|
Psychotherapy 30 min (16-37) 90832
|
Professional
|
Both
|
$333.00
|
|
|
Service Code
|
CPT 90832
|
| Hospital Charge Code |
2990620
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$71.82 |
| Max. Negotiated Rate |
$329.00 |
| Rate for Payer: Aetna Commercial |
$329.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$297.84
|
| Rate for Payer: Aetna Managed Medicare |
$71.82
|
| Rate for Payer: Anthem Medicare Advantage |
$71.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$71.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$71.82
|
| Rate for Payer: Cash Price |
$99.90
|
| Rate for Payer: Cash Price |
$99.90
|
| Rate for Payer: Cigna Commercial |
$329.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$173.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$71.82
|
| Rate for Payer: Health EOS Commercial |
$315.15
|
| Rate for Payer: HFN Commercial |
$329.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$246.23
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$246.23
|
| Rate for Payer: Independent Care Health Plan Medicare |
$71.82
|
| Rate for Payer: Multiplan Commercial |
$277.06
|
| Rate for Payer: NAPHCARE Commercial |
$107.73
|
| Rate for Payer: Preferred Network Access Commercial |
$329.00
|
| Rate for Payer: Quartz Beloit One Network |
$152.38
|
| Rate for Payer: Quartz Commercial |
$197.40
|
| Rate for Payer: Quartz Medicare Advantage |
$71.82
|
| Rate for Payer: The Alliance Commercial |
$179.56
|
| Rate for Payer: United Healthcare Medicare Advantage |
$71.82
|
| Rate for Payer: WEA Trust Commercial |
$190.48
|
| Rate for Payer: WPS Commercial |
$287.29
|
|
|
Psychotherapy 30 minutes w/ patient and/or family 90832
|
Professional
|
Both
|
$333.00
|
|
|
Service Code
|
CPT 90832
|
| Hospital Charge Code |
2990609
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$71.82 |
| Max. Negotiated Rate |
$329.00 |
| Rate for Payer: Aetna Commercial |
$329.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$297.84
|
| Rate for Payer: Aetna Managed Medicare |
$71.82
|
| Rate for Payer: Anthem Medicare Advantage |
$71.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$71.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$71.82
|
| Rate for Payer: Cash Price |
$99.90
|
| Rate for Payer: Cash Price |
$99.90
|
| Rate for Payer: Cigna Commercial |
$329.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$173.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$71.82
|
| Rate for Payer: Health EOS Commercial |
$315.15
|
| Rate for Payer: HFN Commercial |
$329.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$246.23
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$246.23
|
| Rate for Payer: Independent Care Health Plan Medicare |
$71.82
|
| Rate for Payer: Multiplan Commercial |
$277.06
|
| Rate for Payer: NAPHCARE Commercial |
$107.73
|
| Rate for Payer: Preferred Network Access Commercial |
$329.00
|
| Rate for Payer: Quartz Beloit One Network |
$152.38
|
| Rate for Payer: Quartz Commercial |
$197.40
|
| Rate for Payer: Quartz Medicare Advantage |
$71.82
|
| Rate for Payer: The Alliance Commercial |
$179.56
|
| Rate for Payer: United Healthcare Medicare Advantage |
$71.82
|
| Rate for Payer: WEA Trust Commercial |
$190.48
|
| Rate for Payer: WPS Commercial |
$287.29
|
|
|
Psychotherapy 45 minute w/ patient and/or family 90834
|
Professional
|
Both
|
$220.00
|
|
|
Service Code
|
CPT 90834
|
| Hospital Charge Code |
2990608
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$94.80 |
| Max. Negotiated Rate |
$379.18 |
| Rate for Payer: Aetna Commercial |
$217.36
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$196.77
|
| Rate for Payer: Aetna Managed Medicare |
$94.80
|
| Rate for Payer: Anthem Medicare Advantage |
$94.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$94.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$94.80
|
| Rate for Payer: Cash Price |
$66.00
|
| Rate for Payer: Cash Price |
$66.00
|
| Rate for Payer: Cigna Commercial |
$217.36
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$114.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$94.80
