
$389.42
|
| Rate for Payer: Health EOS Commercial |
$376.72
|
| Rate for Payer: HFN Commercial |
$389.42
|
| Rate for Payer: Multiplan Commercial |
$338.62
|
| Rate for Payer: Preferred Network Access Commercial |
$389.42
|
| Rate for Payer: Quartz Beloit One Network |
$207.41
|
| Rate for Payer: Quartz Commercial |
$253.97
|
| Rate for Payer: WEA Trust Commercial |
$232.80
|
| Rate for Payer: WPS Commercial |
$313.51
|
|
|
XR Pod Toes 4th Digit Right
|
Professional
|
Both
|
$391.00
|
|
|
Service Code
|
CPT 73660
|
| Hospital Charge Code |
2448840
|
| Min. Negotiated Rate |
$28.36 |
| Max. Negotiated Rate |
$386.31 |
| Rate for Payer: Aetna Commercial |
$386.31
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$349.71
|
| Rate for Payer: Aetna Managed Medicare |
$28.36
|
| Rate for Payer: Anthem Medicare Advantage |
$28.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$28.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$28.36
|
| Rate for Payer: Cash Price |
$117.30
|
| Rate for Payer: Cash Price |
$117.30
|
| Rate for Payer: Cash Price |
$117.30
|
| Rate for Payer: Cigna Commercial |
$386.31
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$203.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$28.36
|
| Rate for Payer: Health EOS Commercial |
$370.04
|
| Rate for Payer: HFN Commercial |
$386.31
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$101.88
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$101.88
|
| Rate for Payer: Independent Care Health Plan Medicare |
$28.36
|
| Rate for Payer: Multiplan Commercial |
$325.31
|
| Rate for Payer: NAPHCARE Commercial |
$42.54
|
| Rate for Payer: Preferred Network Access Commercial |
$386.31
|
| Rate for Payer: Quartz Beloit One Network |
$178.92
|
| Rate for Payer: Quartz Commercial |
$231.78
|
| Rate for Payer: Quartz Medicare Advantage |
$28.36
|
| Rate for Payer: The Alliance Commercial |
$107.77
|
| Rate for Payer: United Healthcare Medicare Advantage |
$28.36
|
| Rate for Payer: WEA Trust Commercial |
$223.65
|
| Rate for Payer: WPS Commercial |
$141.80
|
|
|
XR Pod Toes 4th Digit Right
|
Facility
|
IP
|
$391.00
|
|
|
Service Code
|
CPT 73660
|
| Hospital Charge Code |
2448840
|
| Min. Negotiated Rate |
$199.25 |
| Max. Negotiated Rate |
$374.11 |
| Rate for Payer: Aetna Commercial |
$365.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$349.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$215.52
|
| Rate for Payer: Cash Price |
$117.30
|
| Rate for Payer: Cigna Commercial |
$374.11
|
| Rate for Payer: Health EOS Commercial |
$361.91
|
| Rate for Payer: HFN Commercial |
$374.11
|
| Rate for Payer: Multiplan Commercial |
$325.31
|
| Rate for Payer: Preferred Network Access Commercial |
$374.11
|
| Rate for Payer: Quartz Beloit One Network |
$199.25
|
| Rate for Payer: Quartz Commercial |
$243.98
|
| Rate for Payer: WEA Trust Commercial |
$223.65
|
| Rate for Payer: WPS Commercial |
$301.19
|
|
|
XR Pod Toes 4th Digit Right
|
Facility
|
OP
|
$407.00
|
|
|
Service Code
|
CPT 73660 T8
|
| Hospital Charge Code |
2587304
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$118.52 |
| Max. Negotiated Rate |
$389.42 |
| Rate for Payer: Aetna Commercial |
$380.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$364.02
|
| Rate for Payer: Aetna Managed Medicare |
$118.52
|
| 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 |
$224.34
|
| 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 |
$389.42
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$236.87
|
| Rate for Payer: Health EOS Commercial |
$376.72
|
| Rate for Payer: HFN Commercial |
$389.42
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$317.46
|
| Rate for Payer: Multiplan Commercial |
$338.62
|
| Rate for Payer: NAPHCARE Commercial |
