|
PGA Amp Target Nuclerc Acid
|
Facility
|
OP
|
$300.00
|
|
| Hospital Charge Code |
2778810
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$84.00 |
| Max. Negotiated Rate |
$1,200.00 |
| Rate for Payer: Aetna Commercial |
$270.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$258.00
|
| Rate for Payer: Aetna Managed Medicare |
$84.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$195.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$150.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$144.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$159.00
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Cigna Commercial |
$276.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$167.88
|
| Rate for Payer: Health EOS Commercial |
$267.00
|
| Rate for Payer: HFN Commercial |
$276.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$225.00
|
| Rate for Payer: Multiplan Commercial |
$240.00
|
| Rate for Payer: NAPHCARE Commercial |
$180.00
|
| Rate for Payer: Preferred Network Access Commercial |
$276.00
|
| Rate for Payer: Quartz Beloit One Network |
$147.00
|
| Rate for Payer: Quartz Commercial |
$195.00
|
| Rate for Payer: Quartz Medicare Advantage |
$180.00
|
| Rate for Payer: The Alliance Commercial |
$1,200.00
|
| Rate for Payer: United Healthcare PPO |
$225.00
|
| Rate for Payer: WEA Trust Commercial |
$165.00
|
| Rate for Payer: WPS Commercial |
$222.21
|
|
|
PGA Amp Target Nuclerc Acid
|
Facility
|
IP
|
$300.00
|
|
| Hospital Charge Code |
2778810
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$147.00 |
| Max. Negotiated Rate |
$276.00 |
| Rate for Payer: Aetna Commercial |
$270.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$258.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$159.00
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Cigna Commercial |
$276.00
|
| Rate for Payer: Health EOS Commercial |
$267.00
|
| Rate for Payer: HFN Commercial |
$276.00
|
| Rate for Payer: Multiplan Commercial |
$240.00
|
| Rate for Payer: NAPHCARE Commercial |
$180.00
|
| Rate for Payer: Preferred Network Access Commercial |
$276.00
|
| Rate for Payer: Quartz Beloit One Network |
$147.00
|
| Rate for Payer: Quartz Commercial |
$180.00
|
| Rate for Payer: WEA Trust Commercial |
$165.00
|
| Rate for Payer: WPS Commercial |
$222.21
|
|
|
PGA Amp Target Nuclerc Acid
|
Professional
|
Both
|
$300.00
|
|
| Hospital Charge Code |
2778810
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$132.00 |
| Max. Negotiated Rate |
$285.00 |
| Rate for Payer: Aetna Commercial |
$285.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$258.00
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Cigna Commercial |
$285.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$150.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$180.00
|
| Rate for Payer: Health EOS Commercial |
$273.00
|
| Rate for Payer: HFN Commercial |
$285.00
|
| Rate for Payer: Multiplan Commercial |
$240.00
|
| Rate for Payer: Preferred Network Access Commercial |
$285.00
|
| Rate for Payer: Quartz Beloit One Network |
$132.00
|
| Rate for Payer: Quartz Commercial |
$171.00
|
| Rate for Payer: The Alliance Commercial |
$150.00
|
| Rate for Payer: WEA Trust Commercial |
$165.00
|
| Rate for Payer: WPS Commercial |
$222.21
|
|
|
PGA Interp & Report
|
Facility
|
OP
|
$114.00
|
|
| Hospital Charge Code |
2778811
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$31.92 |
| Max. Negotiated Rate |
$456.00 |
| Rate for Payer: Aetna Commercial |
$102.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$98.04
|
| Rate for Payer: Aetna Managed Medicare |
$31.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$74.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$57.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$54.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$60.42
|
| Rate for Payer: Cash Price |
