|
PTA Tib/Peroneal
|
Facility
|
OP
|
$10,047.00
|
|
|
Service Code
|
CPT 37228
|
| Hospital Charge Code |
3052449
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,925.69 |
| Max. Negotiated Rate |
$19,394.96 |
| Rate for Payer: Aetna Commercial |
$9,403.99
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,986.04
|
| Rate for Payer: Aetna Managed Medicare |
$2,925.69
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$19,394.96
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$19,394.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$17,919.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,537.91
|
| 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 |
$9,612.97
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12,349.86
|
| Rate for Payer: Health EOS Commercial |
$9,299.50
|
| Rate for Payer: HFN Commercial |
$9,612.97
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,836.66
|
| Rate for Payer: Multiplan Commercial |
$8,359.10
|
| Rate for Payer: NAPHCARE Commercial |
$6,269.33
|
| Rate for Payer: Preferred Network Access Commercial |
$9,612.97
|
| Rate for Payer: Quartz Beloit One Network |
$5,119.95
|
| Rate for Payer: Quartz Commercial |
$6,791.77
|
| Rate for Payer: Quartz Medicare Advantage |
$6,269.33
|
| Rate for Payer: The Alliance Commercial |
$5,224.44
|
| Rate for Payer: United Healthcare PPO |
$9,979.84
|
| Rate for Payer: WEA Trust Commercial |
$5,746.88
|
| Rate for Payer: WPS Commercial |
$7,739.20
|
|
|
PTA Tib/Peroneal
|
Facility
|
IP
|
$10,047.00
|
|
|
Service Code
|
CPT 37228
|
| Hospital Charge Code |
3052449
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$5,119.95 |
| Max. Negotiated Rate |
$9,612.97 |
| Rate for Payer: Aetna Commercial |
$9,403.99
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,986.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,537.91
|
| Rate for Payer: Cash Price |
$3,014.10
|
| Rate for Payer: Cigna Commercial |
$9,612.97
|
| Rate for Payer: Health EOS Commercial |
$9,299.50
|
| Rate for Payer: HFN Commercial |
$9,612.97
|
| Rate for Payer: Multiplan Commercial |
$8,359.10
|
| Rate for Payer: Preferred Network Access Commercial |
$9,612.97
|
| Rate for Payer: Quartz Beloit One Network |
$5,119.95
|
| Rate for Payer: Quartz Commercial |
$6,269.33
|
| Rate for Payer: WEA Trust Commercial |
$5,746.88
|
| Rate for Payer: WPS Commercial |
$7,739.20
|
|
|
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 |
$787.99 |
| Max. Negotiated Rate |
$12,349.86 |
| Rate for Payer: Aetna Commercial |
$2,532.82
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,420.25
|
| Rate for Payer: Aetna Managed Medicare |
$787.99
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,829.26
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,407.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,350.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,491.55
|
| Rate for Payer: Cash Price |
$811.80
|
| Rate for Payer: Cash Price |
$811.80
|
| Rate for Payer: Cigna Commercial |
$2,589.10
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12,349.86
|
| Rate for Payer: Health EOS Commercial |
$2,504.67
|
| Rate for Payer: HFN Commercial |
$2,589.10
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,110.68
|
| Rate for Payer: Multiplan Commercial |
$2,251.39
|
| Rate for Payer: NAPHCARE Commercial |
$1,688.54
|
| Rate for Payer: Preferred Network Access Commercial |
$2,589.10
|
| Rate for Payer: Quartz Beloit One Network |
$1,378.98
|
| Rate for Payer: Quartz Commercial |
$1,829.26
|
| Rate for Payer: Quartz Medicare Advantage |
$1,688.54
|
| Rate for Payer: The Alliance Commercial |
$1,407.12
|
| Rate for Payer: WEA Trust Commercial |
$1,547.83
|
| Rate for Payer: WPS Commercial |
$2,084.43
|
|
|
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 |
$1,378.98 |
| Max. Negotiated Rate |
$2,589.10 |
| Rate for Payer: Aetna Commercial |
$2,532.82
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,420.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,491.55
|
| Rate for Payer: Cash Price |
$811.80
|
| Rate for Payer: Cigna Commercial |
$2,589.10
|
| Rate for Payer: Health EOS Commercial |
$2,504.67
|
| Rate for Payer: HFN Commercial |
$2,589.10
|
| Rate for Payer: Multiplan Commercial |
$2,251.39
|
| Rate for Payer: Preferred Network Access Commercial |
$2,589.10
|
| Rate for Payer: Quartz Beloit One Network |