$253.97
|
| Rate for Payer: Preferred Network Access Commercial |
$389.42
|
| Rate for Payer: Quartz Beloit One Network |
$207.41
|
| Rate for Payer: Quartz Commercial |
$275.13
|
| Rate for Payer: Quartz Medicare Advantage |
$253.97
|
| Rate for Payer: The Alliance Commercial |
$211.64
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$232.80
|
| Rate for Payer: WPS Commercial |
$313.51
|
|
|
XR Pod Toes 4th Digit Right
|
Facility
|
IP
|
$407.00
|
|
|
Service Code
|
CPT 73660 T8
|
| Hospital Charge Code |
2587304
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$207.41 |
| Max. Negotiated Rate |
$389.42 |
| Rate for Payer: Aetna Commercial |
$380.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$364.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$224.34
|
| Rate for Payer: Cash Price |
$122.10
|
| Rate for Payer: Cigna Commercial |
$389.42
|
| Rate for Payer: Health EOS Commercial |
$376.72
|
| Rate for Payer: HFN Commercial |
$389.42
|
| Rate for Payer: Multiplan Commercial |
$338.62
|
| Rate for Payer: Preferred Network Access Commercial |
$389.42
|
| Rate for Payer: Quartz Beloit One Network |
$207.41
|
| Rate for Payer: Quartz Commercial |
$253.97
|
| Rate for Payer: WEA Trust Commercial |
$232.80
|
| Rate for Payer: WPS Commercial |
$313.51
|
|
|
XR Pod Toes 4th Digit Right
|
Facility
|
OP
|
$391.00
|
|
|
Service Code
|
CPT 73660
|
| Hospital Charge Code |
2448840
|
| Min. Negotiated Rate |
$91.58 |
| Max. Negotiated Rate |
$374.11 |
| Rate for Payer: Aetna Commercial |
$365.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$349.71
|
| Rate for Payer: Aetna Managed Medicare |
$91.58
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$264.32
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$203.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$195.19
|
| Rate for Payer: Anthem Medicare Advantage |
$91.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$215.52
|
| 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 |
$117.30
|
| Rate for Payer: Cash Price |
$117.30
|
| Rate for Payer: Cigna Commercial |
$374.11
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$91.58
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$227.56
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$91.58
|
| Rate for Payer: Health EOS Commercial |
$361.91
|
| Rate for Payer: HFN Commercial |
$374.11
|
| 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 |
$325.31
|
| Rate for Payer: NAPHCARE Commercial |
$137.37
|
| Rate for Payer: Preferred Network Access Commercial |
$374.11
|
| Rate for Payer: Quartz Beloit One Network |
$199.25
|
| Rate for Payer: Quartz Commercial |
$264.32
|
| 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 |
$223.65
|
| Rate for Payer: Wellcare Medicare |
$91.58
|
| Rate for Payer: WPS Commercial |
$301.19
|
|
|
XR Pod Toes 4th Digit Right
|
Professional
|
Both
|
$407.00
|
|
|
Service Code
|
CPT 73660 T8
|
| Hospital Charge Code |
2587304
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$101.88 |
| Max. Negotiated Rate |
$402.12 |
| Rate for Payer: Aetna Commercial |
$402.12
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$364.02
|
| 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 |
$402.12
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$211.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$253.97
|
| Rate for Payer: Health EOS Commercial |
$385.18
|
| Rate for Payer: HFN Commercial |
$402.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$101.88
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$101.88
|
| Rate for Payer: Multiplan Commercial |
$338.62
|
| Rate for Payer: Preferred Network Access Commercial |
$402.12
|
| Rate for Payer: Quartz Beloit One Network |
$186.24
|