$34.20
|
| Rate for Payer: Cigna Commercial |
$104.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$63.79
|
| Rate for Payer: Health EOS Commercial |
$101.46
|
| Rate for Payer: HFN Commercial |
$104.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$85.50
|
| Rate for Payer: Multiplan Commercial |
$91.20
|
| Rate for Payer: NAPHCARE Commercial |
$68.40
|
| Rate for Payer: Preferred Network Access Commercial |
$104.88
|
| Rate for Payer: Quartz Beloit One Network |
$55.86
|
| Rate for Payer: Quartz Commercial |
$74.10
|
| Rate for Payer: Quartz Medicare Advantage |
$68.40
|
| Rate for Payer: The Alliance Commercial |
$456.00
|
| Rate for Payer: United Healthcare PPO |
$85.50
|
| Rate for Payer: WEA Trust Commercial |
$62.70
|
| Rate for Payer: WPS Commercial |
$84.44
|
|
|
PGA Interp & Report
|
Facility
|
IP
|
$114.00
|
|
| Hospital Charge Code |
2778811
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$55.86 |
| Max. Negotiated Rate |
$104.88 |
| Rate for Payer: Aetna Commercial |
$102.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$98.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$60.42
|
| Rate for Payer: Cash Price |
$34.20
|
| Rate for Payer: Cigna Commercial |
$104.88
|
| Rate for Payer: Health EOS Commercial |
$101.46
|
| Rate for Payer: HFN Commercial |
$104.88
|
| Rate for Payer: Multiplan Commercial |
$91.20
|
| Rate for Payer: NAPHCARE Commercial |
$68.40
|
| Rate for Payer: Preferred Network Access Commercial |
$104.88
|
| Rate for Payer: Quartz Beloit One Network |
$55.86
|
| Rate for Payer: Quartz Commercial |
$68.40
|
| Rate for Payer: WEA Trust Commercial |
$62.70
|
| Rate for Payer: WPS Commercial |
$84.44
|
|
|
PGA Interp & Report
|
Professional
|
Both
|
$114.00
|
|
| Hospital Charge Code |
2778811
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$50.16 |
| Max. Negotiated Rate |
$108.30 |
| Rate for Payer: Aetna Commercial |
$108.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$98.04
|
| Rate for Payer: Cash Price |
$34.20
|
| Rate for Payer: Cigna Commercial |
$108.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$57.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$68.40
|
| Rate for Payer: Health EOS Commercial |
$103.74
|
| Rate for Payer: HFN Commercial |
$108.30
|
| Rate for Payer: Multiplan Commercial |
$91.20
|
| Rate for Payer: Preferred Network Access Commercial |
$108.30
|
| Rate for Payer: Quartz Beloit One Network |
$50.16
|
| Rate for Payer: Quartz Commercial |
$64.98
|
| Rate for Payer: The Alliance Commercial |
$57.00
|
| Rate for Payer: WEA Trust Commercial |
$62.70
|
| Rate for Payer: WPS Commercial |
$84.44
|
|
|
PGA Iso/Extract Nuclerc Acid
|
Facility
|
OP
|
$79.00
|
|
| Hospital Charge Code |
2778812
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$22.12 |
| Max. Negotiated Rate |
$316.00 |
| Rate for Payer: Aetna Commercial |
$71.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$67.94
|
| Rate for Payer: Aetna Managed Medicare |
$22.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$51.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$39.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$37.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$41.87
|
| Rate for Payer: Cash Price |
$23.70
|
| Rate for Payer: Cigna Commercial |
$72.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$44.21
|
| Rate for Payer: Health EOS Commercial |
$70.31
|
| Rate for Payer: HFN Commercial |
$72.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$59.25
|
| Rate for Payer: Multiplan Commercial |
$63.20
|
| Rate for Payer: NAPHCARE Commercial |
$47.40
|
| Rate for Payer: Preferred Network Access Commercial |
$72.68
|
| Rate for Payer: Quartz Beloit One Network |
$38.71
|
| Rate for Payer: Quartz Commercial |
$51.35
|
| Rate for Payer: Quartz Medicare Advantage |
$47.40
|
| Rate for Payer: The Alliance Commercial |
