|
PTEN Sequencing and Deletion/Duplication
|
Facility
|
IP
|
$396.00
|
|
|
Service Code
|
CPT 81321
|
| Hospital Charge Code |
5484744
|
|
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 Sequencing and Deletion/Duplication
|
Professional
|
Both
|
$396.00
|
|
|
Service Code
|
CPT 81321
|
| Hospital Charge Code |
5484744
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$181.21 |
| Max. Negotiated Rate |
$2,745.60 |
| Rate for Payer: Aetna Commercial |
$391.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$354.18
|
| Rate for Payer: Aetna Managed Medicare |
$624.00
|
| Rate for Payer: Anthem Medicare Advantage |
$624.00
|
| 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 |
$391.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$205.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$624.00
|
| Rate for Payer: Health EOS Commercial |
$374.77
|
| Rate for Payer: HFN Commercial |
$391.25
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,202.72
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$2,202.72
|
| Rate for Payer: Independent Care Health Plan Medicare |
$624.00
|
| Rate for Payer: Multiplan Commercial |
$329.47
|
| Rate for Payer: NAPHCARE Commercial |
$936.00
|
| 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 |
$624.00
|
| Rate for Payer: The Alliance Commercial |
$2,464.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$624.00
|
| Rate for Payer: WEA Trust Commercial |
$226.51
|
| Rate for Payer: WPS Commercial |
$2,745.60
|
|
|
PTERYGIUM
|
Facility
|
IP
|
$3,879.00
|
|
| Hospital Charge Code |
2950491
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,976.74 |
| Max. Negotiated Rate |
$3,711.43 |
| Rate for Payer: Aetna Commercial |
$3,630.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,469.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,138.10
|
| Rate for Payer: Cash Price |
$1,163.70
|
| Rate for Payer: Cigna Commercial |
$3,711.43
|
| Rate for Payer: Health EOS Commercial |
$3,590.40
|
| Rate for Payer: HFN Commercial |
$3,711.43
|
| Rate for Payer: Multiplan Commercial |
$3,227.33
|
| Rate for Payer: Preferred Network Access Commercial |
$3,711.43
|
| Rate for Payer: Quartz Beloit One Network |
$1,976.74
|
| Rate for Payer: Quartz Commercial |
$2,420.50
|
| Rate for Payer: WEA Trust Commercial |
$2,218.79
|
| Rate for Payer: WPS Commercial |
$2,987.99
|
|
|
PTERYGIUM
|
Facility
|
OP
|
$3,879.00
|
|
| Hospital Charge Code |
2950491
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,129.56 |
| Max. Negotiated Rate |
$3,711.43 |
| Rate for Payer: Aetna Commercial |
$3,630.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,469.38
|
| Rate for Payer: Aetna Managed Medicare |
$1,129.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,622.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,017.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,936.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,138.10
|
| Rate for Payer: Cash Price |
$1,163.70
|
| Rate for Payer: Cigna Commercial |
$3,711.43
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,257.58
|
| Rate for Payer: Health EOS Commercial |
$3,590.40
|
| Rate for Payer: HFN Commercial |
$3,711.43
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,025.62
|
| Rate for Payer: Multiplan Commercial |
$3,227.33
|
| Rate for Payer: NAPHCARE Commercial |
$2,420.50
|
| Rate for Payer: Preferred Network Access Commercial |
$3,711.43
|
| Rate for Payer: Quartz Beloit One Network |
$1,976.74
|
| Rate for Payer: Quartz Commercial |
$2,622.20
|
| Rate for Payer: Quartz Medicare Advantage |
$2,420.50
|
| Rate for Payer: The Alliance Commercial |
$2,017.08
|
| Rate for Payer: WEA Trust Commercial |
$2,218.79
|
| Rate for Payer: WPS Commercial |
$2,987.99
|
|
|
PT E-Stim Unattended Charge
|
Facility
|
OP
|
$167.00
|
|
|
Service Code
|
CPT 97014
|
| Hospital Charge Code |
5254609
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$48.63 |
| Max. Negotiated Rate |
$362.96 |
| Rate for Payer: Aetna Commercial |
$156.31
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$149.36
|
| Rate for Payer: Aetna Managed Medicare |
$48.63
|