$1,378.98
|
| Rate for Payer: Quartz Commercial |
$1,688.54
|
| Rate for Payer: WEA Trust Commercial |
$1,547.83
|
| Rate for Payer: WPS Commercial |
$2,084.43
|
|
|
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 |
$479.32 |
| Max. Negotiated Rate |
$12,349.86 |
| Rate for Payer: Aetna Commercial |
$2,291.33
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,189.49
|
| Rate for Payer: Aetna Managed Medicare |
$712.86
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,654.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,272.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,222.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,349.34
|
| Rate for Payer: Cash Price |
$734.40
|
| Rate for Payer: Cash Price |
$734.40
|
| Rate for Payer: Cigna Commercial |
$2,342.25
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12,349.86
|
| Rate for Payer: Health EOS Commercial |
$2,265.87
|
| Rate for Payer: HFN Commercial |
$2,342.25
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,909.44
|
| Rate for Payer: Multiplan Commercial |
$2,036.74
|
| Rate for Payer: NAPHCARE Commercial |
$1,527.55
|
| Rate for Payer: Preferred Network Access Commercial |
$2,342.25
|
| Rate for Payer: Quartz Beloit One Network |
$1,247.50
|
| Rate for Payer: Quartz Commercial |
$1,654.85
|
| Rate for Payer: Quartz Medicare Advantage |
$1,527.55
|
| Rate for Payer: The Alliance Commercial |
$479.32
|
| Rate for Payer: WEA Trust Commercial |
$1,400.26
|
| Rate for Payer: WPS Commercial |
$1,885.69
|
|
|
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 |
$1,247.50 |
| Max. Negotiated Rate |
$2,342.25 |
| Rate for Payer: Aetna Commercial |
$2,291.33
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,189.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,349.34
|
| Rate for Payer: Cash Price |
$734.40
|
| Rate for Payer: Cigna Commercial |
$2,342.25
|
| Rate for Payer: Health EOS Commercial |
$2,265.87
|
| Rate for Payer: HFN Commercial |
$2,342.25
|
| Rate for Payer: Multiplan Commercial |
$2,036.74
|
| Rate for Payer: Preferred Network Access Commercial |
$2,342.25
|
| Rate for Payer: Quartz Beloit One Network |
$1,247.50
|
| Rate for Payer: Quartz Commercial |
$1,527.55
|
| Rate for Payer: WEA Trust Commercial |
$1,400.26
|
| Rate for Payer: WPS Commercial |
$1,885.69
|
|
|
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 |
$2,839.49 |
| Max. Negotiated Rate |
$5,331.29 |
| Rate for Payer: Aetna Commercial |
$5,215.39
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,983.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,071.29
|
| Rate for Payer: Cash Price |
$1,671.60
|
| Rate for Payer: Cigna Commercial |
$5,331.29
|
| Rate for Payer: Health EOS Commercial |
$5,157.44
|
| Rate for Payer: HFN Commercial |
$5,331.29
|
| Rate for Payer: Multiplan Commercial |
$4,635.90
|
| Rate for Payer: Preferred Network Access Commercial |
$5,331.29
|
| Rate for Payer: Quartz Beloit One Network |
$2,839.49
|
| Rate for Payer: Quartz Commercial |
$3,476.93
|
| Rate for Payer: WEA Trust Commercial |
$3,187.18
|
| Rate for Payer: WPS Commercial |
$4,292.11
|
|
|
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 |
$2,839.49 |
| Max. Negotiated Rate |
$23,958.98 |
| Rate for Payer: Aetna Commercial |
$5,215.39
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,983.60
|
| 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 |
$3,071.29
|
| 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 |
$1,671.60
|
| Rate for Payer: Cash Price |
$1,671.60
|
| Rate for Payer: Cash Price |
$1,671.60
|
| Rate for Payer: Cigna Commercial |
$5,331.29
|
| 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 |
$5,157.44
|
| Rate for Payer: HFN Commercial |
$5,331.29
|
| 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 |
$4,635.90
|
| Rate for Payer: NAPHCARE Commercial |
$8,984.62
|
| Rate for Payer: Preferred Network Access Commercial |
$5,331.29
|
| Rate for Payer: Quartz Beloit One Network |
$2,839.49
|
| Rate for Payer: Quartz Commercial |
$3,766.67
|
| 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 |
$3,187.18
|
| Rate for Payer: Wellcare Medicare |
$5,989.74
|
| Rate for Payer: WPS Commercial |
$4,292.11
|
|
|
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 |
$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
|
|
|