$316.00
|
| Rate for Payer: United Healthcare PPO |
$59.25
|
| Rate for Payer: WEA Trust Commercial |
$43.45
|
| Rate for Payer: WPS Commercial |
$58.52
|
|
|
PGA Iso/Extract Nuclerc Acid
|
Facility
|
IP
|
$79.00
|
|
| Hospital Charge Code |
2778812
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$38.71 |
| Max. Negotiated Rate |
$72.68 |
| Rate for Payer: Aetna Commercial |
$71.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$67.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$41.87
|
| Rate for Payer: Cash Price |
$23.70
|
| Rate for Payer: Cigna Commercial |
$72.68
|
| Rate for Payer: Health EOS Commercial |
$70.31
|
| Rate for Payer: HFN Commercial |
$72.68
|
| Rate for Payer: Multiplan Commercial |
$63.20
|
| Rate for Payer: NAPHCARE Commercial |
$47.40
|
| Rate for Payer: Preferred Network Access Commercial |
$72.68
|
| Rate for Payer: Quartz Beloit One Network |
$38.71
|
| Rate for Payer: Quartz Commercial |
$47.40
|
| Rate for Payer: WEA Trust Commercial |
$43.45
|
| Rate for Payer: WPS Commercial |
$58.52
|
|
|
PGA Iso/Extract Nuclerc Acid
|
Professional
|
Both
|
$79.00
|
|
| Hospital Charge Code |
2778812
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$34.76 |
| Max. Negotiated Rate |
$75.05 |
| Rate for Payer: Aetna Commercial |
$75.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$67.94
|
| Rate for Payer: Cash Price |
$23.70
|
| Rate for Payer: Cigna Commercial |
$75.05
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$39.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$47.40
|
| Rate for Payer: Health EOS Commercial |
$71.89
|
| Rate for Payer: HFN Commercial |
$75.05
|
| Rate for Payer: Multiplan Commercial |
$63.20
|
| Rate for Payer: Preferred Network Access Commercial |
$75.05
|
| Rate for Payer: Quartz Beloit One Network |
$34.76
|
| Rate for Payer: Quartz Commercial |
$45.03
|
| Rate for Payer: The Alliance Commercial |
$39.50
|
| Rate for Payer: WEA Trust Commercial |
$43.45
|
| Rate for Payer: WPS Commercial |
$58.52
|
|
|
PGA Mutat ID Enz Ligation
|
Facility
|
IP
|
$285.00
|
|
| Hospital Charge Code |
2778813
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$139.65 |
| Max. Negotiated Rate |
$262.20 |
| Rate for Payer: Aetna Commercial |
$256.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$245.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$151.05
|
| Rate for Payer: Cash Price |
$85.50
|
| Rate for Payer: Cigna Commercial |
$262.20
|
| Rate for Payer: Health EOS Commercial |
$253.65
|
| Rate for Payer: HFN Commercial |
$262.20
|
| Rate for Payer: Multiplan Commercial |
$228.00
|
| Rate for Payer: NAPHCARE Commercial |
$171.00
|
| Rate for Payer: Preferred Network Access Commercial |
$262.20
|
| Rate for Payer: Quartz Beloit One Network |
$139.65
|
| Rate for Payer: Quartz Commercial |
$171.00
|
| Rate for Payer: WEA Trust Commercial |
$156.75
|
| Rate for Payer: WPS Commercial |
$211.10
|
|
|
PGA Mutat ID Enz Ligation
|
Facility
|
OP
|
$285.00
|
|
| Hospital Charge Code |
2778813
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$79.80 |
| Max. Negotiated Rate |
$1,140.00 |
| Rate for Payer: Aetna Commercial |
$256.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$245.10
|
| Rate for Payer: Aetna Managed Medicare |
$79.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$185.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$142.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$136.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$151.05
|
| Rate for Payer: Cash Price |
$85.50
|
| Rate for Payer: Cigna Commercial |
$262.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$159.49
|
| Rate for Payer: Health EOS Commercial |
$253.65
|
| Rate for Payer: HFN Commercial |
$262.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$213.75
|
| Rate for Payer: Multiplan Commercial |
$228.00
|
