|
PTA Tib/Peroneal
|
Facility
|
IP
|
$10,047.00
|
|
|
Service Code
|
CPT 37228
|
| Hospital Charge Code |
3052449
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$4,923.03 |
| Max. Negotiated Rate |
$9,243.24 |
| Rate for Payer: Aetna Commercial |
$9,042.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,640.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,324.91
|
| Rate for Payer: Cash Price |
$3,014.10
|
| Rate for Payer: Cigna Commercial |
$9,243.24
|
| Rate for Payer: Health EOS Commercial |
$8,941.83
|
| Rate for Payer: HFN Commercial |
$9,243.24
|
| Rate for Payer: Multiplan Commercial |
$8,037.60
|
| Rate for Payer: NAPHCARE Commercial |
$6,028.20
|
| Rate for Payer: Preferred Network Access Commercial |
$9,243.24
|
| Rate for Payer: Quartz Beloit One Network |
$4,923.03
|
| Rate for Payer: Quartz Commercial |
$6,028.20
|
| Rate for Payer: WEA Trust Commercial |
$5,525.85
|
| Rate for Payer: WPS Commercial |
$7,441.81
|
|
|
PTA Tib/Peroneal
|
Facility
|
OP
|
$10,047.00
|
|
|
Service Code
|
CPT 37228
|
| Hospital Charge Code |
3052449
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$4,923.03 |
| Max. Negotiated Rate |
$43,494.48 |
| Rate for Payer: Aetna Commercial |
$9,042.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,640.42
|
| Rate for Payer: Aetna Managed Medicare |
$10,873.62
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$18,649.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$18,649.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$17,230.00
|
| Rate for Payer: Anthem Medicare Advantage |
$10,873.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,324.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$10,873.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$10,873.62
|
| Rate for Payer: Cash Price |
$3,014.10
|
| Rate for Payer: Cash Price |
$3,014.10
|
| Rate for Payer: Cash Price |
$3,014.10
|
| Rate for Payer: Cigna Commercial |
$9,243.24
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$10,873.62
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$11,874.87
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$10,873.62
|
| Rate for Payer: Health EOS Commercial |
$8,941.83
|
| Rate for Payer: HFN Commercial |
$9,243.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$40,449.87
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$10,873.62
|
| Rate for Payer: Independent Care Health Plan Medicare |
$10,873.62
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$10,873.62
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$10,873.62
|
| Rate for Payer: Multiplan Commercial |
$8,037.60
|
| Rate for Payer: NAPHCARE Commercial |
$16,310.43
|
| Rate for Payer: Preferred Network Access Commercial |
$9,243.24
|
| Rate for Payer: Quartz Beloit One Network |
$4,923.03
|
| Rate for Payer: Quartz Commercial |
$6,530.55
|
| Rate for Payer: Quartz Medicare Advantage |
$10,873.62
|
| Rate for Payer: The Alliance Commercial |
$43,494.48
|
| Rate for Payer: United Healthcare Medicare Advantage |
$10,873.62
|
| Rate for Payer: United Healthcare PPO |
$9,596.00
|
| Rate for Payer: WEA Trust Commercial |
$5,525.85
|
| Rate for Payer: Wellcare Medicare |
$10,873.62
|
| Rate for Payer: WPS Commercial |
$7,441.81
|
|
|
PTA Tib/Peroneal Ea Add Vessel +
|
Facility
|
OP
|
$2,706.00
|
|
|
Service Code
|
CPT 37232
|
| Hospital Charge Code |
3052453
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$757.68 |
| Max. Negotiated Rate |
$11,874.87 |
| Rate for Payer: Aetna Commercial |
$2,435.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,327.16
|
| Rate for Payer: Aetna Managed Medicare |
$757.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,758.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,353.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,298.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,434.18
|
| Rate for Payer: Cash Price |
$811.80
|
| Rate for Payer: Cash Price |
$811.80
|
| Rate for Payer: Cigna Commercial |
$2,489.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$11,874.87
|
| Rate for Payer: Health EOS Commercial |
$2,408.34
|
| Rate for Payer: HFN Commercial |