| 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 |
$92.05
|
| Rate for Payer: Cash Price |
$50.10
|
| Rate for Payer: Cash Price |
$50.10
|
| Rate for Payer: Cigna Commercial |
$159.79
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$97.19
|
| Rate for Payer: Health EOS Commercial |
$154.58
|
| Rate for Payer: HFN Commercial |
$159.79
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$210.08
|
| Rate for Payer: Multiplan Commercial |
$138.94
|
| Rate for Payer: NAPHCARE Commercial |
$104.21
|
| Rate for Payer: Preferred Network Access Commercial |
$159.79
|
| Rate for Payer: Quartz Beloit One Network |
$85.10
|
| Rate for Payer: Quartz Commercial |
$112.89
|
| Rate for Payer: Quartz Medicare Advantage |
$104.21
|
| Rate for Payer: The Alliance Commercial |
$86.84
|
| Rate for Payer: United Healthcare PPO |
$130.26
|
| Rate for Payer: WEA Trust Commercial |
$95.52
|
| Rate for Payer: WPS Commercial |
$128.64
|
|
|
PT E-Stim Unattended Charge
|
Facility
|
IP
|
$167.00
|
|
|
Service Code
|
CPT 97014
|
| Hospital Charge Code |
5254609
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$85.10 |
| Max. Negotiated Rate |
$159.79 |
| Rate for Payer: Aetna Commercial |
$156.31
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$149.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$92.05
|
| Rate for Payer: Cash Price |
$50.10
|
| Rate for Payer: Cigna Commercial |
$159.79
|
| Rate for Payer: Health EOS Commercial |
$154.58
|
| Rate for Payer: HFN Commercial |
$159.79
|
| Rate for Payer: Multiplan Commercial |
$138.94
|
| Rate for Payer: Preferred Network Access Commercial |
$159.79
|
| Rate for Payer: Quartz Beloit One Network |
$85.10
|
| Rate for Payer: Quartz Commercial |
$104.21
|
| Rate for Payer: WEA Trust Commercial |
$95.52
|
| Rate for Payer: WPS Commercial |
$128.64
|
|
|
PT Evaluation High Complexity
|
Facility
|
IP
|
$702.00
|
|
|
Service Code
|
CPT 97163
|
| Hospital Charge Code |
5250656
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$357.74 |
| Max. Negotiated Rate |
$671.67 |
| Rate for Payer: Aetna Commercial |
$657.07
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$627.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$386.94
|
| Rate for Payer: Cash Price |
$210.60
|
| Rate for Payer: Cigna Commercial |
$671.67
|
| Rate for Payer: Health EOS Commercial |
$649.77
|
| Rate for Payer: HFN Commercial |
$671.67
|
| Rate for Payer: Multiplan Commercial |
$584.06
|
| Rate for Payer: Preferred Network Access Commercial |
$671.67
|
| Rate for Payer: Quartz Beloit One Network |
$357.74
|
| Rate for Payer: Quartz Commercial |
$438.05
|
| Rate for Payer: WEA Trust Commercial |
$401.54
|
| Rate for Payer: WPS Commercial |
$540.75
|
|
|
PT Evaluation High Complexity
|
Facility
|
OP
|
$702.00
|
|
|
Service Code
|
CPT 97163
|
| Hospital Charge Code |
5250656
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$204.42 |
| Max. Negotiated Rate |
$671.67 |
| Rate for Payer: Aetna Commercial |
$657.07
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$627.87
|
| Rate for Payer: Aetna Managed Medicare |
$204.42
|
| 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 |
$386.94
|
| Rate for Payer: Cash Price |
$210.60
|
| Rate for Payer: Cash Price |
$210.60
|
| Rate for Payer: Cash Price |
$210.60
|
| Rate for Payer: Cigna Commercial |
$671.67
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$408.56
|
| Rate for Payer: Health EOS Commercial |
$649.77
|
| Rate for Payer: HFN Commercial |
$671.67
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$210.08
|
| Rate for Payer: Multiplan Commercial |
$584.06
|
| Rate for Payer: NAPHCARE Commercial |
$438.05
|
| Rate for Payer: Preferred Network Access Commercial |
$671.67
|
| Rate for Payer: Quartz Beloit One Network |
$357.74
|
| Rate for Payer: Quartz Commercial |
$474.55
|
| Rate for Payer: Quartz Medicare Advantage |
$438.05
|
| Rate for Payer: The Alliance Commercial |
$398.11
|
| Rate for Payer: United Healthcare PPO |
$547.56
|
| Rate for Payer: WEA Trust Commercial |
$401.54
|
| Rate for Payer: WPS Commercial |
$540.75
|
|
|
PT Evaluation Low Complexity
|
Facility
|
IP
|
$415.00
|
|
|
Service Code
|
CPT 97161