| Rate for Payer: NAPHCARE Commercial |
$171.00
|
| Rate for Payer: Preferred Network Access Commercial |
$262.20
|
| Rate for Payer: Quartz Beloit One Network |
$139.65
|
| Rate for Payer: Quartz Commercial |
$185.25
|
| Rate for Payer: Quartz Medicare Advantage |
$171.00
|
| Rate for Payer: The Alliance Commercial |
$1,140.00
|
| Rate for Payer: United Healthcare PPO |
$213.75
|
| Rate for Payer: WEA Trust Commercial |
$156.75
|
| Rate for Payer: WPS Commercial |
$211.10
|
|
|
PGA Mutat ID Enz Ligation
|
Professional
|
Both
|
$285.00
|
|
| Hospital Charge Code |
2778813
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$125.40 |
| Max. Negotiated Rate |
$270.75 |
| Rate for Payer: Aetna Commercial |
$270.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$245.10
|
| Rate for Payer: Cash Price |
$85.50
|
| Rate for Payer: Cigna Commercial |
$270.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$142.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$171.00
|
| Rate for Payer: Health EOS Commercial |
$259.35
|
| Rate for Payer: HFN Commercial |
$270.75
|
| Rate for Payer: Multiplan Commercial |
$228.00
|
| Rate for Payer: Preferred Network Access Commercial |
$270.75
|
| Rate for Payer: Quartz Beloit One Network |
$125.40
|
| Rate for Payer: Quartz Commercial |
$162.45
|
| Rate for Payer: The Alliance Commercial |
$142.50
|
| Rate for Payer: WEA Trust Commercial |
$156.75
|
| Rate for Payer: WPS Commercial |
$211.10
|
|
|
PGA Sep & ID High Res
|
Facility
|
IP
|
$285.00
|
|
| Hospital Charge Code |
2778814
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$139.65 |
| Max. Negotiated Rate |
$262.20 |
| Rate for Payer: Aetna Commercial |
$256.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$245.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$151.05
|
| Rate for Payer: Cash Price |
$85.50
|
| Rate for Payer: Cigna Commercial |
$262.20
|
| Rate for Payer: Health EOS Commercial |
$253.65
|
| Rate for Payer: HFN Commercial |
$262.20
|
| Rate for Payer: Multiplan Commercial |
$228.00
|
| Rate for Payer: NAPHCARE Commercial |
$171.00
|
| Rate for Payer: Preferred Network Access Commercial |
$262.20
|
| Rate for Payer: Quartz Beloit One Network |
$139.65
|
| Rate for Payer: Quartz Commercial |
$171.00
|
| Rate for Payer: WEA Trust Commercial |
$156.75
|
| Rate for Payer: WPS Commercial |
$211.10
|
|
|
PGA Sep & ID High Res
|
Facility
|
OP
|
$285.00
|
|
| Hospital Charge Code |
2778814
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$79.80 |
| Max. Negotiated Rate |
$1,140.00 |
| Rate for Payer: Aetna Commercial |
$256.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$245.10
|
| Rate for Payer: Aetna Managed Medicare |
$79.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$185.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$142.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$136.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$151.05
|
| Rate for Payer: Cash Price |
$85.50
|
| Rate for Payer: Cigna Commercial |
$262.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$159.49
|
| Rate for Payer: Health EOS Commercial |
$253.65
|
| Rate for Payer: HFN Commercial |
$262.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$213.75
|
| Rate for Payer: Multiplan Commercial |
$228.00
|
| Rate for Payer: NAPHCARE Commercial |
$171.00
|
| Rate for Payer: Preferred Network Access Commercial |
$262.20
|
| Rate for Payer: Quartz Beloit One Network |
$139.65
|
| Rate for Payer: Quartz Commercial |
$185.25
|
| Rate for Payer: Quartz Medicare Advantage |
$171.00
|
| Rate for Payer: The Alliance Commercial |
$1,140.00
|
| Rate for Payer: United Healthcare PPO |
$213.75
|
| Rate for Payer: WEA Trust Commercial |
$156.75
|
| Rate for Payer: WPS Commercial |
$211.10
|
|
|
PGA Sep & ID High Res
|
Professional
|
Both
|
$285.00
|
|
| Hospital Charge Code |
2778814