| Rate for Payer: Quartz Commercial |
$241.27
|
| Rate for Payer: The Alliance Commercial |
$211.64
|
| Rate for Payer: WEA Trust Commercial |
$232.80
|
| Rate for Payer: WPS Commercial |
$313.51
|
|
|
XR Pod Toes 5th Digit Left
|
Facility
|
IP
|
$391.00
|
|
|
Service Code
|
CPT 73660
|
| Hospital Charge Code |
2448836
|
| Min. Negotiated Rate |
$199.25 |
| Max. Negotiated Rate |
$374.11 |
| Rate for Payer: Aetna Commercial |
$365.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$349.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$215.52
|
| Rate for Payer: Cash Price |
$117.30
|
| Rate for Payer: Cigna Commercial |
$374.11
|
| Rate for Payer: Health EOS Commercial |
$361.91
|
| Rate for Payer: HFN Commercial |
$374.11
|
| Rate for Payer: Multiplan Commercial |
$325.31
|
| Rate for Payer: Preferred Network Access Commercial |
$374.11
|
| Rate for Payer: Quartz Beloit One Network |
$199.25
|
| Rate for Payer: Quartz Commercial |
$243.98
|
| Rate for Payer: WEA Trust Commercial |
$223.65
|
| Rate for Payer: WPS Commercial |
$301.19
|
|
|
XR Pod Toes 5th Digit Left
|
Facility
|
OP
|
$391.00
|
|
|
Service Code
|
CPT 73660
|
| Hospital Charge Code |
2448836
|
| Min. Negotiated Rate |
$91.58 |
| Max. Negotiated Rate |
$374.11 |
| Rate for Payer: Aetna Commercial |
$365.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$349.71
|
| Rate for Payer: Aetna Managed Medicare |
$91.58
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$264.32
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$203.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$195.19
|
| Rate for Payer: Anthem Medicare Advantage |
$91.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$215.52
|
| 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 |
$117.30
|
| Rate for Payer: Cash Price |
$117.30
|
| Rate for Payer: Cigna Commercial |
$374.11
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$91.58
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$227.56
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$91.58
|
| Rate for Payer: Health EOS Commercial |
$361.91
|
| Rate for Payer: HFN Commercial |
$374.11
|
| 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 |
$325.31
|
| Rate for Payer: NAPHCARE Commercial |
$137.37
|
| Rate for Payer: Preferred Network Access Commercial |
$374.11
|
| Rate for Payer: Quartz Beloit One Network |
$199.25
|
| Rate for Payer: Quartz Commercial |
$264.32
|
| 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 |
$223.65
|
| Rate for Payer: Wellcare Medicare |
$91.58
|
| Rate for Payer: WPS Commercial |
$301.19
|
|
|
XR Pod Toes 5th Digit Left
|
Professional
|
Both
|
$391.00
|
|
|
Service Code
|
CPT 73660
|
| Hospital Charge Code |
2448836
|
| Min. Negotiated Rate |
$28.36 |
| Max. Negotiated Rate |
$386.31 |
| Rate for Payer: Aetna Commercial |
$386.31
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$349.71
|
| Rate for Payer: Aetna Managed Medicare |
$28.36
|
| Rate for Payer: Anthem Medicare Advantage |
$28.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$28.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$28.36
|
| Rate for Payer: Cash Price |
$117.30
|
| Rate for Payer: Cash Price |
$117.30
|
| Rate for Payer: Cash Price |
$117.30
|
| Rate for Payer: Cigna Commercial |
$386.31
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$203.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$28.36
|
| Rate for Payer: Health EOS Commercial |
$370.04
|
| Rate for Payer: HFN Commercial |
$386.31
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$101.88
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$101.88
|
| Rate for Payer: Independent Care Health Plan Medicare |
$28.36
|
| Rate for Payer: Multiplan Commercial |
$325.31
|
| Rate for Payer: NAPHCARE Commercial |