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 |
$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
|
|
|
PTCA
|
Facility
|
OP
|
$26,883.00
|
|
|
Service Code
|
CPT 92920
|
| Hospital Charge Code |
3052462
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$5,989.74 |
| Max. Negotiated Rate |
$25,721.65 |
| Rate for Payer: Aetna Commercial |
$25,162.49
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$24,044.16
|
| Rate for Payer: Aetna Managed Medicare |
$5,989.74
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$24,243.44
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$21,503.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$20,428.72
|
| Rate for Payer: Anthem Medicare Advantage |
$5,989.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$14,817.91
|
| 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 |
$8,064.90
|
| Rate for Payer: Cash Price |
$8,064.90
|
| Rate for Payer: Cash Price |
$8,064.90
|
| Rate for Payer: Cigna Commercial |
$25,721.65
|
| 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 |
$24,882.90
|
| Rate for Payer: HFN Commercial |
$25,721.65
|
| 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 |
$22,366.66
|
| Rate for Payer: NAPHCARE Commercial |
$8,984.62
|
| Rate for Payer: Preferred Network Access Commercial |
$25,721.65
|
| Rate for Payer: Quartz Beloit One Network |
$13,699.58
|
| Rate for Payer: Quartz Commercial |
$18,172.91
|
| 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 |
$15,377.08
|
| Rate for Payer: Wellcare Medicare |
$5,989.74
|
| Rate for Payer: WPS Commercial |
$20,707.97
|
|
|
PTCA
|
Facility
|
IP
|
$26,883.00
|
|
|
Service Code
|
CPT 92920
|
| Hospital Charge Code |
3052462
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$13,699.58 |
| Max. Negotiated Rate |
$25,721.65 |
| Rate for Payer: Aetna Commercial |
$25,162.49
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$24,044.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$14,817.91
|
| Rate for Payer: Cash Price |
$8,064.90
|
| Rate for Payer: Cigna Commercial |
$25,721.65
|
| Rate for Payer: Health EOS Commercial |
$24,882.90
|
| Rate for Payer: HFN Commercial |
$25,721.65
|
| Rate for Payer: Multiplan Commercial |
$22,366.66
|
| Rate for Payer: Preferred Network Access Commercial |
$25,721.65
|
| Rate for Payer: Quartz Beloit One Network |
$13,699.58
|
| Rate for Payer: Quartz Commercial |
$16,774.99
|
| Rate for Payer: WEA Trust Commercial |
$15,377.08
|
| Rate for Payer: WPS Commercial |
$20,707.97
|
|
|
PTCA Ea Add Branch +
|
Facility
|
OP
|
$17,179.00
|
|
|
Service Code
|
CPT 92921
|
| Hospital Charge Code |
3052463
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$5,002.52 |
| Max. Negotiated Rate |
$24,243.44 |
| Rate for Payer: Aetna Commercial |
$16,079.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$15,364.90
|
| Rate for Payer: Aetna Managed Medicare |
$5,002.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$24,243.44
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$21,503.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$20,428.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,469.06
|
| 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 |
$16,436.87
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12,349.86
|
| Rate for Payer: Health EOS Commercial |
$15,900.88
|
| Rate for Payer: HFN Commercial |
$16,436.87
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$13,399.62
|
| Rate for Payer: Multiplan Commercial |
$14,292.93
|
| Rate for Payer: NAPHCARE Commercial |
$10,719.70
|
| Rate for Payer: Preferred Network Access Commercial |
$16,436.87
|
| Rate for Payer: Quartz Beloit One Network |
$8,754.42
|
| Rate for Payer: Quartz Commercial |
$11,613.00
|
| Rate for Payer: Quartz Medicare Advantage |
$10,719.70
|
| Rate for Payer: The Alliance Commercial |
$8,933.08
|
| Rate for Payer: WEA Trust Commercial |
$9,826.39
|
| Rate for Payer: WPS Commercial |
$13,232.98
|
|
|
PTCA Ea Add Branch +
|
Facility
|
IP
|
$17,179.00
|
|
|
Service Code
|
CPT 92921
|
| Hospital Charge Code |
3052463
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$8,754.42 |
| Max. Negotiated Rate |
$16,436.87 |
| Rate for Payer: Aetna Commercial |
$16,079.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$15,364.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,469.06
|
| Rate for Payer: Cash Price |