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$125.40 |
| Max. Negotiated Rate |
$270.75 |
| Rate for Payer: Aetna Commercial |
$270.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$245.10
|
| Rate for Payer: Cash Price |
$85.50
|
| Rate for Payer: Cigna Commercial |
$270.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$142.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$171.00
|
| Rate for Payer: Health EOS Commercial |
$259.35
|
| Rate for Payer: HFN Commercial |
$270.75
|
| Rate for Payer: Multiplan Commercial |
$228.00
|
| Rate for Payer: Preferred Network Access Commercial |
$270.75
|
| Rate for Payer: Quartz Beloit One Network |
$125.40
|
| Rate for Payer: Quartz Commercial |
$162.45
|
| Rate for Payer: The Alliance Commercial |
$142.50
|
| Rate for Payer: WEA Trust Commercial |
$156.75
|
| Rate for Payer: WPS Commercial |
$211.10
|
|
|
PHALANGECTOMY, TOE, EACH TOE
|
Facility
|
OP
|
$12,797.24
|
|
|
Service Code
|
CPT 28150
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,199.31 |
| Max. Negotiated Rate |
$12,797.24 |
| Rate for Payer: Aetna Managed Medicare |
$3,199.31
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$9,907.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8,043.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,639.00
|
| Rate for Payer: Anthem Medicare Advantage |
$3,199.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3,199.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3,199.31
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3,199.31
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,546.14
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3,199.31
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$11,901.43
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3,199.31
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3,199.31
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$3,199.31
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$3,199.31
|
| Rate for Payer: NAPHCARE Commercial |
$4,798.96
|
| Rate for Payer: Quartz Medicare Advantage |
$3,199.31
|
| Rate for Payer: The Alliance Commercial |
$12,797.24
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,199.31
|
| Rate for Payer: United Healthcare PPO |
$4,103.00
|
| Rate for Payer: Wellcare Medicare |
$3,199.31
|
|
|
Phase 3 Cardiac Rehab
|
Facility
|
OP
|
$499.00
|
|
|
Service Code
|
CPT 93797
|
| Hospital Charge Code |
3052594
|
|
Hospital Revenue Code
|
943
|
| Min. Negotiated Rate |
$130.61 |
| Max. Negotiated Rate |
$522.44 |
| Rate for Payer: Aetna Commercial |
$449.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$429.14
|
| Rate for Payer: Aetna Managed Medicare |
$130.61
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$349.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$287.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$272.00
|
| Rate for Payer: Anthem Medicare Advantage |
$130.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$264.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$130.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$130.61
|
| Rate for Payer: Cash Price |
$149.70
|
| Rate for Payer: Cash Price |
$149.70
|
| Rate for Payer: Cash Price |
$149.70
|
| Rate for Payer: Cigna Commercial |
$459.08
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$130.61
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$279.24
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$130.61
|
| Rate for Payer: Health EOS Commercial |
$444.11
|
| Rate for Payer: HFN Commercial |
$459.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$485.87
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$130.61
|
| Rate for Payer: Independent Care Health Plan Medicare |
$130.61
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$130.61
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$130.61
|
| Rate for Payer: Multiplan Commercial |