|
| Hospital Charge Code |
5250655
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$211.48 |
| Max. Negotiated Rate |
$397.07 |
| Rate for Payer: Aetna Commercial |
$388.44
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$371.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$228.75
|
| Rate for Payer: Cash Price |
$124.50
|
| Rate for Payer: Cigna Commercial |
$397.07
|
| Rate for Payer: Health EOS Commercial |
$384.12
|
| Rate for Payer: HFN Commercial |
$397.07
|
| Rate for Payer: Multiplan Commercial |
$345.28
|
| Rate for Payer: Preferred Network Access Commercial |
$397.07
|
| Rate for Payer: Quartz Beloit One Network |
$211.48
|
| Rate for Payer: Quartz Commercial |
$258.96
|
| Rate for Payer: WEA Trust Commercial |
$237.38
|
| Rate for Payer: WPS Commercial |
$319.67
|
|
|
PT Evaluation Low Complexity
|
Facility
|
OP
|
$415.00
|
|
|
Service Code
|
CPT 97161
|
| Hospital Charge Code |
5250655
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$120.85 |
| Max. Negotiated Rate |
$398.11 |
| Rate for Payer: Aetna Commercial |
$388.44
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$371.18
|
| Rate for Payer: Aetna Managed Medicare |
$120.85
|
| 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 |
$228.75
|
| Rate for Payer: Cash Price |
$124.50
|
| Rate for Payer: Cash Price |
$124.50
|
| Rate for Payer: Cash Price |
$124.50
|
| Rate for Payer: Cigna Commercial |
$397.07
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$241.53
|
| Rate for Payer: Health EOS Commercial |
$384.12
|
| Rate for Payer: HFN Commercial |
$397.07
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$210.08
|
| Rate for Payer: Multiplan Commercial |
$345.28
|
| Rate for Payer: NAPHCARE Commercial |
$258.96
|
| Rate for Payer: Preferred Network Access Commercial |
$397.07
|
| Rate for Payer: Quartz Beloit One Network |
$211.48
|
| Rate for Payer: Quartz Commercial |
$280.54
|
| Rate for Payer: Quartz Medicare Advantage |
$258.96
|
| Rate for Payer: The Alliance Commercial |
$398.11
|
| Rate for Payer: United Healthcare PPO |
$323.70
|
| Rate for Payer: WEA Trust Commercial |
$237.38
|
| Rate for Payer: WPS Commercial |
$319.67
|
|
|
PT Evaluation Moderate Complex 30 min
|
Facility
|
IP
|
$640.00
|
|
|
Service Code
|
CPT 97162
|
| Hospital Charge Code |
5247109
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$326.14 |
| Max. Negotiated Rate |
$612.35 |
| Rate for Payer: Aetna Commercial |
$599.04
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$572.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$352.77
|
| Rate for Payer: Cash Price |
$192.00
|
| Rate for Payer: Cigna Commercial |
$612.35
|
| Rate for Payer: Health EOS Commercial |
$592.38
|
| Rate for Payer: HFN Commercial |
$612.35
|
| Rate for Payer: Multiplan Commercial |
$532.48
|
| Rate for Payer: Preferred Network Access Commercial |
$612.35
|
| Rate for Payer: Quartz Beloit One Network |
$326.14
|
| Rate for Payer: Quartz Commercial |
$399.36
|
| Rate for Payer: WEA Trust Commercial |
$366.08
|
| Rate for Payer: WPS Commercial |
$492.99
|
|
|
PT Evaluation Moderate Complex 30 min
|
Facility
|
OP
|
$640.00
|
|
|
Service Code
|
CPT 97162
|
| Hospital Charge Code |
5247109
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$186.37 |
| Max. Negotiated Rate |
$612.35 |
| Rate for Payer: Aetna Commercial |
$599.04
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$572.42
|
| Rate for Payer: Aetna Managed Medicare |
$186.37
|
| 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 |
$352.77
|
| Rate for Payer: Cash Price |
$192.00
|
| Rate for Payer: Cash Price |
$192.00
|
| Rate for Payer: Cash Price |
$192.00
|
| Rate for Payer: Cigna Commercial |
$612.35
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$372.48
|
| Rate for Payer: Health EOS Commercial |
$592.38
|
| Rate for Payer: HFN Commercial |
$612.35
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$210.08
|
| Rate for Payer: Multiplan Commercial |
$532.48
|
| Rate for Payer: NAPHCARE Commercial |
$399.36
|
| Rate for Payer: Preferred Network Access Commercial |
$612.35
|
| Rate for Payer: Quartz Beloit One Network |
$326.14
|