$5,153.70
|
| Rate for Payer: Cigna Commercial |
$16,436.87
|
| Rate for Payer: Health EOS Commercial |
$15,900.88
|
| Rate for Payer: HFN Commercial |
$16,436.87
|
| Rate for Payer: Multiplan Commercial |
$14,292.93
|
| Rate for Payer: Preferred Network Access Commercial |
$16,436.87
|
| Rate for Payer: Quartz Beloit One Network |
$8,754.42
|
| Rate for Payer: Quartz Commercial |
$10,719.70
|
| Rate for Payer: WEA Trust Commercial |
$9,826.39
|
| Rate for Payer: WPS Commercial |
$13,232.98
|
|
|
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 |
$36.18 |
| Max. Negotiated Rate |
$67.93 |
| Rate for Payer: Aetna Commercial |
$66.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$63.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$39.14
|
| Rate for Payer: Cash Price |
$21.30
|
| Rate for Payer: Cigna Commercial |
$67.93
|
| Rate for Payer: Health EOS Commercial |
$65.72
|
| Rate for Payer: HFN Commercial |
$67.93
|
| Rate for Payer: Multiplan Commercial |
$59.07
|
| Rate for Payer: Preferred Network Access Commercial |
$67.93
|
| Rate for Payer: Quartz Beloit One Network |
$36.18
|
| Rate for Payer: Quartz Commercial |
$44.30
|
| Rate for Payer: WEA Trust Commercial |
$40.61
|
| Rate for Payer: WPS Commercial |
$54.69
|
|
|
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 |
$20.68 |
| Max. Negotiated Rate |
$286.12 |
| Rate for Payer: Aetna Commercial |
$66.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$63.50
|
| Rate for Payer: Aetna Managed Medicare |
$20.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$48.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$36.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$35.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$39.14
|
| Rate for Payer: Cash Price |
$21.30
|
| Rate for Payer: Cash Price |
$21.30
|
| Rate for Payer: Cigna Commercial |
$67.93
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$41.32
|
| Rate for Payer: Health EOS Commercial |
$65.72
|
| Rate for Payer: HFN Commercial |
$67.93
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$55.38
|
| Rate for Payer: Multiplan Commercial |
$59.07
|
| Rate for Payer: NAPHCARE Commercial |
$44.30
|
| Rate for Payer: Preferred Network Access Commercial |
$67.93
|
| Rate for Payer: Quartz Beloit One Network |
$36.18
|
| Rate for Payer: Quartz Commercial |
$48.00
|
| Rate for Payer: Quartz Medicare Advantage |
$44.30
|
| Rate for Payer: The Alliance Commercial |
$286.12
|
| Rate for Payer: United Healthcare PPO |
$55.38
|
| Rate for Payer: WEA Trust Commercial |
$40.61
|
| Rate for Payer: WPS Commercial |
$54.69
|
|
|
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 |
$71.53 |
| Max. Negotiated Rate |
$286.12 |
| Rate for Payer: Aetna Commercial |
$156.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$141.32
|
| Rate for Payer: Aetna Managed Medicare |
$71.53
|
| Rate for Payer: Anthem Medicare Advantage |
$71.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$71.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$71.53
|
| 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 |
$156.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$82.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$71.53
|
| Rate for Payer: Health EOS Commercial |
$149.53
|
| Rate for Payer: HFN Commercial |
$156.10
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$230.78
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$230.78
|
| Rate for Payer: Independent Care Health Plan Medicare |
$71.53
|
| Rate for Payer: Multiplan Commercial |
$131.46
|
| Rate for Payer: NAPHCARE Commercial |
$107.30
|
| Rate for Payer: Preferred Network Access Commercial |
$156.10
|
| Rate for Payer: Quartz Beloit One Network |
$72.30
|
| Rate for Payer: Quartz Commercial |
$93.66
|
| Rate for Payer: Quartz Medicare Advantage |
$71.53
|
| Rate for Payer: The Alliance Commercial |
$271.82
|
| Rate for Payer: United Healthcare Medicare Advantage |
$71.53
|
| Rate for Payer: WEA Trust Commercial |
$90.38
|
| Rate for Payer: WPS Commercial |
$286.12
|
|
|
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 |
$62.32 |
| Max. Negotiated Rate |
$362.96 |
| Rate for Payer: Aetna Commercial |
$200.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$191.40
|
| Rate for Payer: Aetna Managed Medicare |
$62.32
|
| 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 |