$399.20
|
| Rate for Payer: NAPHCARE Commercial |
$195.92
|
| Rate for Payer: Preferred Network Access Commercial |
$459.08
|
| Rate for Payer: Quartz Beloit One Network |
$244.51
|
| Rate for Payer: Quartz Commercial |
$324.35
|
| Rate for Payer: Quartz Medicare Advantage |
$130.61
|
| Rate for Payer: The Alliance Commercial |
$522.44
|
| Rate for Payer: United Healthcare Medicare Advantage |
$130.61
|
| Rate for Payer: United Healthcare PPO |
$374.25
|
| Rate for Payer: WEA Trust Commercial |
$274.45
|
| Rate for Payer: Wellcare Medicare |
$130.61
|
| Rate for Payer: WPS Commercial |
$369.61
|
|
|
Phase 3 Cardiac Rehab
|
Facility
|
IP
|
$499.00
|
|
|
Service Code
|
CPT 93797
|
| Hospital Charge Code |
3052594
|
|
Hospital Revenue Code
|
943
|
| Min. Negotiated Rate |
$244.51 |
| Max. Negotiated Rate |
$459.08 |
| Rate for Payer: Aetna Commercial |
$449.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$429.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$264.47
|
| Rate for Payer: Cash Price |
$149.70
|
| Rate for Payer: Cigna Commercial |
$459.08
|
| Rate for Payer: Health EOS Commercial |
$444.11
|
| Rate for Payer: HFN Commercial |
$459.08
|
| Rate for Payer: Multiplan Commercial |
$399.20
|
| Rate for Payer: NAPHCARE Commercial |
$299.40
|
| Rate for Payer: Preferred Network Access Commercial |
$459.08
|
| Rate for Payer: Quartz Beloit One Network |
$244.51
|
| Rate for Payer: Quartz Commercial |
$299.40
|
| Rate for Payer: WEA Trust Commercial |
$274.45
|
| Rate for Payer: WPS Commercial |
$369.61
|
|
|
Phase II COPD - Pulmonary Rehab
|
Facility
|
OP
|
$371.00
|
|
|
Service Code
|
CPT 94626
|
| Hospital Charge Code |
2990161
|
|
Hospital Revenue Code
|
948
|
| Min. Negotiated Rate |
$60.46 |
| Max. Negotiated Rate |
$341.32 |
| Rate for Payer: Aetna Commercial |
$333.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$319.06
|
| Rate for Payer: Aetna Managed Medicare |
$60.46
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$241.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$185.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$178.08
|
| Rate for Payer: Anthem Medicare Advantage |
$60.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$196.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$60.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$60.46
|
| Rate for Payer: Cash Price |
$111.30
|
| Rate for Payer: Cash Price |
$111.30
|
| Rate for Payer: Cigna Commercial |
$341.32
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$60.46
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$207.61
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$60.46
|
| Rate for Payer: Health EOS Commercial |
$330.19
|
| Rate for Payer: HFN Commercial |
$341.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$224.91
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$60.46
|
| Rate for Payer: Independent Care Health Plan Medicare |
$60.46
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$60.46
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$60.46
|
| Rate for Payer: Multiplan Commercial |
$296.80
|
| Rate for Payer: NAPHCARE Commercial |
$90.69
|
| Rate for Payer: Preferred Network Access Commercial |
$341.32
|
| Rate for Payer: Quartz Beloit One Network |
$181.79
|
| Rate for Payer: Quartz Commercial |
$241.15
|
| Rate for Payer: Quartz Medicare Advantage |
$60.46
|
| Rate for Payer: The Alliance Commercial |
$241.84
|
| Rate for Payer: United Healthcare Medicare Advantage |
$60.46
|
| Rate for Payer: WEA Trust Commercial |
$204.05
|
| Rate for Payer: Wellcare Medicare |
$60.46
|
| Rate for Payer: WPS Commercial |
$274.80
|
|
|
Phase II COPD - Pulmonary Rehab
|
Facility
|
IP
|
$371.00
|
|
|
Service Code
|
CPT 94626
|
| Hospital Charge Code |
2990161
|
|
Hospital Revenue Code
|
948
|
| Min. Negotiated Rate |
$181.79 |
| Max. Negotiated Rate |
$341.32 |