|
| Rate for Payer: Health EOS Commercial |
$208.21
|
| Rate for Payer: HFN Commercial |
$217.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$324.13
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$324.13
|
| Rate for Payer: Independent Care Health Plan Medicare |
$94.80
|
| Rate for Payer: Multiplan Commercial |
$183.04
|
| Rate for Payer: NAPHCARE Commercial |
$142.19
|
| Rate for Payer: Preferred Network Access Commercial |
$217.36
|
| Rate for Payer: Quartz Beloit One Network |
$100.67
|
| Rate for Payer: Quartz Commercial |
$130.42
|
| Rate for Payer: Quartz Medicare Advantage |
$94.80
|
| Rate for Payer: The Alliance Commercial |
$236.99
|
| Rate for Payer: United Healthcare Medicare Advantage |
$94.80
|
| Rate for Payer: WEA Trust Commercial |
$125.84
|
| Rate for Payer: WPS Commercial |
$379.18
|
|
|
Psychotherapy 60 min w/ patient and/or family 90837
|
Professional
|
Both
|
$485.00
|
|
|
Service Code
|
CPT 90837
|
| Hospital Charge Code |
2990607
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$139.84 |
| Max. Negotiated Rate |
$559.35 |
| Rate for Payer: Aetna Commercial |
$479.18
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$433.78
|
| Rate for Payer: Aetna Managed Medicare |
$139.84
|
| Rate for Payer: Anthem Medicare Advantage |
$139.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$139.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$139.84
|
| Rate for Payer: Cash Price |
$145.50
|
| Rate for Payer: Cash Price |
$145.50
|
| Rate for Payer: Cigna Commercial |
$479.18
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$252.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$139.84
|
| Rate for Payer: Health EOS Commercial |
$459.00
|
| Rate for Payer: HFN Commercial |
$479.18
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$479.61
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$479.61
|
| Rate for Payer: Independent Care Health Plan Medicare |
$139.84
|
| Rate for Payer: Multiplan Commercial |
$403.52
|
| Rate for Payer: NAPHCARE Commercial |
$209.76
|
| Rate for Payer: Preferred Network Access Commercial |
$479.18
|
| Rate for Payer: Quartz Beloit One Network |
$221.94
|
| Rate for Payer: Quartz Commercial |
$287.51
|
| Rate for Payer: Quartz Medicare Advantage |
$139.84
|
| Rate for Payer: The Alliance Commercial |
$349.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$139.84
|
| Rate for Payer: WEA Trust Commercial |
$277.42
|
| Rate for Payer: WPS Commercial |
$559.35
|
|
|
PTA ADL/Training 15 min Charge
|
Facility
|
IP
|
$251.00
|
|
|
Service Code
|
CPT 97535 GP,CQ
|
| Hospital Charge Code |
5565419
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$127.91 |
| Max. Negotiated Rate |
$240.16 |
| Rate for Payer: Aetna Commercial |
$234.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$224.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$138.35
|
| Rate for Payer: Cash Price |
$75.30
|
| Rate for Payer: Cigna Commercial |
$240.16
|
| Rate for Payer: Health EOS Commercial |
$232.33
|
| Rate for Payer: HFN Commercial |
$240.16
|
| Rate for Payer: Multiplan Commercial |
$208.83
|
| Rate for Payer: Preferred Network Access Commercial |
$240.16
|
| Rate for Payer: Quartz Beloit One Network |
$127.91
|
| Rate for Payer: Quartz Commercial |
$156.62
|
| Rate for Payer: WEA Trust Commercial |
$143.57
|
| Rate for Payer: WPS Commercial |
$193.35
|
|
|
PTA ADL/Training 15 min Charge
|
Facility
|
OP
|
$251.00
|
|
|
Service Code
|
CPT 97535 GP,CQ
|
| Hospital Charge Code |
5565419
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$73.09 |
| Max. Negotiated Rate |
$362.96 |
| Rate for Payer: Aetna Commercial |
$234.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$224.49
|
| Rate for Payer: Aetna Managed Medicare |
$73.09
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$362.96
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$298.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$282.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$138.35
|
| Rate for Payer: Cash Price |
$75.30
|
| Rate for Payer: Cash Price |
$75.30
|