| Rate for Payer: Quartz Commercial |
$432.64
|
| Rate for Payer: Quartz Medicare Advantage |
$399.36
|
| Rate for Payer: The Alliance Commercial |
$398.11
|
| Rate for Payer: United Healthcare PPO |
$499.20
|
| Rate for Payer: WEA Trust Commercial |
$366.08
|
| Rate for Payer: WPS Commercial |
$492.99
|
|
|
PT Finger
|
Facility
|
OP
|
$52.00
|
|
|
Service Code
|
CPT 85610
|
| Hospital Charge Code |
979846
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.46 |
| Max. Negotiated Rate |
$49.75 |
| Rate for Payer: Aetna Commercial |
$48.67
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$46.51
|
| Rate for Payer: Aetna Managed Medicare |
$4.46
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$16.73
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$7.81
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7.41
|
| Rate for Payer: Anthem Medicare Advantage |
$4.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$28.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$4.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$4.46
|
| Rate for Payer: Cash Price |
$15.60
|
| Rate for Payer: Cash Price |
$15.60
|
| Rate for Payer: Cigna Commercial |
$49.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$4.46
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$30.26
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$4.46
|
| Rate for Payer: Health EOS Commercial |
$48.13
|
| Rate for Payer: HFN Commercial |
$49.75
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$16.60
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$4.46
|
| Rate for Payer: Independent Care Health Plan Medicare |
$4.46
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$4.46
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$4.46
|
| Rate for Payer: Multiplan Commercial |
$43.26
|
| Rate for Payer: NAPHCARE Commercial |
$6.69
|
| Rate for Payer: Preferred Network Access Commercial |
$49.75
|
| Rate for Payer: Quartz Beloit One Network |
$26.50
|
| Rate for Payer: Quartz Commercial |
$35.15
|
| Rate for Payer: Quartz Medicare Advantage |
$4.46
|
| Rate for Payer: The Alliance Commercial |
$17.85
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4.46
|
| Rate for Payer: United Healthcare PPO |
$40.56
|
| Rate for Payer: WEA Trust Commercial |
$29.74
|
| Rate for Payer: Wellcare Medicare |
$4.46
|
| Rate for Payer: WPS Commercial |
$40.06
|
|
|
PT Finger
|
Facility
|
IP
|
$52.00
|
|
|
Service Code
|
CPT 85610
|
| Hospital Charge Code |
979846
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$26.50 |
| Max. Negotiated Rate |
$49.75 |
| Rate for Payer: Aetna Commercial |
$48.67
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$46.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$28.66
|
| Rate for Payer: Cash Price |
$15.60
|
| Rate for Payer: Cigna Commercial |
$49.75
|
| Rate for Payer: Health EOS Commercial |
$48.13
|
| Rate for Payer: HFN Commercial |
$49.75
|
| Rate for Payer: Multiplan Commercial |
$43.26
|
| Rate for Payer: Preferred Network Access Commercial |
$49.75
|
| Rate for Payer: Quartz Beloit One Network |
$26.50
|
| Rate for Payer: Quartz Commercial |
$32.45
|
| Rate for Payer: WEA Trust Commercial |
$29.74
|
| Rate for Payer: WPS Commercial |
$40.06
|
|
|
PT Finger
|
Professional
|
Both
|
$52.00
|
|
|
Service Code
|
CPT 85610
|
| Hospital Charge Code |
979846
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.46 |
| Max. Negotiated Rate |
$51.38 |
| Rate for Payer: Aetna Commercial |
$51.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$46.51
|
| Rate for Payer: Aetna Managed Medicare |
$4.46
|
| Rate for Payer: Anthem Medicare Advantage |
$4.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$4.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$4.46
|
| Rate for Payer: Cash Price |
$15.60
|
| Rate for Payer: Cash Price |
$15.60
|
| Rate for Payer: Cigna Commercial |
$51.38
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$27.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4.46
|
| Rate for Payer: Health EOS Commercial |
$49.21
|
| Rate for Payer: HFN Commercial |
$51.38
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$15.75