$2,489.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,029.50
|
| Rate for Payer: Multiplan Commercial |
$2,164.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,623.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,489.52
|
| Rate for Payer: Quartz Beloit One Network |
$1,325.94
|
| Rate for Payer: Quartz Commercial |
$1,758.90
|
| Rate for Payer: Quartz Medicare Advantage |
$1,623.60
|
| Rate for Payer: The Alliance Commercial |
$10,824.00
|
| Rate for Payer: WEA Trust Commercial |
$1,488.30
|
| Rate for Payer: WPS Commercial |
$2,004.33
|
|
|
PTA Tib/Peroneal Ea Add Vessel +
|
Facility
|
IP
|
$2,706.00
|
|
|
Service Code
|
CPT 37232
|
| Hospital Charge Code |
3052453
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,325.94 |
| Max. Negotiated Rate |
$2,489.52 |
| Rate for Payer: Aetna Commercial |
$2,435.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,327.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,434.18
|
| Rate for Payer: Cash Price |
$811.80
|
| Rate for Payer: Cigna Commercial |
$2,489.52
|
| Rate for Payer: Health EOS Commercial |
$2,408.34
|
| Rate for Payer: HFN Commercial |
$2,489.52
|
| Rate for Payer: Multiplan Commercial |
$2,164.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,623.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,489.52
|
| Rate for Payer: Quartz Beloit One Network |
$1,325.94
|
| Rate for Payer: Quartz Commercial |
$1,623.60
|
| Rate for Payer: WEA Trust Commercial |
$1,488.30
|
| Rate for Payer: WPS Commercial |
$2,004.33
|
|
|
PTA Venous (Exc Dialysis Circuit) Ea Add Vein
|
Facility
|
IP
|
$2,448.00
|
|
|
Service Code
|
CPT 37249
|
| Hospital Charge Code |
5238884
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,199.52 |
| Max. Negotiated Rate |
$2,252.16 |
| Rate for Payer: Aetna Commercial |
$2,203.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,105.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,297.44
|
| Rate for Payer: Cash Price |
$734.40
|
| Rate for Payer: Cigna Commercial |
$2,252.16
|
| Rate for Payer: Health EOS Commercial |
$2,178.72
|
| Rate for Payer: HFN Commercial |
$2,252.16
|
| Rate for Payer: Multiplan Commercial |
$1,958.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,468.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,252.16
|
| Rate for Payer: Quartz Beloit One Network |
$1,199.52
|
| Rate for Payer: Quartz Commercial |
$1,468.80
|
| Rate for Payer: WEA Trust Commercial |
$1,346.40
|
| Rate for Payer: WPS Commercial |
$1,813.23
|
|
|
PTA Venous (Exc Dialysis Circuit) Ea Add Vein
|
Facility
|
OP
|
$2,448.00
|
|
|
Service Code
|
CPT 37249
|
| Hospital Charge Code |
5238884
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$685.44 |
| Max. Negotiated Rate |
$11,874.87 |
| Rate for Payer: Aetna Commercial |
$2,203.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,105.28
|
| Rate for Payer: Aetna Managed Medicare |
$685.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,591.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,224.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,175.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,297.44
|
| Rate for Payer: Cash Price |
$734.40
|
| Rate for Payer: Cash Price |
$734.40
|
| Rate for Payer: Cigna Commercial |
$2,252.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$11,874.87
|
| Rate for Payer: Health EOS Commercial |
$2,178.72
|
| Rate for Payer: HFN Commercial |
$2,252.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,836.00
|
| Rate for Payer: Multiplan Commercial |
$1,958.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,468.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,252.16
|
| Rate for Payer: Quartz Beloit One Network |
$1,199.52
|
| Rate for Payer: Quartz Commercial |
$1,591.20
|
| Rate for Payer: Quartz Medicare Advantage |
$1,468.80
|
| Rate for Payer: The Alliance Commercial |
$9,792.00
|
| Rate for Payer: WEA Trust Commercial |
$1,346.40
|
| Rate for Payer: WPS Commercial |
$1,813.23
|
|
|
PTA Venous (Ex Dialysis Circuit)
|
Facility
|
IP
|
$5,572.00
|
|
|
Service Code
|
CPT 37248
|
| Hospital Charge Code |
5238880
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,730.28 |
| Max. Negotiated Rate |