| Rate for Payer: Cigna Commercial |
$240.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$146.08
|
| Rate for Payer: Health EOS Commercial |
$232.33
|
| Rate for Payer: HFN Commercial |
$240.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$210.08
|
| Rate for Payer: Multiplan Commercial |
$208.83
|
| Rate for Payer: NAPHCARE Commercial |
$156.62
|
| Rate for Payer: Preferred Network Access Commercial |
$240.16
|
| Rate for Payer: Quartz Beloit One Network |
$127.91
|
| Rate for Payer: Quartz Commercial |
$169.68
|
| Rate for Payer: Quartz Medicare Advantage |
$156.62
|
| Rate for Payer: The Alliance Commercial |
$130.52
|
| Rate for Payer: United Healthcare PPO |
$195.78
|
| Rate for Payer: WEA Trust Commercial |
$143.57
|
| Rate for Payer: WPS Commercial |
$193.35
|
|
|
PTA Aquatic Therapy Charge
|
Professional
|
Both
|
$235.00
|
|
|
Service Code
|
CPT 97113 GP,CQ
|
| Hospital Charge Code |
5565399
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$107.54 |
| Max. Negotiated Rate |
$232.18 |
| Rate for Payer: Aetna Commercial |
$232.18
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$210.18
|
| Rate for Payer: Cash Price |
$70.50
|
| Rate for Payer: Cash Price |
$70.50
|
| Rate for Payer: Cash Price |
$70.50
|
| Rate for Payer: Cigna Commercial |
$232.18
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$122.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$146.64
|
| Rate for Payer: Health EOS Commercial |
$222.40
|
| Rate for Payer: HFN Commercial |
$232.18
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$134.66
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$134.66
|
| Rate for Payer: Multiplan Commercial |
$195.52
|
| Rate for Payer: Preferred Network Access Commercial |
$232.18
|
| Rate for Payer: Quartz Beloit One Network |
$107.54
|
| Rate for Payer: Quartz Commercial |
$139.31
|
| Rate for Payer: The Alliance Commercial |
$122.20
|
| Rate for Payer: WEA Trust Commercial |
$134.42
|
| Rate for Payer: WPS Commercial |
$181.02
|
|
|
PTA Aquatic Therapy Charge
|
Facility
|
IP
|
$235.00
|
|
|
Service Code
|
CPT 97113 GP,CQ
|
| Hospital Charge Code |
5565399
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$119.76 |
| Max. Negotiated Rate |
$224.85 |
| Rate for Payer: Aetna Commercial |
$219.96
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$210.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$129.53
|
| Rate for Payer: Cash Price |
$70.50
|
| Rate for Payer: Cigna Commercial |
$224.85
|
| Rate for Payer: Health EOS Commercial |
$217.52
|
| Rate for Payer: HFN Commercial |
$224.85
|
| Rate for Payer: Multiplan Commercial |
$195.52
|
| Rate for Payer: Preferred Network Access Commercial |
$224.85
|
| Rate for Payer: Quartz Beloit One Network |
$119.76
|
| Rate for Payer: Quartz Commercial |
$146.64
|
| Rate for Payer: WEA Trust Commercial |
$134.42
|
| Rate for Payer: WPS Commercial |
$181.02
|
|
|
PTA Aquatic Therapy Charge
|
Facility
|
OP
|
$235.00
|
|
|
Service Code
|
CPT 97113 GP,CQ
|
| Hospital Charge Code |
5565399
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$68.43 |
| Max. Negotiated Rate |
$362.96 |
| Rate for Payer: Aetna Commercial |
$219.96
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$210.18
|
| Rate for Payer: Aetna Managed Medicare |
$68.43
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$362.96
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$298.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$282.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$129.53
|
| Rate for Payer: Cash Price |
$70.50
|
| Rate for Payer: Cash Price |
$70.50
|
| Rate for Payer: Cigna Commercial |
$224.85
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$136.77
|
| Rate for Payer: Health EOS Commercial |
$217.52
|
| Rate for Payer: HFN Commercial |
$224.85
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$210.08
|
| Rate for Payer: Multiplan Commercial |
$195.52
|
| Rate for Payer: NAPHCARE Commercial |
$146.64
|
| Rate for Payer: Preferred Network Access Commercial |
$224.85
|
| Rate for Payer: Quartz Beloit One Network |
$119.76
|