$42.54
|
| Rate for Payer: Preferred Network Access Commercial |
$386.31
|
| Rate for Payer: Quartz Beloit One Network |
$178.92
|
| Rate for Payer: Quartz Commercial |
$231.78
|
| Rate for Payer: Quartz Medicare Advantage |
$28.36
|
| Rate for Payer: The Alliance Commercial |
$107.77
|
| Rate for Payer: United Healthcare Medicare Advantage |
$28.36
|
| Rate for Payer: WEA Trust Commercial |
$223.65
|
| Rate for Payer: WPS Commercial |
$141.80
|
|
|
XR Pod Toes 5th Digit Left
|
Facility
|
IP
|
$407.00
|
|
|
Service Code
|
CPT 73660 T4
|
| Hospital Charge Code |
2587307
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$207.41 |
| Max. Negotiated Rate |
$389.42 |
| Rate for Payer: Aetna Commercial |
$380.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$364.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$224.34
|
| Rate for Payer: Cash Price |
$122.10
|
| Rate for Payer: Cigna Commercial |
$389.42
|
| Rate for Payer: Health EOS Commercial |
$376.72
|
| Rate for Payer: HFN Commercial |
$389.42
|
| Rate for Payer: Multiplan Commercial |
$338.62
|
| Rate for Payer: Preferred Network Access Commercial |
$389.42
|
| Rate for Payer: Quartz Beloit One Network |
$207.41
|
| Rate for Payer: Quartz Commercial |
$253.97
|
| Rate for Payer: WEA Trust Commercial |
$232.80
|
| Rate for Payer: WPS Commercial |
$313.51
|
|
|
XR Pod Toes 5th Digit Left
|
Professional
|
Both
|
$407.00
|
|
|
Service Code
|
CPT 73660 T4
|
| Hospital Charge Code |
2587307
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$101.88 |
| Max. Negotiated Rate |
$402.12 |
| Rate for Payer: Aetna Commercial |
$402.12
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$364.02
|
| 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 |
$402.12
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$211.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$253.97
|
| Rate for Payer: Health EOS Commercial |
$385.18
|
| Rate for Payer: HFN Commercial |
$402.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$101.88
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$101.88
|
| Rate for Payer: Multiplan Commercial |
$338.62
|
| Rate for Payer: Preferred Network Access Commercial |
$402.12
|
| Rate for Payer: Quartz Beloit One Network |
$186.24
|
| Rate for Payer: Quartz Commercial |
$241.27
|
| Rate for Payer: The Alliance Commercial |
$211.64
|
| Rate for Payer: WEA Trust Commercial |
$232.80
|
| Rate for Payer: WPS Commercial |
$313.51
|
|
|
XR Pod Toes 5th Digit Left
|
Facility
|
OP
|
$407.00
|
|
|
Service Code
|
CPT 73660 T4
|
| Hospital Charge Code |
2587307
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$118.52 |
| Max. Negotiated Rate |
$389.42 |
| Rate for Payer: Aetna Commercial |
$380.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$364.02
|
| Rate for Payer: Aetna Managed Medicare |
$118.52
|
| 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 |
$224.34
|
| 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 |
$389.42
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$236.87
|
| Rate for Payer: Health EOS Commercial |
$376.72
|
| Rate for Payer: HFN Commercial |
$389.42
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$317.46
|
| Rate for Payer: Multiplan Commercial |
$338.62
|
| Rate for Payer: NAPHCARE Commercial |
$253.97
|
| Rate for Payer: Preferred Network Access Commercial |
$389.42
|
| Rate for Payer: Quartz Beloit One Network |
$207.41
|
| Rate for Payer: Quartz Commercial |
$275.13
|
| Rate for Payer: Quartz Medicare Advantage |
$253.97
|
| Rate for Payer: The Alliance Commercial |
$211.64
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$232.80
|
| Rate for Payer: WPS Commercial |
$313.51
|
|
|
XR Pod Toes 5th Digit Right
|
Facility
|
OP
|
$391.00
|
|
|
Service Code