$5,126.24 |
| Rate for Payer: Aetna Commercial |
$5,014.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,791.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,953.16
|
| Rate for Payer: Cash Price |
$1,671.60
|
| Rate for Payer: Cigna Commercial |
$5,126.24
|
| Rate for Payer: Health EOS Commercial |
$4,959.08
|
| Rate for Payer: HFN Commercial |
$5,126.24
|
| Rate for Payer: Multiplan Commercial |
$4,457.60
|
| Rate for Payer: NAPHCARE Commercial |
$3,343.20
|
| Rate for Payer: Preferred Network Access Commercial |
$5,126.24
|
| Rate for Payer: Quartz Beloit One Network |
$2,730.28
|
| Rate for Payer: Quartz Commercial |
$3,343.20
|
| Rate for Payer: WEA Trust Commercial |
$3,064.60
|
| Rate for Payer: WPS Commercial |
$4,127.18
|
|
|
PTA Venous (Ex Dialysis Circuit)
|
Facility
|
OP
|
$5,572.00
|
|
|
Service Code
|
CPT 37248
|
| Hospital Charge Code |
5238880
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,730.28 |
| Max. Negotiated Rate |
$22,597.64 |
| Rate for Payer: Aetna Commercial |
$5,014.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,791.92
|
| Rate for Payer: Aetna Managed Medicare |
$5,649.41
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$16,318.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$13,785.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$13,096.00
|
| Rate for Payer: Anthem Medicare Advantage |
$5,649.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,953.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5,649.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5,649.41
|
| Rate for Payer: Cash Price |
$1,671.60
|
| Rate for Payer: Cash Price |
$1,671.60
|
| Rate for Payer: Cash Price |
$1,671.60
|
| Rate for Payer: Cigna Commercial |
$5,126.24
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$5,649.41
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$11,874.87
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$5,649.41
|
| Rate for Payer: Health EOS Commercial |
$4,959.08
|
| Rate for Payer: HFN Commercial |
$5,126.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$21,015.81
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$5,649.41
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5,649.41
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$5,649.41
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$5,649.41
|
| Rate for Payer: Multiplan Commercial |
$4,457.60
|
| Rate for Payer: NAPHCARE Commercial |
$8,474.12
|
| Rate for Payer: Preferred Network Access Commercial |
$5,126.24
|
| Rate for Payer: Quartz Beloit One Network |
$2,730.28
|
| Rate for Payer: Quartz Commercial |
$3,621.80
|
| Rate for Payer: Quartz Medicare Advantage |
$5,649.41
|
| Rate for Payer: The Alliance Commercial |
$22,597.64
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5,649.41
|
| Rate for Payer: United Healthcare PPO |
$6,154.00
|
| Rate for Payer: WEA Trust Commercial |
$3,064.60
|
| Rate for Payer: Wellcare Medicare |
$5,649.41
|
| Rate for Payer: WPS Commercial |
$4,127.18
|
|
|
PTA Wheelchair Management Charge
|
Facility
|
IP
|
$223.00
|
|
|
Service Code
|
CPT 97542 GP,CQ
|
| Hospital Charge Code |
5565361
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$109.27 |
| Max. Negotiated Rate |
$205.16 |
| Rate for Payer: Aetna Commercial |
$200.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$191.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$118.19
|
| Rate for Payer: Cash Price |
$66.90
|
| Rate for Payer: Cigna Commercial |
$205.16
|
| Rate for Payer: Health EOS Commercial |
$198.47
|
| Rate for Payer: HFN Commercial |
$205.16
|
| Rate for Payer: Multiplan Commercial |
$178.40
|
| Rate for Payer: NAPHCARE Commercial |
$133.80
|
| Rate for Payer: Preferred Network Access Commercial |
$205.16
|
| Rate for Payer: Quartz Beloit One Network |
$109.27
|
| Rate for Payer: Quartz Commercial |
$133.80
|
| Rate for Payer: WEA Trust Commercial |
$122.65
|
| Rate for Payer: WPS Commercial |
$165.18
|
|
|
PTA Wheelchair Management Charge
|
Facility
|
OP
|
$223.00
|
|
|
Service Code
|
CPT 97542 GP,CQ
|
| Hospital Charge Code |
5565361
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$62.44 |