$117.96
|
| Rate for Payer: Cash Price |
$64.20
|
| Rate for Payer: Cash Price |
$64.20
|
| Rate for Payer: Cigna Commercial |
$204.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$124.55
|
| Rate for Payer: Health EOS Commercial |
$198.08
|
| Rate for Payer: HFN Commercial |
$204.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$210.08
|
| Rate for Payer: Multiplan Commercial |
$178.05
|
| Rate for Payer: NAPHCARE Commercial |
$133.54
|
| Rate for Payer: Preferred Network Access Commercial |
$204.76
|
| Rate for Payer: Quartz Beloit One Network |
$109.05
|
| Rate for Payer: Quartz Commercial |
$144.66
|
| Rate for Payer: Quartz Medicare Advantage |
$133.54
|
| Rate for Payer: The Alliance Commercial |
$111.28
|
| Rate for Payer: United Healthcare PPO |
$166.92
|
| Rate for Payer: WEA Trust Commercial |
$122.41
|
| Rate for Payer: WPS Commercial |
$164.84
|
|
|
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 |
$109.05 |
| Max. Negotiated Rate |
$204.76 |
| Rate for Payer: Aetna Commercial |
$200.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$191.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$117.96
|
| Rate for Payer: Cash Price |
$64.20
|
| Rate for Payer: Cigna Commercial |
$204.76
|
| Rate for Payer: Health EOS Commercial |
$198.08
|
| Rate for Payer: HFN Commercial |
$204.76
|
| Rate for Payer: Multiplan Commercial |
$178.05
|
| Rate for Payer: Preferred Network Access Commercial |
$204.76
|
| Rate for Payer: Quartz Beloit One Network |
$109.05
|
| Rate for Payer: Quartz Commercial |
$133.54
|
| Rate for Payer: WEA Trust Commercial |
$122.41
|
| Rate for Payer: WPS Commercial |
$164.84
|
|
|
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 |
$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
|
|
|
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 |
$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
|
|
|
PTEN Deletion/Duplication
|
Facility
|
IP
|
$396.00
|
|
|
Service Code
|
CPT 81323
|
| Hospital Charge Code |
5484797
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$201.80 |
| Max. Negotiated Rate |
$378.89 |
| Rate for Payer: Aetna Commercial |
$370.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$354.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$218.28
|
| Rate for Payer: Cash Price |
$118.80
|
| Rate for Payer: Cigna Commercial |
$378.89
|
| Rate for Payer: Health EOS Commercial |
$366.54
|
| Rate for Payer: HFN Commercial |
$378.89
|
| Rate for Payer: Multiplan Commercial |
$329.47
|
| Rate for Payer: Preferred Network Access Commercial |
$378.89
|
| Rate for Payer: Quartz Beloit One Network |
$201.80
|
| Rate for Payer: Quartz Commercial |
$247.10
|
| Rate for Payer: WEA Trust Commercial |
$226.51
|
| Rate for Payer: WPS Commercial |
$305.04
|
|
|
PTEN Deletion/Duplication
|
Professional
|
Both
|
$396.00
|
|
|
Service Code
|
CPT 81323
|
| Hospital Charge Code |
5484797
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$181.21 |
| Max. Negotiated Rate |
$1,372.80 |
| Rate for Payer: Aetna Commercial |
$391.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$354.18
|
| Rate for Payer: Aetna Managed Medicare |
$312.00
|
| Rate for Payer: Anthem Medicare Advantage |
$312.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$312.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$312.00
|
| Rate for Payer: Cash Price |
$118.80
|
| Rate for Payer: Cash Price |
$118.80
|
| Rate for Payer: Cigna Commercial |
$391.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$205.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$312.00
|
| Rate for Payer: Health EOS Commercial |
$374.77
|
| Rate for Payer: HFN Commercial |
$391.25
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,101.36
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,101.36
|
| Rate for Payer: Independent Care Health Plan Medicare |
$312.00
|
| Rate for Payer: Multiplan Commercial |
$329.47
|
| Rate for Payer: NAPHCARE Commercial |
$468.00
|
| Rate for Payer: Preferred Network Access Commercial |
$391.25
|
| Rate for Payer: Quartz Beloit One Network |
$181.21
|
| Rate for Payer: Quartz Commercial |
$234.75
|
| Rate for Payer: Quartz Medicare Advantage |
$312.00
|
| Rate for Payer: The Alliance Commercial |
$1,232.40
|
| Rate for Payer: United Healthcare Medicare Advantage |
$312.00
|
| Rate for Payer: WEA Trust Commercial |