|
CPT 73660
|
| Hospital Charge Code |
2448841
|
| Min. Negotiated Rate |
$91.58 |
| Max. Negotiated Rate |
$374.11 |
| Rate for Payer: Aetna Commercial |
$365.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$349.71
|
| Rate for Payer: Aetna Managed Medicare |
$91.58
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$264.32
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$203.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$195.19
|
| Rate for Payer: Anthem Medicare Advantage |
$91.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$215.52
|
| 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 |
$117.30
|
| Rate for Payer: Cash Price |
$117.30
|
| Rate for Payer: Cigna Commercial |
$374.11
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$91.58
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$227.56
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$91.58
|
| Rate for Payer: Health EOS Commercial |
$361.91
|
| Rate for Payer: HFN Commercial |
$374.11
|
| 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 |
$325.31
|
| Rate for Payer: NAPHCARE Commercial |
$137.37
|
| Rate for Payer: Preferred Network Access Commercial |
$374.11
|
| Rate for Payer: Quartz Beloit One Network |
$199.25
|
| Rate for Payer: Quartz Commercial |
$264.32
|
| 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 |
$223.65
|
| Rate for Payer: Wellcare Medicare |
$91.58
|
| Rate for Payer: WPS Commercial |
$301.19
|
|
|
XR Pod Toes 5th Digit Right
|
Facility
|
IP
|
$391.00
|
|
|
Service Code
|
CPT 73660
|
| Hospital Charge Code |
2448841
|
| Min. Negotiated Rate |
$199.25 |
| Max. Negotiated Rate |
$374.11 |
| Rate for Payer: Aetna Commercial |
$365.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$349.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$215.52
|
| Rate for Payer: Cash Price |
$117.30
|
| Rate for Payer: Cigna Commercial |
$374.11
|
| Rate for Payer: Health EOS Commercial |
$361.91
|
| Rate for Payer: HFN Commercial |
$374.11
|
| Rate for Payer: Multiplan Commercial |
$325.31
|
| Rate for Payer: Preferred Network Access Commercial |
$374.11
|
| Rate for Payer: Quartz Beloit One Network |
$199.25
|
| Rate for Payer: Quartz Commercial |
$243.98
|
| Rate for Payer: WEA Trust Commercial |
$223.65
|
| Rate for Payer: WPS Commercial |
$301.19
|
|
|
XR Pod Toes 5th Digit Right
|
Facility
|
IP
|
$407.00
|
|
|
Service Code
|
CPT 73660 T9
|
| Hospital Charge Code |
2587310
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$207.41 |
| Max. Negotiated Rate |
$389.42 |
| Rate for Payer: Aetna Commercial |
$380.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$364.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$224.34
|
| Rate for Payer: Cash Price |
$122.10
|
| Rate for Payer: Cigna Commercial |
$389.42
|
| Rate for Payer: Health EOS Commercial |
$376.72
|
| Rate for Payer: HFN Commercial |
$389.42
|
| Rate for Payer: Multiplan Commercial |
$338.62
|
| Rate for Payer: Preferred Network Access Commercial |
$389.42
|
| Rate for Payer: Quartz Beloit One Network |
$207.41
|
| Rate for Payer: Quartz Commercial |
$253.97
|
| Rate for Payer: WEA Trust Commercial |
$232.80
|
| Rate for Payer: WPS Commercial |
$313.51
|
|
|
XR Pod Toes 5th Digit Right
|
Professional
|
Both
|
$407.00
|
|
|
Service Code
|
CPT 73660 T9
|
| Hospital Charge Code |
2587310
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$101.88 |
| Max. Negotiated Rate |
$402.12 |
| Rate for Payer: Aetna Commercial |
$402.12
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$364.02
|
| 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 |
$402.12
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$211.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$253.97
|
| Rate for Payer: Health EOS Commercial |