| Max. Negotiated Rate |
$892.00 |
| Rate for Payer: Aetna Commercial |
$200.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$191.78
|
| Rate for Payer: Aetna Managed Medicare |
$62.44
|
| 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: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$118.19
|
| Rate for Payer: Cash Price |
$66.90
|
| Rate for Payer: Cash Price |
$66.90
|
| Rate for Payer: Cigna Commercial |
$205.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$124.79
|
| Rate for Payer: Health EOS Commercial |
$198.47
|
| Rate for Payer: HFN Commercial |
$205.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$202.00
|
| Rate for Payer: Multiplan Commercial |
$178.40
|
| Rate for Payer: NAPHCARE Commercial |
$133.80
|
| Rate for Payer: Preferred Network Access Commercial |
$205.16
|
| Rate for Payer: Quartz Beloit One Network |
$109.27
|
| Rate for Payer: Quartz Commercial |
$144.95
|
| Rate for Payer: Quartz Medicare Advantage |
$133.80
|
| Rate for Payer: The Alliance Commercial |
$892.00
|
| Rate for Payer: United Healthcare PPO |
$167.25
|
| Rate for Payer: WEA Trust Commercial |
$122.65
|
| Rate for Payer: WPS Commercial |
$165.18
|
|
|
PTCA
|
Facility
|
IP
|
$26,883.00
|
|
|
Service Code
|
CPT 92920
|
| Hospital Charge Code |
3052462
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$13,172.67 |
| Max. Negotiated Rate |
$24,732.36 |
| Rate for Payer: Aetna Commercial |
$24,194.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$23,119.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$14,247.99
|
| Rate for Payer: Cash Price |
$8,064.90
|
| Rate for Payer: Cigna Commercial |
$24,732.36
|
| Rate for Payer: Health EOS Commercial |
$23,925.87
|
| Rate for Payer: HFN Commercial |
$24,732.36
|
| Rate for Payer: Multiplan Commercial |
$21,506.40
|
| Rate for Payer: NAPHCARE Commercial |
$16,129.80
|
| Rate for Payer: Preferred Network Access Commercial |
$24,732.36
|
| Rate for Payer: Quartz Beloit One Network |
$13,172.67
|
| Rate for Payer: Quartz Commercial |
$16,129.80
|
| Rate for Payer: WEA Trust Commercial |
$14,785.65
|
| Rate for Payer: WPS Commercial |
$19,912.24
|
|
|
PTCA
|
Facility
|
OP
|
$26,883.00
|
|
|
Service Code
|
CPT 92920
|
| Hospital Charge Code |
3052462
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$5,649.41 |
| Max. Negotiated Rate |
$24,732.36 |
| Rate for Payer: Aetna Commercial |
$24,194.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$23,119.38
|
| Rate for Payer: Aetna Managed Medicare |
$5,649.41
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$23,311.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$20,676.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$19,643.00
|
| Rate for Payer: Anthem Medicare Advantage |
$5,649.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$14,247.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5,649.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5,649.41
|
| Rate for Payer: Cash Price |
$8,064.90
|
| Rate for Payer: Cash Price |
$8,064.90
|
| Rate for Payer: Cash Price |
$8,064.90
|
| Rate for Payer: Cigna Commercial |
$24,732.36
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$5,649.41
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$11,874.87
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$5,649.41
|
| Rate for Payer: Health EOS Commercial |
$23,925.87
|
| Rate for Payer: HFN Commercial |
$24,732.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$21,015.81
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$5,649.41
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5,649.41
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$5,649.41
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$5,649.41
|
| Rate for Payer: Multiplan Commercial |
$21,506.40
|
| Rate for Payer: NAPHCARE Commercial |
$8,474.12
|
| Rate for Payer: Preferred Network Access Commercial |
$24,732.36
|
| Rate for Payer: Quartz Beloit One Network |
$13,172.67
|
| Rate for Payer: Quartz Commercial |
$17,473.95
|
| Rate for Payer: Quartz Medicare Advantage |
$5,649.41
|
| Rate for Payer: The Alliance Commercial |
$22,597.64
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5,649.41