$226.51
|
| Rate for Payer: WPS Commercial |
$1,372.80
|
|
|
PTEN Deletion/Duplication
|
Facility
|
OP
|
$396.00
|
|
|
Service Code
|
CPT 81323
|
| Hospital Charge Code |
5484797
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$201.80 |
| Max. Negotiated Rate |
$1,248.00 |
| Rate for Payer: Aetna Commercial |
$370.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$354.18
|
| Rate for Payer: Aetna Managed Medicare |
$312.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,170.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$546.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$517.92
|
| Rate for Payer: Anthem Medicare Advantage |
$312.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$218.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$312.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$312.00
|
| Rate for Payer: Cash Price |
$118.80
|
| Rate for Payer: Cash Price |
$118.80
|
| Rate for Payer: Cigna Commercial |
$378.89
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$312.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$230.47
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$312.00
|
| Rate for Payer: Health EOS Commercial |
$366.54
|
| Rate for Payer: HFN Commercial |
$378.89
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,160.64
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$312.00
|
| Rate for Payer: Independent Care Health Plan Medicare |
$312.00
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$312.00
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$312.00
|
| Rate for Payer: Multiplan Commercial |
$329.47
|
| Rate for Payer: NAPHCARE Commercial |
$468.00
|
| Rate for Payer: Preferred Network Access Commercial |
$378.89
|
| Rate for Payer: Quartz Beloit One Network |
$201.80
|
| Rate for Payer: Quartz Commercial |
$267.70
|
| Rate for Payer: Quartz Medicare Advantage |
$312.00
|
| Rate for Payer: The Alliance Commercial |
$1,248.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$312.00
|
| Rate for Payer: United Healthcare PPO |
$308.88
|
| Rate for Payer: WEA Trust Commercial |
$226.51
|
| Rate for Payer: Wellcare Medicare |
$312.00
|
| Rate for Payer: WPS Commercial |
$305.04
|
|
|
PTEN Sequencing and Deletion/Duplication
|
Facility
|
OP
|
$396.00
|
|
|
Service Code
|
CPT 81321
|
| Hospital Charge Code |
5484744
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$201.80 |
| Max. Negotiated Rate |
$2,496.00 |
| Rate for Payer: Aetna Commercial |
$370.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$354.18
|
| Rate for Payer: Aetna Managed Medicare |
$624.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,340.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,092.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,035.84
|
| Rate for Payer: Anthem Medicare Advantage |
$624.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$218.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$624.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$624.00
|
| Rate for Payer: Cash Price |
$118.80
|
| Rate for Payer: Cash Price |
$118.80
|
| Rate for Payer: Cigna Commercial |
$378.89
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$624.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$230.47
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$624.00
|
| Rate for Payer: Health EOS Commercial |
$366.54
|
| Rate for Payer: HFN Commercial |
$378.89
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,321.28
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$624.00
|
| Rate for Payer: Independent Care Health Plan Medicare |
$624.00
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$624.00
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$624.00
|
| Rate for Payer: Multiplan Commercial |
$329.47
|
| Rate for Payer: NAPHCARE Commercial |
$936.00
|
| Rate for Payer: Preferred Network Access Commercial |
$378.89
|
| Rate for Payer: Quartz Beloit One Network |
$201.80
|
| Rate for Payer: Quartz Commercial |
$267.70
|
| Rate for Payer: Quartz Medicare Advantage |
$624.00
|
| Rate for Payer: The Alliance Commercial |
$2,496.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$624.00
|
| Rate for Payer: United Healthcare PPO |
$308.88
|
| Rate for Payer: WEA Trust Commercial |
$226.51
|
| Rate for Payer: Wellcare Medicare |
$624.00
|
| Rate for Payer: WPS Commercial |
$305.04
|
|