| Rate for Payer: Quartz Commercial |
$158.86
|
| Rate for Payer: Quartz Medicare Advantage |
$146.64
|
| Rate for Payer: The Alliance Commercial |
$122.20
|
| Rate for Payer: United Healthcare PPO |
$183.30
|
| Rate for Payer: WEA Trust Commercial |
$134.42
|
| Rate for Payer: WPS Commercial |
$181.02
|
|
|
PTA Community/Work Reintegration Charge
|
Facility
|
IP
|
$223.00
|
|
|
Service Code
|
CPT 97537 GP,CQ
|
| Hospital Charge Code |
5565387
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$113.64 |
| Max. Negotiated Rate |
$213.37 |
| Rate for Payer: Aetna Commercial |
$208.73
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$199.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$122.92
|
| Rate for Payer: Cash Price |
$66.90
|
| Rate for Payer: Cigna Commercial |
$213.37
|
| Rate for Payer: Health EOS Commercial |
$206.41
|
| Rate for Payer: HFN Commercial |
$213.37
|
| Rate for Payer: Multiplan Commercial |
$185.54
|
| Rate for Payer: Preferred Network Access Commercial |
$213.37
|
| Rate for Payer: Quartz Beloit One Network |
$113.64
|
| Rate for Payer: Quartz Commercial |
$139.15
|
| Rate for Payer: WEA Trust Commercial |
$127.56
|
| Rate for Payer: WPS Commercial |
$171.78
|
|
|
PTA Community/Work Reintegration Charge
|
Facility
|
OP
|
$223.00
|
|
|
Service Code
|
CPT 97537 GP,CQ
|
| Hospital Charge Code |
5565387
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$64.94 |
| Max. Negotiated Rate |
$362.96 |
| Rate for Payer: Aetna Commercial |
$208.73
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$199.45
|
| Rate for Payer: Aetna Managed Medicare |
$64.94
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$362.96
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$298.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$282.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$122.92
|
| Rate for Payer: Cash Price |
$66.90
|
| Rate for Payer: Cash Price |
$66.90
|
| Rate for Payer: Cigna Commercial |
$213.37
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$129.79
|
| Rate for Payer: Health EOS Commercial |
$206.41
|
| Rate for Payer: HFN Commercial |
$213.37
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$210.08
|
| Rate for Payer: Multiplan Commercial |
$185.54
|
| Rate for Payer: NAPHCARE Commercial |
$139.15
|
| Rate for Payer: Preferred Network Access Commercial |
$213.37
|
| Rate for Payer: Quartz Beloit One Network |
$113.64
|
| Rate for Payer: Quartz Commercial |
$150.75
|
| Rate for Payer: Quartz Medicare Advantage |
$139.15
|
| Rate for Payer: The Alliance Commercial |
$115.96
|
| Rate for Payer: United Healthcare PPO |
$173.94
|
| Rate for Payer: WEA Trust Commercial |
$127.56
|
| Rate for Payer: WPS Commercial |
$171.78
|
|
|
PT ADL Training/15 Min Charges
|
Facility
|
IP
|
$251.00
|
|
|
Service Code
|
CPT 97535 GP
|
| Hospital Charge Code |
2989839
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$127.91 |
| Max. Negotiated Rate |
$240.16 |
| Rate for Payer: Aetna Commercial |
$234.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$224.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$138.35
|
| Rate for Payer: Cash Price |
$75.30
|
| Rate for Payer: Cigna Commercial |
$240.16
|
| Rate for Payer: Health EOS Commercial |
$232.33
|
| Rate for Payer: HFN Commercial |
$240.16
|
| Rate for Payer: Multiplan Commercial |
$208.83
|
| Rate for Payer: Preferred Network Access Commercial |
$240.16
|
| Rate for Payer: Quartz Beloit One Network |
$127.91
|
| Rate for Payer: Quartz Commercial |
$156.62
|
| Rate for Payer: WEA Trust Commercial |
$143.57
|
| Rate for Payer: WPS Commercial |
$193.35
|
|
|
PT ADL Training/15 Min Charges
|
Facility
|
OP
|
$251.00
|
|
|
Service Code
|
CPT 97535 GP
|
| Hospital Charge Code |
2989839
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$73.09 |
| Max. Negotiated Rate |
$362.96 |
| Rate for Payer: Aetna Commercial |
$234.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$224.49
|
| Rate for Payer: Aetna Managed Medicare |
$73.09
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$362.96