|
| Rate for Payer: United Healthcare PPO |
$6,154.00
|
| Rate for Payer: WEA Trust Commercial |
$14,785.65
|
| Rate for Payer: Wellcare Medicare |
$5,649.41
|
| Rate for Payer: WPS Commercial |
$19,912.24
|
|
|
PTCA Ea Add Branch +
|
Facility
|
IP
|
$17,179.00
|
|
|
Service Code
|
CPT 92921
|
| Hospital Charge Code |
3052463
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$8,417.71 |
| Max. Negotiated Rate |
$15,804.68 |
| Rate for Payer: Aetna Commercial |
$15,461.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$14,773.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,104.87
|
| Rate for Payer: Cash Price |
$5,153.70
|
| Rate for Payer: Cigna Commercial |
$15,804.68
|
| Rate for Payer: Health EOS Commercial |
$15,289.31
|
| Rate for Payer: HFN Commercial |
$15,804.68
|
| Rate for Payer: Multiplan Commercial |
$13,743.20
|
| Rate for Payer: NAPHCARE Commercial |
$10,307.40
|
| Rate for Payer: Preferred Network Access Commercial |
$15,804.68
|
| Rate for Payer: Quartz Beloit One Network |
$8,417.71
|
| Rate for Payer: Quartz Commercial |
$10,307.40
|
| Rate for Payer: WEA Trust Commercial |
$9,448.45
|
| Rate for Payer: WPS Commercial |
$12,724.49
|
|
|
PTCA Ea Add Branch +
|
Facility
|
OP
|
$17,179.00
|
|
|
Service Code
|
CPT 92921
|
| Hospital Charge Code |
3052463
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$4,810.12 |
| Max. Negotiated Rate |
$68,716.00 |
| Rate for Payer: Aetna Commercial |
$15,461.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$14,773.94
|
| Rate for Payer: Aetna Managed Medicare |
$4,810.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$23,311.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$20,676.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$19,643.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,104.87
|
| Rate for Payer: Cash Price |
$5,153.70
|
| Rate for Payer: Cash Price |
$5,153.70
|
| Rate for Payer: Cash Price |
$5,153.70
|
| Rate for Payer: Cigna Commercial |
$15,804.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$11,874.87
|
| Rate for Payer: Health EOS Commercial |
$15,289.31
|
| Rate for Payer: HFN Commercial |
$15,804.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$12,884.25
|
| Rate for Payer: Multiplan Commercial |
$13,743.20
|
| Rate for Payer: NAPHCARE Commercial |
$10,307.40
|
| Rate for Payer: Preferred Network Access Commercial |
$15,804.68
|
| Rate for Payer: Quartz Beloit One Network |
$8,417.71
|
| Rate for Payer: Quartz Commercial |
$11,166.35
|
| Rate for Payer: Quartz Medicare Advantage |
$10,307.40
|
| Rate for Payer: The Alliance Commercial |
$68,716.00
|
| Rate for Payer: WEA Trust Commercial |
$9,448.45
|
| Rate for Payer: WPS Commercial |
$12,724.49
|
|
|
PT/CAREGIVER TRAINING FOR INITIATION HOME INR MNTR - 93792
|
Facility
|
OP
|
$71.00
|
|
|
Service Code
|
CPT 93792
|
| Hospital Charge Code |
6081629
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$19.88 |
| Max. Negotiated Rate |
$284.00 |
| Rate for Payer: Aetna Commercial |
$63.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$61.06
|
| Rate for Payer: Aetna Managed Medicare |
$19.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$46.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$35.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$34.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$37.63
|
| Rate for Payer: Cash Price |
$21.30
|
| Rate for Payer: Cigna Commercial |
$65.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$39.73
|
| Rate for Payer: Health EOS Commercial |
$63.19
|
| Rate for Payer: HFN Commercial |
$65.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$53.25
|
| Rate for Payer: Multiplan Commercial |
$56.80
|
| Rate for Payer: NAPHCARE Commercial |
$42.60
|
| Rate for Payer: Preferred Network Access Commercial |
$65.32
|
| Rate for Payer: Quartz Beloit One Network |
$34.79
|
| Rate for Payer: Quartz Commercial |
$46.15
|
| Rate for Payer: Quartz Medicare Advantage |
$42.60
|
| Rate for Payer: The Alliance Commercial |
$284.00
|
| Rate for Payer: United Healthcare PPO |
$53.25
|
| Rate for Payer: WEA Trust Commercial |
$39.05
|