| Rate for Payer: Aetna Commercial |
$333.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$319.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$196.63
|
| Rate for Payer: Cash Price |
$111.30
|
| Rate for Payer: Cigna Commercial |
$341.32
|
| Rate for Payer: Health EOS Commercial |
$330.19
|
| Rate for Payer: HFN Commercial |
$341.32
|
| Rate for Payer: Multiplan Commercial |
$296.80
|
| Rate for Payer: NAPHCARE Commercial |
$222.60
|
| Rate for Payer: Preferred Network Access Commercial |
$341.32
|
| Rate for Payer: Quartz Beloit One Network |
$181.79
|
| Rate for Payer: Quartz Commercial |
$222.60
|
| Rate for Payer: WEA Trust Commercial |
$204.05
|
| Rate for Payer: WPS Commercial |
$274.80
|
|
|
Phase II COPD - W/MTR Pulmonary Rehab 94626
|
Facility
|
IP
|
$371.00
|
|
|
Service Code
|
CPT 94626
|
| Hospital Charge Code |
6121637
|
|
Hospital Revenue Code
|
948
|
| Min. Negotiated Rate |
$181.79 |
| Max. Negotiated Rate |
$341.32 |
| Rate for Payer: Aetna Commercial |
$333.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$319.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$196.63
|
| Rate for Payer: Cash Price |
$111.30
|
| Rate for Payer: Cigna Commercial |
$341.32
|
| Rate for Payer: Health EOS Commercial |
$330.19
|
| Rate for Payer: HFN Commercial |
$341.32
|
| Rate for Payer: Multiplan Commercial |
$296.80
|
| Rate for Payer: NAPHCARE Commercial |
$222.60
|
| Rate for Payer: Preferred Network Access Commercial |
$341.32
|
| Rate for Payer: Quartz Beloit One Network |
$181.79
|
| Rate for Payer: Quartz Commercial |
$222.60
|
| Rate for Payer: WEA Trust Commercial |
$204.05
|
| Rate for Payer: WPS Commercial |
$274.80
|
|
|
Phase II COPD - W/MTR Pulmonary Rehab 94626
|
Facility
|
OP
|
$371.00
|
|
|
Service Code
|
CPT 94626
|
| Hospital Charge Code |
6121637
|
|
Hospital Revenue Code
|
948
|
| Min. Negotiated Rate |
$60.46 |
| Max. Negotiated Rate |
$341.32 |
| Rate for Payer: Aetna Commercial |
$333.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$319.06
|
| Rate for Payer: Aetna Managed Medicare |
$60.46
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$241.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$185.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$178.08
|
| Rate for Payer: Anthem Medicare Advantage |
$60.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$196.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$60.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$60.46
|
| Rate for Payer: Cash Price |
$111.30
|
| Rate for Payer: Cash Price |
$111.30
|
| Rate for Payer: Cigna Commercial |
$341.32
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$60.46
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$207.61
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$60.46
|
| Rate for Payer: Health EOS Commercial |
$330.19
|
| Rate for Payer: HFN Commercial |
$341.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$224.91
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$60.46
|
| Rate for Payer: Independent Care Health Plan Medicare |
$60.46
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$60.46
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$60.46
|
| Rate for Payer: Multiplan Commercial |
$296.80
|
| Rate for Payer: NAPHCARE Commercial |
$90.69
|
| Rate for Payer: Preferred Network Access Commercial |
$341.32
|
| Rate for Payer: Quartz Beloit One Network |
$181.79
|
| Rate for Payer: Quartz Commercial |
$241.15
|
| Rate for Payer: Quartz Medicare Advantage |
$60.46
|
| Rate for Payer: The Alliance Commercial |
$241.84
|
| Rate for Payer: United Healthcare Medicare Advantage |
$60.46
|
| Rate for Payer: WEA Trust Commercial |
$204.05
|
| Rate for Payer: Wellcare Medicare |
$60.46
|
| Rate for Payer: WPS Commercial |
$274.80
|
|
|
Phase II COPD - W/O MTR Pulmonary Rehab 94625
|
Facility
|
OP
|
$238.00
|
|
|