$385.18
|
| Rate for Payer: HFN Commercial |
$402.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$101.88
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$101.88
|
| Rate for Payer: Multiplan Commercial |
$338.62
|
| Rate for Payer: Preferred Network Access Commercial |
$402.12
|
| Rate for Payer: Quartz Beloit One Network |
$186.24
|
| Rate for Payer: Quartz Commercial |
$241.27
|
| Rate for Payer: The Alliance Commercial |
$211.64
|
| Rate for Payer: WEA Trust Commercial |
$232.80
|
| Rate for Payer: WPS Commercial |
$313.51
|
|
|
XR Pod Toes 5th Digit Right
|
Facility
|
OP
|
$407.00
|
|
|
Service Code
|
CPT 73660 T9
|
| Hospital Charge Code |
2587310
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$118.52 |
| Max. Negotiated Rate |
$389.42 |
| Rate for Payer: Aetna Commercial |
$380.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$364.02
|
| Rate for Payer: Aetna Managed Medicare |
$118.52
|
| 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 |
$224.34
|
| 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 |
$389.42
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$236.87
|
| Rate for Payer: Health EOS Commercial |
$376.72
|
| Rate for Payer: HFN Commercial |
$389.42
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$317.46
|
| Rate for Payer: Multiplan Commercial |
$338.62
|
| Rate for Payer: NAPHCARE Commercial |
$253.97
|
| Rate for Payer: Preferred Network Access Commercial |
$389.42
|
| Rate for Payer: Quartz Beloit One Network |
$207.41
|
| Rate for Payer: Quartz Commercial |
$275.13
|
| Rate for Payer: Quartz Medicare Advantage |
$253.97
|
| Rate for Payer: The Alliance Commercial |
$211.64
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$232.80
|
| Rate for Payer: WPS Commercial |
$313.51
|
|
|
XR Pod Toes 5th Digit Right
|
Professional
|
Both
|
$391.00
|
|
|
Service Code
|
CPT 73660
|
| Hospital Charge Code |
2448841
|
| Min. Negotiated Rate |
$28.36 |
| Max. Negotiated Rate |
$386.31 |
| Rate for Payer: Aetna Commercial |
$386.31
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$349.71
|
| Rate for Payer: Aetna Managed Medicare |
$28.36
|
| Rate for Payer: Anthem Medicare Advantage |
$28.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$28.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$28.36
|
| Rate for Payer: Cash Price |
$117.30
|
| Rate for Payer: Cash Price |
$117.30
|
| Rate for Payer: Cash Price |
$117.30
|
| Rate for Payer: Cigna Commercial |
$386.31
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$203.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$28.36
|
| Rate for Payer: Health EOS Commercial |
$370.04
|
| Rate for Payer: HFN Commercial |
$386.31
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$101.88
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$101.88
|
| Rate for Payer: Independent Care Health Plan Medicare |
$28.36
|
| Rate for Payer: Multiplan Commercial |
$325.31
|
| Rate for Payer: NAPHCARE Commercial |
$42.54
|
| Rate for Payer: Preferred Network Access Commercial |
$386.31
|
| Rate for Payer: Quartz Beloit One Network |
$178.92
|
| Rate for Payer: Quartz Commercial |
$231.78
|
| Rate for Payer: Quartz Medicare Advantage |
$28.36
|
| Rate for Payer: The Alliance Commercial |
$107.77
|
| Rate for Payer: United Healthcare Medicare Advantage |
$28.36
|
| Rate for Payer: WEA Trust Commercial |
$223.65
|
| Rate for Payer: WPS Commercial |
$141.80
|
|
|
XR Pod Toes Great Left
|
Facility
|
IP
|
$391.00
|
|
|
Service Code
|
CPT 73660
|
| Hospital Charge Code |
2448837
|
| Min. Negotiated Rate |
$199.25 |
| Max. Negotiated Rate |
$374.11 |
| Rate for Payer: Aetna Commercial |
$365.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$349.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$215.52