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$298.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$282.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$138.35
|
| Rate for Payer: Cash Price |
$75.30
|
| Rate for Payer: Cash Price |
$75.30
|
| Rate for Payer: Cigna Commercial |
$240.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$146.08
|
| Rate for Payer: Health EOS Commercial |
$232.33
|
| Rate for Payer: HFN Commercial |
$240.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$210.08
|
| Rate for Payer: Multiplan Commercial |
$208.83
|
| Rate for Payer: NAPHCARE Commercial |
$156.62
|
| Rate for Payer: Preferred Network Access Commercial |
$240.16
|
| Rate for Payer: Quartz Beloit One Network |
$127.91
|
| Rate for Payer: Quartz Commercial |
$169.68
|
| Rate for Payer: Quartz Medicare Advantage |
$156.62
|
| Rate for Payer: The Alliance Commercial |
$130.52
|
| Rate for Payer: United Healthcare PPO |
$195.78
|
| Rate for Payer: WEA Trust Commercial |
$143.57
|
| Rate for Payer: WPS Commercial |
$193.35
|
|
|
PTA Except (Le,Cere,Cor,Pulm,Dialysis)
|
Facility
|
OP
|
$8,220.00
|
|
|
Service Code
|
CPT 37246
|
| Hospital Charge Code |
5238882
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$4,188.91 |
| Max. Negotiated Rate |
$23,958.98 |
| Rate for Payer: Aetna Commercial |
$7,693.92
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,351.97
|
| Rate for Payer: Aetna Managed Medicare |
$5,989.74
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$16,970.72
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$14,336.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$13,619.84
|
| Rate for Payer: Anthem Medicare Advantage |
$5,989.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,530.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5,989.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5,989.74
|
| Rate for Payer: Cash Price |
$2,466.00
|
| Rate for Payer: Cash Price |
$2,466.00
|
| Rate for Payer: Cash Price |
$2,466.00
|
| Rate for Payer: Cigna Commercial |
$7,864.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$5,989.74
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12,349.86
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$5,989.74
|
| Rate for Payer: Health EOS Commercial |
$7,608.43
|
| Rate for Payer: HFN Commercial |
$7,864.90
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$22,281.85
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$5,989.74
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5,989.74
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$5,989.74
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$5,989.74
|
| Rate for Payer: Multiplan Commercial |
$6,839.04
|
| Rate for Payer: NAPHCARE Commercial |
$8,984.62
|
| Rate for Payer: Preferred Network Access Commercial |
$7,864.90
|
| Rate for Payer: Quartz Beloit One Network |
$4,188.91
|
| Rate for Payer: Quartz Commercial |
$5,556.72
|
| Rate for Payer: Quartz Medicare Advantage |
$5,989.74
|
| Rate for Payer: The Alliance Commercial |
$23,958.98
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5,989.74
|
| Rate for Payer: United Healthcare PPO |
$6,400.16
|
| Rate for Payer: WEA Trust Commercial |
$4,701.84
|
| Rate for Payer: Wellcare Medicare |
$5,989.74
|
| Rate for Payer: WPS Commercial |
$6,331.87
|
|
|
PTA Except (Le,Cere,Cor,Pulm,Dialysis)
|
Facility
|
IP
|
$8,220.00
|
|
|
Service Code
|
CPT 37246
|
| Hospital Charge Code |
5238882
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$4,188.91 |
| Max. Negotiated Rate |
$7,864.90 |
| Rate for Payer: Aetna Commercial |
$7,693.92
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,351.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,530.86
|
| Rate for Payer: Cash Price |
$2,466.00
|
| Rate for Payer: Cigna Commercial |
$7,864.90
|
| Rate for Payer: Health EOS Commercial |
$7,608.43
|
| Rate for Payer: HFN Commercial |
$7,864.90
|
| Rate for Payer: Multiplan Commercial |
$6,839.04
|
| Rate for Payer: Preferred Network Access Commercial |
$7,864.90
|
| Rate for Payer: Quartz Beloit One Network |
$4,188.91
|
| Rate for Payer: Quartz Commercial |
