|
XR Pod Foot 2 Views Bilateral
|
Facility
|
OP
|
$468.00
|
|
|
Service Code
|
CPT 73620 LT
|
| Hospital Charge Code |
2587271
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$136.28 |
| Max. Negotiated Rate |
$447.78 |
| Rate for Payer: Aetna Commercial |
$438.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$418.58
|
| Rate for Payer: Aetna Managed Medicare |
$136.28
|
| 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 |
$257.96
|
| Rate for Payer: Cash Price |
$140.40
|
| Rate for Payer: Cash Price |
$140.40
|
| Rate for Payer: Cash Price |
$140.40
|
| Rate for Payer: Cigna Commercial |
$447.78
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$272.38
|
| Rate for Payer: Health EOS Commercial |
$433.18
|
| Rate for Payer: HFN Commercial |
$447.78
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$365.04
|
| Rate for Payer: Multiplan Commercial |
$389.38
|
| Rate for Payer: NAPHCARE Commercial |
$292.03
|
| Rate for Payer: Preferred Network Access Commercial |
$447.78
|
| Rate for Payer: Quartz Beloit One Network |
$238.49
|
| Rate for Payer: Quartz Commercial |
$316.37
|
| Rate for Payer: Quartz Medicare Advantage |
$292.03
|
| Rate for Payer: The Alliance Commercial |
$243.36
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$267.70
|
| Rate for Payer: WPS Commercial |
$360.50
|
|
|
XR Pod Foot 2 Views Bilateral
|
Facility
|
IP
|
$468.00
|
|
|
Service Code
|
CPT 73620 LT
|
| Hospital Charge Code |
2587271
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$238.49 |
| Max. Negotiated Rate |
$447.78 |
| Rate for Payer: Aetna Commercial |
$438.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$418.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$257.96
|
| Rate for Payer: Cash Price |
$140.40
|
| Rate for Payer: Cigna Commercial |
$447.78
|
| Rate for Payer: Health EOS Commercial |
$433.18
|
| Rate for Payer: HFN Commercial |
$447.78
|
| Rate for Payer: Multiplan Commercial |
$389.38
|
| Rate for Payer: Preferred Network Access Commercial |
$447.78
|
| Rate for Payer: Quartz Beloit One Network |
$238.49
|
| Rate for Payer: Quartz Commercial |
$292.03
|
| Rate for Payer: WEA Trust Commercial |
$267.70
|
| Rate for Payer: WPS Commercial |
$360.50
|
|
|
XR Pod Foot 2 Views Bilateral
|
Professional
|
Both
|
$468.00
|
|
|
Service Code
|
CPT 73620 LT
|
| Hospital Charge Code |
2587271
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$99.67 |
| Max. Negotiated Rate |
$462.38 |
| Rate for Payer: Aetna Commercial |
$462.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$418.58
|
| Rate for Payer: Cash Price |
$140.40
|
| Rate for Payer: Cash Price |
$140.40
|
| Rate for Payer: Cash Price |
$140.40
|
| Rate for Payer: Cigna Commercial |
$462.38
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$243.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$292.03
|
| Rate for Payer: Health EOS Commercial |
$442.92
|
| Rate for Payer: HFN Commercial |
$462.38
|
| 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 |
$389.38
|
| Rate for Payer: Preferred Network Access Commercial |
$462.38
|
| Rate for Payer: Quartz Beloit One Network |
$214.16
|
| Rate for Payer: Quartz Commercial |
$277.43
|
| Rate for Payer: The Alliance Commercial |
$243.36
|
| Rate for Payer: WEA Trust Commercial |
$267.70
|
| Rate for Payer: WPS Commercial |
$360.50
|
|
|
XR Pod Foot 2 Views Left
|
Professional
|
Both
|
$486.00
|
|
|
Service Code
|
CPT 73620 LT
|
| Hospital Charge Code |
2587274
|
|
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 Pod Foot 2 Views Left
|
Professional
|
Both
|
$450.00
|
|
|
Service Code
|
CPT 73620
|
| Hospital Charge Code |
2448828
|
| 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 Pod Foot 2 Views Left
|
Facility
|
OP
|
$486.00
|
|
|
Service Code
|
CPT 73620 LT
|
| Hospital Charge Code |
2587274
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$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 Pod Foot 2 Views Left
|
Facility
|
IP
|
$450.00
|
|
|
Service Code
|
CPT 73620
|
| Hospital Charge Code |
2448828
|
| 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 Pod Foot 2 Views Left
|
Facility
|
IP
|
$486.00
|
|
|
Service Code
|
CPT 73620 LT
|
| Hospital Charge Code |
2587274
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$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 Pod Foot 2 Views Left
|
Facility
|
OP
|
$450.00
|
|
|
Service Code
|
CPT 73620
|
| Hospital Charge Code |
2448828
|
| 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 Pod Foot 2 Views Right
|
Professional
|
Both
|
$486.00
|
|
|