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$15.75
|
| Rate for Payer: Independent Care Health Plan Medicare |
$4.46
|
| Rate for Payer: Multiplan Commercial |
$43.26
|
| Rate for Payer: NAPHCARE Commercial |
$6.69
|
| Rate for Payer: Preferred Network Access Commercial |
$51.38
|
| Rate for Payer: Quartz Beloit One Network |
$23.80
|
| Rate for Payer: Quartz Commercial |
$30.83
|
| Rate for Payer: Quartz Medicare Advantage |
$4.46
|
| Rate for Payer: The Alliance Commercial |
$17.62
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4.46
|
| Rate for Payer: WEA Trust Commercial |
$29.74
|
| Rate for Payer: WPS Commercial |
$19.63
|
|
|
PTH Antibody
|
Facility
|
OP
|
$379.00
|
|
|
Service Code
|
CPT 83519
|
| Hospital Charge Code |
983380
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$19.14 |
| Max. Negotiated Rate |
$362.63 |
| Rate for Payer: Aetna Commercial |
$354.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$338.98
|
| Rate for Payer: Aetna Managed Medicare |
$19.14
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$71.76
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$33.49
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$31.77
|
| Rate for Payer: Anthem Medicare Advantage |
$19.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$208.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$19.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$19.14
|
| Rate for Payer: Cash Price |
$113.70
|
| Rate for Payer: Cash Price |
$113.70
|
| Rate for Payer: Cigna Commercial |
$362.63
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$19.14
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$220.58
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$19.14
|
| Rate for Payer: Health EOS Commercial |
$350.80
|
| Rate for Payer: HFN Commercial |
$362.63
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$71.19
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$19.14
|
| Rate for Payer: Independent Care Health Plan Medicare |
$19.14
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$19.14
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$19.14
|
| Rate for Payer: Multiplan Commercial |
$315.33
|
| Rate for Payer: NAPHCARE Commercial |
$28.70
|
| Rate for Payer: Preferred Network Access Commercial |
$362.63
|
| Rate for Payer: Quartz Beloit One Network |
$193.14
|
| Rate for Payer: Quartz Commercial |
$256.20
|
| Rate for Payer: Quartz Medicare Advantage |
$19.14
|
| Rate for Payer: The Alliance Commercial |
$76.54
|
| Rate for Payer: United Healthcare Medicare Advantage |
$19.14
|
| Rate for Payer: United Healthcare PPO |
$295.62
|
| Rate for Payer: WEA Trust Commercial |
$216.79
|
| Rate for Payer: Wellcare Medicare |
$19.14
|
| Rate for Payer: WPS Commercial |
$291.94
|
|
|
PTH Antibody
|
Facility
|
IP
|
$379.00
|
|
|
Service Code
|
CPT 83519
|
| Hospital Charge Code |
983380
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$193.14 |
| Max. Negotiated Rate |
$362.63 |
| Rate for Payer: Aetna Commercial |
$354.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$338.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$208.90
|
| Rate for Payer: Cash Price |
$113.70
|
| Rate for Payer: Cigna Commercial |
$362.63
|
| Rate for Payer: Health EOS Commercial |
$350.80
|
| Rate for Payer: HFN Commercial |
$362.63
|
| Rate for Payer: Multiplan Commercial |
$315.33
|
| Rate for Payer: Preferred Network Access Commercial |
$362.63
|
| Rate for Payer: Quartz Beloit One Network |
$193.14
|
| Rate for Payer: Quartz Commercial |
$236.50
|
| Rate for Payer: WEA Trust Commercial |
$216.79
|
| Rate for Payer: WPS Commercial |
$291.94
|
|
|
PTH Antibody
|
Professional
|
Both
|
$379.00
|
|
|
Service Code
|
CPT 83519
|
| Hospital Charge Code |
983380
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$19.14 |
| Max. Negotiated Rate |
$374.45 |
| Rate for Payer: Aetna Commercial |
$374.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$338.98
|
| Rate for Payer: Aetna Managed Medicare |
$19.14
|
| Rate for Payer: Anthem Medicare Advantage |
$19.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$19.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$19.14