| Rate for Payer: WPS Commercial |
$52.59
|
|
|
PT/CAREGIVER TRAINING FOR INITIATION HOME INR MNTR - 93792
|
Facility
|
IP
|
$71.00
|
|
|
Service Code
|
CPT 93792
|
| Hospital Charge Code |
6081629
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$34.79 |
| Max. Negotiated Rate |
$65.32 |
| Rate for Payer: Aetna Commercial |
$63.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$61.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$37.63
|
| Rate for Payer: Cash Price |
$21.30
|
| Rate for Payer: Cigna Commercial |
$65.32
|
| Rate for Payer: Health EOS Commercial |
$63.19
|
| Rate for Payer: HFN Commercial |
$65.32
|
| Rate for Payer: Multiplan Commercial |
$56.80
|
| Rate for Payer: NAPHCARE Commercial |
$42.60
|
| Rate for Payer: Preferred Network Access Commercial |
$65.32
|
| Rate for Payer: Quartz Beloit One Network |
$34.79
|
| Rate for Payer: Quartz Commercial |
$42.60
|
| Rate for Payer: WEA Trust Commercial |
$39.05
|
| Rate for Payer: WPS Commercial |
$52.59
|
|
|
PT/Caregiver Training Home INR - 93792
|
Professional
|
Both
|
$158.00
|
|
|
Service Code
|
CPT 93792
|
| Hospital Charge Code |
6178126
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$69.52 |
| Max. Negotiated Rate |
$221.90 |
| Rate for Payer: Aetna Commercial |
$150.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$135.88
|
| Rate for Payer: Cash Price |
$47.40
|
| Rate for Payer: Cash Price |
$47.40
|
| Rate for Payer: Cash Price |
$47.40
|
| Rate for Payer: Cigna Commercial |
$150.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$79.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$94.80
|
| Rate for Payer: Health EOS Commercial |
$143.78
|
| Rate for Payer: HFN Commercial |
$150.10
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$221.90
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$221.90
|
| Rate for Payer: Multiplan Commercial |
$126.40
|
| Rate for Payer: Preferred Network Access Commercial |
$150.10
|
| Rate for Payer: Quartz Beloit One Network |
$69.52
|
| Rate for Payer: Quartz Commercial |
$90.06
|
| Rate for Payer: The Alliance Commercial |
$79.00
|
| Rate for Payer: WEA Trust Commercial |
$86.90
|
| Rate for Payer: WPS Commercial |
$117.03
|
|
|
PT Cognitive Function Intervention Chrg
|
Facility
|
IP
|
$214.00
|
|
|
Service Code
|
CPT 97129 GP
|
| Hospital Charge Code |
5344658
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$104.86 |
| Max. Negotiated Rate |
$196.88 |
| Rate for Payer: Aetna Commercial |
$192.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$184.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$113.42
|
| Rate for Payer: Cash Price |
$64.20
|
| Rate for Payer: Cigna Commercial |
$196.88
|
| Rate for Payer: Health EOS Commercial |
$190.46
|
| Rate for Payer: HFN Commercial |
$196.88
|
| Rate for Payer: Multiplan Commercial |
$171.20
|
| Rate for Payer: NAPHCARE Commercial |
$128.40
|
| Rate for Payer: Preferred Network Access Commercial |
$196.88
|
| Rate for Payer: Quartz Beloit One Network |
$104.86
|
| Rate for Payer: Quartz Commercial |
$128.40
|
| Rate for Payer: WEA Trust Commercial |
$117.70
|
| Rate for Payer: WPS Commercial |
$158.51
|
|
|
PT Cognitive Function Intervention Chrg
|
Facility
|
OP
|
$214.00
|
|
|
Service Code
|
CPT 97129 GP
|
| Hospital Charge Code |
5344658
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$59.92 |
| Max. Negotiated Rate |
$856.00 |
| Rate for Payer: Aetna Commercial |
$192.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$184.04
|
| Rate for Payer: Aetna Managed Medicare |
$59.92
|
| 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: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$113.42
|
| Rate for Payer: Cash Price |
$64.20
|
| Rate for Payer: Cash Price |
$64.20
|
| Rate for Payer: Cigna Commercial |
$196.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$119.75
|
| Rate for Payer: Health EOS Commercial |
$190.46
|
| Rate for Payer: HFN Commercial |
$196.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$202.00
|
| Rate for Payer: Multiplan Commercial |
$171.20
|
| Rate for Payer: NAPHCARE Commercial |
$128.40
|
| Rate for Payer: Preferred Network Access Commercial |
$196.88
|