Service Code
|
CPT 73620 RT
|
| Hospital Charge Code |
2587277
|
|
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 Pod Foot 2 Views Right
|
Facility
|
IP
|
$450.00
|
|
|
Service Code
|
CPT 73620
|
| Hospital Charge Code |
2448829
|
| 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 Pod Foot 2 Views Right
|
Facility
|
OP
|
$450.00
|
|
|
Service Code
|
CPT 73620
|
| Hospital Charge Code |
2448829
|
| 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 Pod Foot 2 Views Right
|
Facility
|
OP
|
$468.00
|
|
|
Service Code
|
CPT 73620 TC,RT
|
| Hospital Charge Code |
2980066
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$136.28 |
| Max. Negotiated Rate |
$447.78 |
| Rate for Payer: Aetna Commercial |
$438.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$418.58
|
| Rate for Payer: Aetna Managed Medicare |
$136.28
|
| 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 |
$257.96
|
| Rate for Payer: Cash Price |
$140.40
|
| Rate for Payer: Cash Price |
$140.40
|
| Rate for Payer: Cash Price |
$140.40
|
| Rate for Payer: Cigna Commercial |
$447.78
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$272.38
|
| Rate for Payer: Health EOS Commercial |
$433.18
|
| Rate for Payer: HFN Commercial |
$447.78
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$365.04
|
| Rate for Payer: Multiplan Commercial |
$389.38
|
| Rate for Payer: NAPHCARE Commercial |
$292.03
|
| Rate for Payer: Preferred Network Access Commercial |
$447.78
|
| Rate for Payer: Quartz Beloit One Network |
$238.49
|
| Rate for Payer: Quartz Commercial |
$316.37
|
| Rate for Payer: Quartz Medicare Advantage |
$292.03
|
| Rate for Payer: The Alliance Commercial |
$243.36
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$267.70
|
| Rate for Payer: WPS Commercial |
$360.50
|
|
|
XR Pod Foot 2 Views Right
|
Professional
|
Both
|
$468.00
|
|
|
Service Code
|
CPT 73620 TC,RT
|
| Hospital Charge Code |
2980066
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$99.67 |
| Max. Negotiated Rate |
$462.38 |
| Rate for Payer: Aetna Commercial |
$462.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$418.58
|
| Rate for Payer: Cash Price |
$140.40
|
| Rate for Payer: Cash Price |
$140.40
|
| Rate for Payer: Cash Price |
$140.40
|
| Rate for Payer: Cigna Commercial |
$462.38
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$243.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$292.03
|
| Rate for Payer: Health EOS Commercial |
$442.92
|
| Rate for Payer: HFN Commercial |
$462.38
|
| 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 |
$389.38
|
| Rate for Payer: Preferred Network Access Commercial |
$462.38
|
| Rate for Payer: Quartz Beloit One Network |
$214.16
|
| Rate for Payer: Quartz Commercial |
$277.43
|
| Rate for Payer: The Alliance Commercial |
$243.36
|
| Rate for Payer: WEA Trust Commercial |
$267.70
|
| Rate for Payer: WPS Commercial |
$360.50
|
|
|
XR Pod Foot 2 Views Right
|
Facility
|
OP
|
$486.00
|
|
|
Service Code
|
CPT 73620 RT
|
| Hospital Charge Code |
2587277
|
|
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 Pod Foot 2 Views Right
|
Facility
|
IP
|
$468.00
|
|
|
Service Code
|
CPT 73620 TC,RT
|
| Hospital Charge Code |
2980066
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$238.49 |
| Max. Negotiated Rate |
$447.78 |
| Rate for Payer: Aetna Commercial |
$438.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$418.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$257.96
|
| Rate for Payer: Cash Price |
$140.40
|
| Rate for Payer: Cigna Commercial |
$447.78
|
| Rate for Payer: Health EOS Commercial |
$433.18
|
| Rate for Payer: HFN Commercial |
$447.78
|
| Rate for Payer: Multiplan Commercial |
$389.38
|
| Rate for Payer: Preferred Network Access Commercial |
$447.78
|
| Rate for Payer: Quartz Beloit One Network |
$238.49
|
| Rate for Payer: Quartz Commercial |
$292.03
|
| Rate for Payer: WEA Trust Commercial |
$267.70
|
| Rate for Payer: WPS Commercial |
$360.50
|
|
|
XR Pod Foot 2 Views Right
|
Facility
|
IP
|
$486.00
|
|
|
Service Code
|
CPT 73620 RT
|
| Hospital Charge Code |
2587277
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$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 Pod Foot 2 Views Right
|
Professional
|
Both
|
$450.00
|
|
|
Service Code
|
CPT 73620
|
| Hospital Charge Code |
2448829
|
| 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 Pod Foot Complete Bilateral
|
Facility
|
OP
|
$558.00
|
|
|
Service Code
|
CPT 73630 LT
|
| Hospital Charge Code |
2587280
|
|
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 Pod Foot Complete Bilateral