$5,129.28
|
| Rate for Payer: WEA Trust Commercial |
$4,701.84
|
| Rate for Payer: WPS Commercial |
$6,331.87
|
|
|
PTA Except (Le,Cere,Cor,Pulm,Dialysis) Ea Add Artery +
|
Facility
|
OP
|
$3,246.00
|
|
|
Service Code
|
CPT 37247
|
| Hospital Charge Code |
5238881
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$569.55 |
| Max. Negotiated Rate |
$12,349.86 |
| Rate for Payer: Aetna Commercial |
$3,038.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,903.22
|
| Rate for Payer: Aetna Managed Medicare |
$945.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,194.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,687.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,620.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,789.20
|
| Rate for Payer: Cash Price |
$973.80
|
| Rate for Payer: Cash Price |
$973.80
|
| Rate for Payer: Cigna Commercial |
$3,105.77
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12,349.86
|
| Rate for Payer: Health EOS Commercial |
$3,004.50
|
| Rate for Payer: HFN Commercial |
$3,105.77
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,531.88
|
| Rate for Payer: Multiplan Commercial |
$2,700.67
|
| Rate for Payer: NAPHCARE Commercial |
$2,025.50
|
| Rate for Payer: Preferred Network Access Commercial |
$3,105.77
|
| Rate for Payer: Quartz Beloit One Network |
$1,654.16
|
| Rate for Payer: Quartz Commercial |
$2,194.30
|
| Rate for Payer: Quartz Medicare Advantage |
$2,025.50
|
| Rate for Payer: The Alliance Commercial |
$569.55
|
| Rate for Payer: WEA Trust Commercial |
$1,856.71
|
| Rate for Payer: WPS Commercial |
$2,500.39
|
|
|
PTA Except (Le,Cere,Cor,Pulm,Dialysis) Ea Add Artery +
|
Facility
|
IP
|
$3,246.00
|
|
|
Service Code
|
CPT 37247
|
| Hospital Charge Code |
5238881
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,654.16 |
| Max. Negotiated Rate |
$3,105.77 |
| Rate for Payer: Aetna Commercial |
$3,038.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,903.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,789.20
|
| Rate for Payer: Cash Price |
$973.80
|
| Rate for Payer: Cigna Commercial |
$3,105.77
|
| Rate for Payer: Health EOS Commercial |
$3,004.50
|
| Rate for Payer: HFN Commercial |
$3,105.77
|
| Rate for Payer: Multiplan Commercial |
$2,700.67
|
| Rate for Payer: Preferred Network Access Commercial |
$3,105.77
|
| Rate for Payer: Quartz Beloit One Network |
$1,654.16
|
| Rate for Payer: Quartz Commercial |
$2,025.50
|
| Rate for Payer: WEA Trust Commercial |
$1,856.71
|
| Rate for Payer: WPS Commercial |
$2,500.39
|
|
|
PTA Fem/Pop
|
Facility
|
IP
|
$8,238.00
|
|
|
Service Code
|
CPT 37224
|
| Hospital Charge Code |
3052445
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$4,198.08 |
| Max. Negotiated Rate |
$7,882.12 |
| Rate for Payer: Aetna Commercial |
$7,710.77
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,368.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,540.79
|
| Rate for Payer: Cash Price |
$2,471.40
|
| Rate for Payer: Cigna Commercial |
$7,882.12
|
| Rate for Payer: Health EOS Commercial |
$7,625.09
|
| Rate for Payer: HFN Commercial |
$7,882.12
|
| Rate for Payer: Multiplan Commercial |
$6,854.02
|
| Rate for Payer: Preferred Network Access Commercial |
$7,882.12
|
| Rate for Payer: Quartz Beloit One Network |
$4,198.08
|
| Rate for Payer: Quartz Commercial |
$5,140.51
|
| Rate for Payer: WEA Trust Commercial |
$4,712.14
|
| Rate for Payer: WPS Commercial |
$6,345.73
|
|
|
PTA Fem/Pop
|
Facility
|
OP
|
$8,238.00
|
|
|
Service Code
|
CPT 37224
|
| Hospital Charge Code |
3052445
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,398.91 |
| Max. Negotiated Rate |
$16,970.72 |
| Rate for Payer: Aetna Commercial |
$7,710.77
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,368.07
|
| Rate for Payer: Aetna Managed Medicare |
$2,398.91
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$16,970.72
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$14,336.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$13,619.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,540.79
|
| Rate for Payer: Cash Price |