| Rate for Payer: Quartz Beloit One Network |
$104.86
|
| Rate for Payer: Quartz Commercial |
$139.10
|
| Rate for Payer: Quartz Medicare Advantage |
$128.40
|
| Rate for Payer: The Alliance Commercial |
$856.00
|
| Rate for Payer: United Healthcare PPO |
$160.50
|
| Rate for Payer: WEA Trust Commercial |
$117.70
|
| Rate for Payer: WPS Commercial |
$158.51
|
|
|
PT Community/ Work Reintegration Charges
|
Facility
|
IP
|
$223.00
|
|
|
Service Code
|
CPT 97537 GP
|
| Hospital Charge Code |
2989843
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$109.27 |
| Max. Negotiated Rate |
$205.16 |
| Rate for Payer: Aetna Commercial |
$200.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$191.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$118.19
|
| Rate for Payer: Cash Price |
$66.90
|
| Rate for Payer: Cigna Commercial |
$205.16
|
| Rate for Payer: Health EOS Commercial |
$198.47
|
| Rate for Payer: HFN Commercial |
$205.16
|
| Rate for Payer: Multiplan Commercial |
$178.40
|
| Rate for Payer: NAPHCARE Commercial |
$133.80
|
| Rate for Payer: Preferred Network Access Commercial |
$205.16
|
| Rate for Payer: Quartz Beloit One Network |
$109.27
|
| Rate for Payer: Quartz Commercial |
$133.80
|
| Rate for Payer: WEA Trust Commercial |
$122.65
|
| Rate for Payer: WPS Commercial |
$165.18
|
|
|
PT Community/ Work Reintegration Charges
|
Facility
|
OP
|
$223.00
|
|
|
Service Code
|
CPT 97537 GP
|
| Hospital Charge Code |
2989843
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$62.44 |
| Max. Negotiated Rate |
$892.00 |
| Rate for Payer: Aetna Commercial |
$200.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$191.78
|
| Rate for Payer: Aetna Managed Medicare |
$62.44
|
| 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: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$118.19
|
| Rate for Payer: Cash Price |
$66.90
|
| Rate for Payer: Cash Price |
$66.90
|
| Rate for Payer: Cigna Commercial |
$205.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$124.79
|
| Rate for Payer: Health EOS Commercial |
$198.47
|
| Rate for Payer: HFN Commercial |
$205.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$202.00
|
| Rate for Payer: Multiplan Commercial |
$178.40
|
| Rate for Payer: NAPHCARE Commercial |
$133.80
|
| Rate for Payer: Preferred Network Access Commercial |
$205.16
|
| Rate for Payer: Quartz Beloit One Network |
$109.27
|
| Rate for Payer: Quartz Commercial |
$144.95
|
| Rate for Payer: Quartz Medicare Advantage |
$133.80
|
| Rate for Payer: The Alliance Commercial |
$892.00
|
| Rate for Payer: United Healthcare PPO |
$167.25
|
| Rate for Payer: WEA Trust Commercial |
$122.65
|
| Rate for Payer: WPS Commercial |
$165.18
|
|
|
PTEN Deletion/Duplication
|
Facility
|
IP
|
$396.00
|
|
|
Service Code
|
CPT 81323
|
| Hospital Charge Code |
5484797
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$194.04 |
| Max. Negotiated Rate |
$364.32 |
| Rate for Payer: Aetna Commercial |
$356.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$340.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$209.88
|
| Rate for Payer: Cash Price |
$118.80
|
| Rate for Payer: Cigna Commercial |
$364.32
|
| Rate for Payer: Health EOS Commercial |
$352.44
|
| Rate for Payer: HFN Commercial |
$364.32
|
| Rate for Payer: Multiplan Commercial |
$316.80
|
| Rate for Payer: NAPHCARE Commercial |
$237.60
|
| Rate for Payer: Preferred Network Access Commercial |
$364.32
|
| Rate for Payer: Quartz Beloit One Network |
$194.04
|
| Rate for Payer: Quartz Commercial |
$237.60
|
| Rate for Payer: WEA Trust Commercial |
$217.80
|
| Rate for Payer: WPS Commercial |
$293.32
|
|
|
PTEN Deletion/Duplication
|
Professional
|
Both
|
$396.00
|
|
|
Service Code
|
CPT 81323
|
| Hospital Charge Code |
5484797
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$174.24 |
| Max. Negotiated Rate |
$1,059.00 |
| Rate for Payer: Aetna Commercial |
$376.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$340.56
|
| Rate for Payer: Cash Price |
$118.80
|
| Rate for Payer: Cash Price |
$118.80
|
| Rate for Payer: Cigna Commercial |
$376.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$198.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$237.60