|
| Rate for Payer: Cash Price |
$117.30
|
| Rate for Payer: Cigna Commercial |
$374.11
|
| Rate for Payer: Health EOS Commercial |
$361.91
|
| Rate for Payer: HFN Commercial |
$374.11
|
| Rate for Payer: Multiplan Commercial |
$325.31
|
| Rate for Payer: Preferred Network Access Commercial |
$374.11
|
| Rate for Payer: Quartz Beloit One Network |
$199.25
|
| Rate for Payer: Quartz Commercial |
$243.98
|
| Rate for Payer: WEA Trust Commercial |
$223.65
|
| Rate for Payer: WPS Commercial |
$301.19
|
|
|
XR Pod Toes Great Left
|
Facility
|
IP
|
$407.00
|
|
|
Service Code
|
CPT 73660 TA
|
| Hospital Charge Code |
2587313
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$207.41 |
| Max. Negotiated Rate |
$389.42 |
| Rate for Payer: Aetna Commercial |
$380.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$364.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$224.34
|
| Rate for Payer: Cash Price |
$122.10
|
| Rate for Payer: Cigna Commercial |
$389.42
|
| Rate for Payer: Health EOS Commercial |
$376.72
|
| Rate for Payer: HFN Commercial |
$389.42
|
| Rate for Payer: Multiplan Commercial |
$338.62
|
| Rate for Payer: Preferred Network Access Commercial |
$389.42
|
| Rate for Payer: Quartz Beloit One Network |
$207.41
|
| Rate for Payer: Quartz Commercial |
$253.97
|
| Rate for Payer: WEA Trust Commercial |
$232.80
|
| Rate for Payer: WPS Commercial |
$313.51
|
|
|
XR Pod Toes Great Left
|
Professional
|
Both
|
$407.00
|
|
|
Service Code
|
CPT 73660 TA
|
| Hospital Charge Code |
2587313
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$101.88 |
| Max. Negotiated Rate |
$402.12 |
| Rate for Payer: Aetna Commercial |
$402.12
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$364.02
|
| 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 |
$402.12
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$211.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$253.97
|
| Rate for Payer: Health EOS Commercial |
$385.18
|
| Rate for Payer: HFN Commercial |
$402.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$101.88
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$101.88
|
| Rate for Payer: Multiplan Commercial |
$338.62
|
| Rate for Payer: Preferred Network Access Commercial |
$402.12
|
| Rate for Payer: Quartz Beloit One Network |
$186.24
|
| Rate for Payer: Quartz Commercial |
$241.27
|
| Rate for Payer: The Alliance Commercial |
$211.64
|
| Rate for Payer: WEA Trust Commercial |
$232.80
|
| Rate for Payer: WPS Commercial |
$313.51
|
|
|
XR Pod Toes Great Left
|
Facility
|
OP
|
$407.00
|
|
|
Service Code
|
CPT 73660 TA
|
| Hospital Charge Code |
2587313
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$118.52 |
| Max. Negotiated Rate |
$389.42 |
| Rate for Payer: Aetna Commercial |
$380.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$364.02
|
| Rate for Payer: Aetna Managed Medicare |
$118.52
|
| 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 |
$224.34
|
| 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 |
$389.42
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$236.87
|
| Rate for Payer: Health EOS Commercial |
$376.72
|
| Rate for Payer: HFN Commercial |
$389.42
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$317.46
|
| Rate for Payer: Multiplan Commercial |
$338.62
|
| Rate for Payer: NAPHCARE Commercial |
$253.97
|
| Rate for Payer: Preferred Network Access Commercial |
$389.42
|
| Rate for Payer: Quartz Beloit One Network |
$207.41
|
| Rate for Payer: Quartz Commercial |
$275.13
|
| Rate for Payer: Quartz Medicare Advantage |
$253.97
|
| Rate for Payer: The Alliance Commercial |
$211.64
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$232.80
|
| Rate for Payer: WPS Commercial |
$313.51
|
|