$2,471.40
|
| Rate for Payer: Cash Price |
$2,471.40
|
| Rate for Payer: Cash Price |
$2,471.40
|
| Rate for Payer: Cigna Commercial |
$7,882.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12,349.86
|
| Rate for Payer: Health EOS Commercial |
$7,625.09
|
| Rate for Payer: HFN Commercial |
$7,882.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,425.64
|
| Rate for Payer: Multiplan Commercial |
$6,854.02
|
| Rate for Payer: NAPHCARE Commercial |
$5,140.51
|
| Rate for Payer: Preferred Network Access Commercial |
$7,882.12
|
| Rate for Payer: Quartz Beloit One Network |
$4,198.08
|
| Rate for Payer: Quartz Commercial |
$5,568.89
|
| Rate for Payer: Quartz Medicare Advantage |
$5,140.51
|
| Rate for Payer: The Alliance Commercial |
$4,283.76
|
| Rate for Payer: United Healthcare PPO |
$6,400.16
|
| Rate for Payer: WEA Trust Commercial |
$4,712.14
|
| Rate for Payer: WPS Commercial |
$6,345.73
|
|
|
PTA Gait Training Charge
|
Facility
|
OP
|
$264.00
|
|
|
Service Code
|
CPT 97116 GP,CQ
|
| Hospital Charge Code |
5565345
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$76.88 |
| Max. Negotiated Rate |
$362.96 |
| Rate for Payer: Aetna Commercial |
$247.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$236.12
|
| Rate for Payer: Aetna Managed Medicare |
$76.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$362.96
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$298.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$282.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$145.52
|
| Rate for Payer: Cash Price |
$79.20
|
| Rate for Payer: Cash Price |
$79.20
|
| Rate for Payer: Cigna Commercial |
$252.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$153.65
|
| Rate for Payer: Health EOS Commercial |
$244.36
|
| Rate for Payer: HFN Commercial |
$252.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$210.08
|
| Rate for Payer: Multiplan Commercial |
$219.65
|
| Rate for Payer: NAPHCARE Commercial |
$164.74
|
| Rate for Payer: Preferred Network Access Commercial |
$252.60
|
| Rate for Payer: Quartz Beloit One Network |
$134.53
|
| Rate for Payer: Quartz Commercial |
$178.46
|
| Rate for Payer: Quartz Medicare Advantage |
$164.74
|
| Rate for Payer: The Alliance Commercial |
$137.28
|
| Rate for Payer: United Healthcare PPO |
$205.92
|
| Rate for Payer: WEA Trust Commercial |
$151.01
|
| Rate for Payer: WPS Commercial |
$203.36
|
|
|
PTA Gait Training Charge
|
Facility
|
IP
|
$264.00
|
|
|
Service Code
|
CPT 97116 GP,CQ
|
| Hospital Charge Code |
5565345
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$134.53 |
| Max. Negotiated Rate |
$252.60 |
| Rate for Payer: Aetna Commercial |
$247.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$236.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$145.52
|
| Rate for Payer: Cash Price |
$79.20
|
| Rate for Payer: Cigna Commercial |
$252.60
|
| Rate for Payer: Health EOS Commercial |
$244.36
|
| Rate for Payer: HFN Commercial |
$252.60
|
| Rate for Payer: Multiplan Commercial |
$219.65
|
| Rate for Payer: Preferred Network Access Commercial |
$252.60
|
| Rate for Payer: Quartz Beloit One Network |
$134.53
|
| Rate for Payer: Quartz Commercial |
$164.74
|
| Rate for Payer: WEA Trust Commercial |
$151.01
|
| Rate for Payer: WPS Commercial |
$203.36
|
|
|
PTA Iliac Artery
|
Facility
|
OP
|
$6,159.00
|
|
|
Service Code
|
CPT 37220
|
| Hospital Charge Code |
3052441
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,793.50 |
| Max. Negotiated Rate |
$16,970.72 |
| Rate for Payer: Aetna Commercial |
$5,764.82
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,508.61
|
| Rate for Payer: Aetna Managed Medicare |
$1,793.50
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$16,970.72
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$14,336.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$13,619.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,394.84
|
| Rate for Payer: Cash Price |
$1,847.70
|
| Rate for Payer: Cash Price |
$1,847.70
|
| Rate for Payer: Cash Price |
$1,847.70
|
| Rate for Payer: Cigna Commercial |
