|
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
|
OP
|
$516.00
|
|
|
Service Code
|
CPT 73630
|
| Hospital Charge Code |
2448831
|
| Min. Negotiated Rate |
$91.58 |
| Max. Negotiated Rate |
$493.71 |
| Rate for Payer: Aetna Commercial |
$482.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$461.51
|
| Rate for Payer: Aetna Managed Medicare |
$91.58
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$348.82
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$268.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$257.59
|
| Rate for Payer: Anthem Medicare Advantage |
$91.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$284.42
|
| 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 |
$154.80
|
| Rate for Payer: Cash Price |
$154.80
|
| Rate for Payer: Cigna Commercial |
$493.71
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$91.58
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$300.31
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$91.58
|
| Rate for Payer: Health EOS Commercial |
$477.61
|
| Rate for Payer: HFN Commercial |
$493.71
|
| 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 |
$429.31
|
| Rate for Payer: NAPHCARE Commercial |
$137.37
|
| Rate for Payer: Preferred Network Access Commercial |
$493.71
|
| Rate for Payer: Quartz Beloit One Network |
$262.95
|
| Rate for Payer: Quartz Commercial |
$348.82
|
| 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 |
$295.15
|
| Rate for Payer: Wellcare Medicare |
$91.58
|
| Rate for Payer: WPS Commercial |
$397.47
|
|
|
XR Pod Foot Complete Right
|
Facility
|
IP
|
$516.00
|
|
|
Service Code
|
CPT 73630
|
| Hospital Charge Code |
2448832
|
| 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
|
|
|
XR Pod Foot Complete Right
|
Facility
|
OP
|
$516.00
|
|
|
Service Code
|
CPT 73630
|
| Hospital Charge Code |
2448832
|
| Min. Negotiated Rate |
$91.58 |
| Max. Negotiated Rate |
$493.71 |
| Rate for Payer: Aetna Commercial |
$482.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$461.51
|
| Rate for Payer: Aetna Managed Medicare |
$91.58
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$348.82
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$268.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$257.59
|
| Rate for Payer: Anthem Medicare Advantage |
$91.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$284.42
|
| 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 |
$154.80
|
| Rate for Payer: Cash Price |
$154.80
|
| Rate for Payer: Cigna Commercial |
$493.71
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$91.58
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$300.31
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$91.58
|
| Rate for Payer: Health EOS Commercial |
$477.61
|
| Rate for Payer: HFN Commercial |
$493.71
|
| 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 |
$429.31
|
| Rate for Payer: NAPHCARE Commercial |
$137.37
|
| Rate for Payer: Preferred Network Access Commercial |
$493.71
|
| Rate for Payer: Quartz Beloit One Network |
$262.95
|
| Rate for Payer: Quartz Commercial |
$348.82
|
| 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 |
$295.15
|
| Rate for Payer: Wellcare Medicare |
$91.58
|
| Rate for Payer: WPS Commercial |
$397.47
|
|
|
XR Pod Foot Complete Right
|
Professional
|
Both
|
$516.00
|
|
|
Service Code
|
CPT 73630
|
| Hospital Charge Code |
2448832
|
| 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 Right
|
Facility
|
IP
|
$558.00
|
|
|
Service Code
|
CPT 73630 TC,RT
|
| Hospital Charge Code |
3100297
|
|
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 Right
|
Facility
|
IP
|
$558.00
|
|
|
Service Code
|
CPT 73630 RT
|
| Hospital Charge Code |
2587286
|
|
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 Right
|
Professional
|
Both
|
$558.00
|
|
|
Service Code
|
CPT 73630 TC,RT
|
| Hospital Charge Code |
3100297
|
|
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 Right
|
Facility
|
OP
|
$558.00
|
|
|
Service Code
|
CPT 73630 RT
|
| Hospital Charge Code |
2587286
|
|
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 Right
|
Facility
|
OP
|
$558.00
|
|
|
Service Code
|
CPT 73630 TC,RT
|
| Hospital Charge Code |
3100297
|
|
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 Right
|
Professional
|
Both
|
$558.00
|
|
|
Service Code
|
CPT 73630 RT
|
| Hospital Charge Code |
2587286
|
|
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 Toes 2nd Digit Left
|
Facility
|
IP
|
$407.00
|
|
|
Service Code
|
CPT 73660 T1
|
| Hospital Charge Code |
2587289
|
|
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 2nd Digit Left
|
Professional
|
Both
|
$391.00
|
|
|
Service Code
|
CPT 73660
|
| Hospital Charge Code |
2448833
|
| 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 2nd Digit Left
|
Facility
|
OP
|
$391.00
|
|
|
Service Code
|
CPT 73660
|
| Hospital Charge Code |
2448833
|
| 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 2nd Digit Left
|
Professional
|
Both
|
$407.00
|
|
|
Service Code
|
CPT 73660 T1
|
| Hospital Charge Code |
2587289
|
|
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 2nd Digit Left
|
Facility
|
OP
|
$407.00
|
|
|
Service Code
|
CPT 73660 T1
|
| Hospital Charge Code |
2587289
|
|
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 2nd Digit Left
|
Facility
|
IP
|
$391.00
|
|
|
Service Code
|
CPT 73660
|
| Hospital Charge Code |
2448833
|
| 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 2nd Digit Right
|
Facility
|
OP
|
$391.00
|
|
|
Service Code
|
CPT 73660
|
| Hospital Charge Code |
2448838
|
| 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 2nd Digit Right
|
Professional
|
Both
|
$407.00
|
|
|
Service Code
|
CPT 73660 T6
|
| Hospital Charge Code |
2587292
|
|
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 2nd Digit Right
|
Professional
|
Both
|
$391.00
|
|
|
Service Code
|
CPT 73660
|
| Hospital Charge Code |
2448838
|
| 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 2nd Digit Right
|
Facility
|
IP
|
$391.00
|
|
|
Service Code
|
CPT 73660
|
| Hospital Charge Code |
2448838
|
| 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 2nd Digit Right
|
Facility
|
IP
|
$407.00
|
|
|
Service Code
|
CPT 73660 T6
|
| Hospital Charge Code |
2587292
|
|
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 2nd Digit Right
|
Facility
|
OP
|
$407.00
|
|
|
Service Code
|
CPT 73660 T6
|
| Hospital Charge Code |
2587292
|
|
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 3rd Digit Left
|
Professional
|
Both
|
$391.00
|
|
|
Service Code
|
CPT 73660
|
| Hospital Charge Code |
2448834
|
| 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 3rd Digit Left
|
Facility
|
OP
|
$407.00
|
|
|
Service Code
|
CPT 73660 T2
|
| Hospital Charge Code |
2587295
|
|
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
|
|