|
| Rate for Payer: Health EOS Commercial |
$360.36
|
| Rate for Payer: HFN Commercial |
$376.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,059.00
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,059.00
|
| Rate for Payer: Multiplan Commercial |
$316.80
|
| Rate for Payer: Preferred Network Access Commercial |
$376.20
|
| Rate for Payer: Quartz Beloit One Network |
$174.24
|
| Rate for Payer: Quartz Commercial |
$225.72
|
| Rate for Payer: The Alliance Commercial |
$198.00
|
| Rate for Payer: WEA Trust Commercial |
$217.80
|
| Rate for Payer: WPS Commercial |
$293.32
|
|
|
PTEN Deletion/Duplication
|
Facility
|
OP
|
$396.00
|
|
|
Service Code
|
CPT 81323
|
| Hospital Charge Code |
5484797
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$70.08 |
| Max. Negotiated Rate |
$1,200.00 |
| Rate for Payer: Aetna Commercial |
$356.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$340.56
|
| Rate for Payer: Aetna Managed Medicare |
$300.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,125.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$525.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$498.00
|
| Rate for Payer: Anthem Medicaid |
$70.08
|
| Rate for Payer: Anthem Medicare Advantage |
$300.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$209.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$300.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$300.00
|
| Rate for Payer: Cash Price |
$118.80
|
| Rate for Payer: Cash Price |
$118.80
|
| Rate for Payer: Cigna Commercial |
$364.32
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$300.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$70.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$221.60
|
| Rate for Payer: Dean Health Medicaid |
$70.08
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$300.00
|
| Rate for Payer: Health EOS Commercial |
$352.44
|
| Rate for Payer: HFN Commercial |
$364.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,116.00
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$300.00
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$70.08
|
| Rate for Payer: Independent Care Health Plan Medicare |
$300.00
|
| Rate for Payer: Managed Health Services Medicaid |
$72.88
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$300.00
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$300.00
|
| Rate for Payer: Multiplan Commercial |
$316.80
|
| Rate for Payer: NAPHCARE Commercial |
$450.00
|
| Rate for Payer: Preferred Network Access Commercial |
$364.32
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$70.08
|
| Rate for Payer: Quartz Beloit One Network |
$194.04
|
| Rate for Payer: Quartz Commercial |
$257.40
|
| Rate for Payer: Quartz Medicare Advantage |
$300.00
|
| Rate for Payer: The Alliance Commercial |
$1,200.00
|
| Rate for Payer: United Healthcare Medicaid |
$70.08
|
| Rate for Payer: United Healthcare Medicare Advantage |
$300.00
|
| Rate for Payer: United Healthcare PPO |
$297.00
|
| Rate for Payer: WEA Trust Commercial |
$217.80
|
| Rate for Payer: Wellcare Medicare |
$300.00
|
| Rate for Payer: WMAP Medicaid |
$70.08
|
| Rate for Payer: WPS Commercial |
$293.32
|
|
|
PTEN Sequencing and Deletion/Duplication
|
Facility
|
IP
|
$396.00
|
|
|
Service Code
|
CPT 81321
|
| Hospital Charge Code |
5484744
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$194.04 |
| Max. Negotiated Rate |
$364.32 |
| Rate for Payer: Aetna Commercial |
$356.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$340.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$209.88
|
| Rate for Payer: Cash Price |
$118.80
|
| Rate for Payer: Cigna Commercial |
$364.32
|
| Rate for Payer: Health EOS Commercial |
$352.44
|
| Rate for Payer: HFN Commercial |
$364.32
|
| Rate for Payer: Multiplan Commercial |
$316.80
|
| Rate for Payer: NAPHCARE Commercial |
$237.60
|
| Rate for Payer: Preferred Network Access Commercial |
$364.32
|
| Rate for Payer: Quartz Beloit One Network |
$194.04
|
| Rate for Payer: Quartz Commercial |
$237.60
|
| Rate for Payer: WEA Trust Commercial |
$217.80
|
| Rate for Payer: WPS Commercial |
$293.32
|
|