$5,892.93
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12,349.86
|
| Rate for Payer: Health EOS Commercial |
$5,700.77
|
| Rate for Payer: HFN Commercial |
$5,892.93
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,804.02
|
| Rate for Payer: Multiplan Commercial |
$5,124.29
|
| Rate for Payer: NAPHCARE Commercial |
$3,843.22
|
| Rate for Payer: Preferred Network Access Commercial |
$5,892.93
|
| Rate for Payer: Quartz Beloit One Network |
$3,138.63
|
| Rate for Payer: Quartz Commercial |
$4,163.48
|
| Rate for Payer: Quartz Medicare Advantage |
$3,843.22
|
| Rate for Payer: The Alliance Commercial |
$3,202.68
|
| Rate for Payer: United Healthcare PPO |
$6,400.16
|
| Rate for Payer: WEA Trust Commercial |
$3,522.95
|
| Rate for Payer: WPS Commercial |
$4,744.28
|
|
|
PTA Iliac Artery
|
Facility
|
IP
|
$6,159.00
|
|
|
Service Code
|
CPT 37220
|
| Hospital Charge Code |
3052441
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$3,138.63 |
| Max. Negotiated Rate |
$5,892.93 |
| Rate for Payer: Aetna Commercial |
$5,764.82
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,508.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,394.84
|
| Rate for Payer: Cash Price |
$1,847.70
|
| Rate for Payer: Cigna Commercial |
$5,892.93
|
| Rate for Payer: Health EOS Commercial |
$5,700.77
|
| Rate for Payer: HFN Commercial |
$5,892.93
|
| Rate for Payer: Multiplan Commercial |
$5,124.29
|
| Rate for Payer: Preferred Network Access Commercial |
$5,892.93
|
| Rate for Payer: Quartz Beloit One Network |
$3,138.63
|
| Rate for Payer: Quartz Commercial |
$3,843.22
|
| Rate for Payer: WEA Trust Commercial |
$3,522.95
|
| Rate for Payer: WPS Commercial |
$4,744.28
|
|
|
PTA Iliac Artery Each Additional +
|
Facility
|
OP
|
$2,374.00
|
|
|
Service Code
|
CPT 37222
|
| Hospital Charge Code |
3052443
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$691.31 |
| Max. Negotiated Rate |
$12,349.86 |
| Rate for Payer: Aetna Commercial |
$2,222.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,123.31
|
| Rate for Payer: Aetna Managed Medicare |
$691.31
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,604.82
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,234.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,185.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,308.55
|
| Rate for Payer: Cash Price |
$712.20
|
| Rate for Payer: Cash Price |
$712.20
|
| Rate for Payer: Cigna Commercial |
$2,271.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12,349.86
|
| Rate for Payer: Health EOS Commercial |
$2,197.37
|
| Rate for Payer: HFN Commercial |
$2,271.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,851.72
|
| Rate for Payer: Multiplan Commercial |
$1,975.17
|
| Rate for Payer: NAPHCARE Commercial |
$1,481.38
|
| Rate for Payer: Preferred Network Access Commercial |
$2,271.44
|
| Rate for Payer: Quartz Beloit One Network |
$1,209.79
|
| Rate for Payer: Quartz Commercial |
$1,604.82
|
| Rate for Payer: Quartz Medicare Advantage |
$1,481.38
|
| Rate for Payer: The Alliance Commercial |
$1,234.48
|
| Rate for Payer: WEA Trust Commercial |
$1,357.93
|
| Rate for Payer: WPS Commercial |
$1,828.69
|
|
|
PTA Iliac Artery Each Additional +
|
Facility
|
IP
|
$2,374.00
|
|
|
Service Code
|
CPT 37222
|
| Hospital Charge Code |
3052443
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,209.79 |
| Max. Negotiated Rate |
$2,271.44 |
| Rate for Payer: Aetna Commercial |
$2,222.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,123.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,308.55
|
| Rate for Payer: Cash Price |
$712.20
|
| Rate for Payer: Cigna Commercial |
$2,271.44
|
| Rate for Payer: Health EOS Commercial |
$2,197.37
|
| Rate for Payer: HFN Commercial |
$2,271.44
|
| Rate for Payer: Multiplan Commercial |
$1,975.17
|
| Rate for Payer: Preferred Network Access Commercial |
$2,271.44
|
| Rate for Payer: Quartz Beloit One Network |
$1,209.79
|
| Rate for Payer: Quartz Commercial |
$1,481.38
|
| Rate for Payer: WEA Trust Commercial |
$1,357.93
|
| Rate for Payer: WPS Commercial |
$1,828.69
|
|