|
Facility
|
IP
|
$558.00
|
|
|
Service Code
|
CPT 73630 LT
|
| Hospital Charge Code |
2587280
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$284.36 |
| Max. Negotiated Rate |
$533.89 |
| Rate for Payer: Aetna Commercial |
$522.29
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$499.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$307.57
|
| Rate for Payer: Cash Price |
$167.40
|
| Rate for Payer: Cigna Commercial |
$533.89
|
| Rate for Payer: Health EOS Commercial |
$516.48
|
| Rate for Payer: HFN Commercial |
$533.89
|
| Rate for Payer: Multiplan Commercial |
$464.26
|
| Rate for Payer: Preferred Network Access Commercial |
$533.89
|
| Rate for Payer: Quartz Beloit One Network |
$284.36
|
| Rate for Payer: Quartz Commercial |
$348.19
|
| Rate for Payer: WEA Trust Commercial |
$319.18
|
| Rate for Payer: WPS Commercial |
$429.83
|
|
|
XR Pod Foot Complete Bilateral
|
Professional
|
Both
|
$558.00
|
|
|
Service Code
|
CPT 73630 LT
|
| Hospital Charge Code |
2587280
|
|
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 Pod Foot Complete Left
|
Facility
|
OP
|
$558.00
|
|
|
Service Code
|
CPT 73630 LT
|
| Hospital Charge Code |
2587283
|
|
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 Pod Foot Complete Left
|
Facility
|
IP
|
$558.00
|
|
|
Service Code
|
CPT 73630 LT
|
| Hospital Charge Code |
2587283
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$284.36 |
| Max. Negotiated Rate |
$533.89 |
| Rate for Payer: Aetna Commercial |
$522.29
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$499.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$307.57
|
| Rate for Payer: Cash Price |
$167.40
|
| Rate for Payer: Cigna Commercial |
$533.89
|
| Rate for Payer: Health EOS Commercial |
$516.48
|
| Rate for Payer: HFN Commercial |
$533.89
|
| Rate for Payer: Multiplan Commercial |
$464.26
|
| Rate for Payer: Preferred Network Access Commercial |
$533.89
|
| Rate for Payer: Quartz Beloit One Network |
$284.36
|
| Rate for Payer: Quartz Commercial |
$348.19
|
| Rate for Payer: WEA Trust Commercial |
$319.18
|
| Rate for Payer: WPS Commercial |
$429.83
|
|
|
XR Pod Foot Complete Left
|
Professional
|
Both
|
$516.00
|
|
|
Service Code
|
CPT 73630
|
| Hospital Charge Code |
2448831
|
| Min. Negotiated Rate |
$33.74 |
| Max. Negotiated Rate |
$509.81 |
| Rate for Payer: Aetna Commercial |
$509.81
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$461.51
|
| Rate for Payer: Aetna Managed Medicare |
$33.74
|
| Rate for Payer: Anthem Medicare Advantage |
$33.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$33.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$33.74
|
| Rate for Payer: Cash Price |
$154.80
|
| Rate for Payer: Cash Price |
$154.80
|
| Rate for Payer: Cash Price |
$154.80
|
| Rate for Payer: Cigna Commercial |
$509.81
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$268.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$33.74
|
| Rate for Payer: Health EOS Commercial |
$488.34
|
| Rate for Payer: HFN Commercial |
$509.81
|
| 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: Independent Care Health Plan Medicare |
$33.74
|
| Rate for Payer: Multiplan Commercial |
$429.31
|
| Rate for Payer: NAPHCARE Commercial |
$50.61
|
| Rate for Payer: Preferred Network Access Commercial |
$509.81
|
| Rate for Payer: Quartz Beloit One Network |
$236.12
|
| Rate for Payer: Quartz Commercial |
$305.88
|
| Rate for Payer: Quartz Medicare Advantage |
$33.74
|
| Rate for Payer: The Alliance Commercial |
$128.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$33.74
|
| Rate for Payer: WEA Trust Commercial |
$295.15
|
| Rate for Payer: WPS Commercial |
$168.69
|
|
|
XR Pod Foot Complete Left
|
Facility
|
IP
|
$516.00
|
|
|
Service Code
|
CPT 73630
|
| Hospital Charge Code |
2448831
|
| Min. Negotiated Rate |
$262.95 |
| Max. Negotiated Rate |
$493.71 |
| Rate for Payer: Aetna Commercial |
$482.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$461.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$284.42
|
| Rate for Payer: Cash Price |
$154.80
|
| Rate for Payer: Cigna Commercial |
$493.71
|
| Rate for Payer: Health EOS Commercial |
$477.61
|
| Rate for Payer: HFN Commercial |
$493.71
|
| Rate for Payer: Multiplan Commercial |
$429.31
|
| Rate for Payer: Preferred Network Access Commercial |
$493.71
|
| Rate for Payer: Quartz Beloit One Network |
$262.95
|
| Rate for Payer: Quartz Commercial |
$321.98
|
| Rate for Payer: WEA Trust Commercial |
$295.15
|
| Rate for Payer: WPS Commercial |
$397.47
|
|