Service Code
|
CPT 94625
|
| Hospital Charge Code |
6121636
|
|
Hospital Revenue Code
|
948
|
| Min. Negotiated Rate |
$60.46 |
| Max. Negotiated Rate |
$241.84 |
| Rate for Payer: Aetna Commercial |
$214.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$204.68
|
| Rate for Payer: Aetna Managed Medicare |
$60.46
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$154.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$119.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$114.24
|
| Rate for Payer: Anthem Medicare Advantage |
$60.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$126.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$60.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$60.46
|
| Rate for Payer: Cash Price |
$71.40
|
| Rate for Payer: Cash Price |
$71.40
|
| Rate for Payer: Cigna Commercial |
$218.96
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$60.46
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$133.18
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$60.46
|
| Rate for Payer: Health EOS Commercial |
$211.82
|
| Rate for Payer: HFN Commercial |
$218.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$224.91
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$60.46
|
| Rate for Payer: Independent Care Health Plan Medicare |
$60.46
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$60.46
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$60.46
|
| Rate for Payer: Multiplan Commercial |
$190.40
|
| Rate for Payer: NAPHCARE Commercial |
$90.69
|
| Rate for Payer: Preferred Network Access Commercial |
$218.96
|
| Rate for Payer: Quartz Beloit One Network |
$116.62
|
| Rate for Payer: Quartz Commercial |
$154.70
|
| Rate for Payer: Quartz Medicare Advantage |
$60.46
|
| Rate for Payer: The Alliance Commercial |
$241.84
|
| Rate for Payer: United Healthcare Medicare Advantage |
$60.46
|
| Rate for Payer: WEA Trust Commercial |
$130.90
|
| Rate for Payer: Wellcare Medicare |
$60.46
|
| Rate for Payer: WPS Commercial |
$176.29
|
|
|
Phase II COPD - W/O MTR Pulmonary Rehab 94625
|
Facility
|
IP
|
$238.00
|
|
|
Service Code
|
CPT 94625
|
| Hospital Charge Code |
6121636
|
|
Hospital Revenue Code
|
948
|
| Min. Negotiated Rate |
$116.62 |
| Max. Negotiated Rate |
$218.96 |
| Rate for Payer: Aetna Commercial |
$214.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$204.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$126.14
|
| Rate for Payer: Cash Price |
$71.40
|
| Rate for Payer: Cigna Commercial |
$218.96
|
| Rate for Payer: Health EOS Commercial |
$211.82
|
| Rate for Payer: HFN Commercial |
$218.96
|
| Rate for Payer: Multiplan Commercial |
$190.40
|
| Rate for Payer: NAPHCARE Commercial |
$142.80
|
| Rate for Payer: Preferred Network Access Commercial |
$218.96
|
| Rate for Payer: Quartz Beloit One Network |
$116.62
|
| Rate for Payer: Quartz Commercial |
$142.80
|
| Rate for Payer: WEA Trust Commercial |
$130.90
|
| Rate for Payer: WPS Commercial |
$176.29
|
|
|
Phase III - Pulmonary Rehab
|
Facility
|
IP
|
$90.00
|
|
| Hospital Charge Code |
3004212
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$44.10 |
| Max. Negotiated Rate |
$82.80 |
| Rate for Payer: Aetna Commercial |
$81.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$77.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$47.70
|
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Cigna Commercial |
$82.80
|
| Rate for Payer: Health EOS Commercial |
$80.10
|
| Rate for Payer: HFN Commercial |
$82.80
|
| Rate for Payer: Multiplan Commercial |
$72.00
|
| Rate for Payer: NAPHCARE Commercial |
$54.00
|
| Rate for Payer: Preferred Network Access Commercial |
$82.80
|
| Rate for Payer: Quartz Beloit One Network |
$44.10
|
| Rate for Payer: Quartz Commercial |
$54.00
|
| Rate for Payer: WEA Trust Commercial |
$49.50
|
| Rate for Payer: WPS Commercial |
$66.66
|
|