|
| Rate for Payer: Cash Price |
$113.70
|
| Rate for Payer: Cash Price |
$113.70
|
| Rate for Payer: Cigna Commercial |
$374.45
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$197.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$19.14
|
| Rate for Payer: Health EOS Commercial |
$358.69
|
| Rate for Payer: HFN Commercial |
$374.45
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$67.55
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$67.55
|
| Rate for Payer: Independent Care Health Plan Medicare |
$19.14
|
| Rate for Payer: Multiplan Commercial |
$315.33
|
| Rate for Payer: NAPHCARE Commercial |
$28.70
|
| Rate for Payer: Preferred Network Access Commercial |
$374.45
|
| Rate for Payer: Quartz Beloit One Network |
$173.43
|
| Rate for Payer: Quartz Commercial |
$224.67
|
| Rate for Payer: Quartz Medicare Advantage |
$19.14
|
| Rate for Payer: The Alliance Commercial |
$75.59
|
| Rate for Payer: United Healthcare Medicare Advantage |
$19.14
|
| Rate for Payer: WEA Trust Commercial |
$216.79
|
| Rate for Payer: WPS Commercial |
$84.20
|
|
|
PTH-Related Protein
|
Professional
|
Both
|
$729.00
|
|
|
Service Code
|
CPT 83519
|
| Hospital Charge Code |
983382
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$19.14 |
| Max. Negotiated Rate |
$720.25 |
| Rate for Payer: Aetna Commercial |
$720.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$652.02
|
| Rate for Payer: Aetna Managed Medicare |
$19.14
|
| Rate for Payer: Anthem Medicare Advantage |
$19.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$19.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$19.14
|
| Rate for Payer: Cash Price |
$218.70
|
| Rate for Payer: Cash Price |
$218.70
|
| Rate for Payer: Cigna Commercial |
$720.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$379.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$19.14
|
| Rate for Payer: Health EOS Commercial |
$689.93
|
| Rate for Payer: HFN Commercial |
$720.25
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$67.55
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$67.55
|
| Rate for Payer: Independent Care Health Plan Medicare |
$19.14
|
| Rate for Payer: Multiplan Commercial |
$606.53
|
| Rate for Payer: NAPHCARE Commercial |
$28.70
|
| Rate for Payer: Preferred Network Access Commercial |
$720.25
|
| Rate for Payer: Quartz Beloit One Network |
$333.59
|
| Rate for Payer: Quartz Commercial |
$432.15
|
| Rate for Payer: Quartz Medicare Advantage |
$19.14
|
| Rate for Payer: The Alliance Commercial |
$75.59
|
| Rate for Payer: United Healthcare Medicare Advantage |
$19.14
|
| Rate for Payer: WEA Trust Commercial |
$416.99
|
| Rate for Payer: WPS Commercial |
$84.20
|
|
|
PTH-Related Protein
|
Facility
|
IP
|
$729.00
|
|
|
Service Code
|
CPT 83519
|
| Hospital Charge Code |
983382
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$371.50 |
| Max. Negotiated Rate |
$697.51 |
| Rate for Payer: Aetna Commercial |
$682.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$652.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$401.82
|
| Rate for Payer: Cash Price |
$218.70
|
| Rate for Payer: Cigna Commercial |
$697.51
|
| Rate for Payer: Health EOS Commercial |
$674.76
|
| Rate for Payer: HFN Commercial |
$697.51
|
| Rate for Payer: Multiplan Commercial |
$606.53
|
| Rate for Payer: Preferred Network Access Commercial |
$697.51
|
| Rate for Payer: Quartz Beloit One Network |
$371.50
|
| Rate for Payer: Quartz Commercial |
$454.90
|
| Rate for Payer: WEA Trust Commercial |
$416.99
|
| Rate for Payer: WPS Commercial |
$561.55
|
|
|
PTH-Related Protein
|
Facility
|
OP
|
$729.00
|
|
|
Service Code
|
CPT 83519
|
| Hospital Charge Code |
983382
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$19.14 |
| Max. Negotiated Rate |
$697.51 |
| Rate for Payer: Aetna Commercial |
$682.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$652.02
|
| Rate for Payer: Aetna Managed Medicare |
$19.14
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$71.76
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$33.49
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$31.77
|
| Rate for Payer: Anthem Medicare Advantage |
$19.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$401.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$19.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$19.14
|
| Rate for Payer: Cash Price |
$218.70
|
| Rate for Payer: Cash Price |
$218.70
|
| Rate for Payer: Cigna Commercial |
$697.51
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$19.14
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$424.28
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$19.14
|
| Rate for Payer: Health EOS Commercial |
$674.76
|
| Rate for Payer: HFN Commercial |
$697.51
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$71.19
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$19.14
|
| Rate for Payer: Independent Care Health Plan Medicare |
$19.14
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$19.14
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$19.14
|
| Rate for Payer: Multiplan Commercial |
$606.53
|
| Rate for Payer: NAPHCARE Commercial |
$28.70
|
| Rate for Payer: Preferred Network Access Commercial |
$697.51
|
| Rate for Payer: Quartz Beloit One Network |
$371.50
|
| Rate for Payer: Quartz Commercial |
$492.80
|
| Rate for Payer: Quartz Medicare Advantage |
$19.14
|
| Rate for Payer: The Alliance Commercial |
$76.54
|
| Rate for Payer: United Healthcare Medicare Advantage |
$19.14
|
| Rate for Payer: United Healthcare PPO |
$568.62
|
| Rate for Payer: WEA Trust Commercial |
$416.99
|
| Rate for Payer: Wellcare Medicare |
$19.14
|
| Rate for Payer: WPS Commercial |
$561.55
|
|
|
PT Manual Therapy Charge Units
|
Facility
|
OP
|
$234.00
|
|
|
Service Code
|
CPT 97140 GP
|
| Hospital Charge Code |
2989847
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$68.14 |
| Max. Negotiated Rate |
$362.96 |
| Rate for Payer: Aetna Commercial |
$219.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$209.29
|
| Rate for Payer: Aetna Managed Medicare |
$68.14
|
| 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 |
$128.98
|
| Rate for Payer: Cash Price |
$70.20
|
| Rate for Payer: Cash Price |
$70.20
|
| Rate for Payer: Cigna Commercial |
$223.89
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$136.19
|
| Rate for Payer: Health EOS Commercial |
$216.59
|
| Rate for Payer: HFN Commercial |
$223.89
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$210.08
|
| Rate for Payer: Multiplan Commercial |
$194.69
|
| Rate for Payer: NAPHCARE Commercial |
$146.02
|
| Rate for Payer: Preferred Network Access Commercial |
$223.89
|
| Rate for Payer: Quartz Beloit One Network |
$119.25
|
| Rate for Payer: Quartz Commercial |
$158.18
|
| Rate for Payer: Quartz Medicare Advantage |
$146.02
|
| Rate for Payer: The Alliance Commercial |
$121.68
|
| Rate for Payer: United Healthcare PPO |
$182.52
|
| Rate for Payer: WEA Trust Commercial |
$133.85
|
| Rate for Payer: WPS Commercial |
$180.25
|
|
|
PT Manual Therapy Charge Units
|
Facility
|
OP
|
$234.00
|
|
|
Service Code
|
CPT 97140
|
| Hospital Charge Code |
5247108
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$68.14 |
| Max. Negotiated Rate |
$362.96 |
| Rate for Payer: Aetna Commercial |
$219.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$209.29
|
| Rate for Payer: Aetna Managed Medicare |
$68.14
|
| 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 |
$128.98
|
| Rate for Payer: Cash Price |
$70.20
|
| Rate for Payer: Cash Price |
$70.20
|
| Rate for Payer: Cash Price |
$70.20
|
| Rate for Payer: Cigna Commercial |
$223.89
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$136.19
|
| Rate for Payer: Health EOS Commercial |
$216.59
|
| Rate for Payer: HFN Commercial |
$223.89
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$210.08
|
| Rate for Payer: Multiplan Commercial |
$194.69
|
| Rate for Payer: NAPHCARE Commercial |
$146.02
|
| Rate for Payer: Preferred Network Access Commercial |
$223.89
|
| Rate for Payer: Quartz Beloit One Network |
$119.25
|
| Rate for Payer: Quartz Commercial |
$158.18
|
| Rate for Payer: Quartz Medicare Advantage |
$146.02
|
| Rate for Payer: The Alliance Commercial |
$112.07
|
| Rate for Payer: United Healthcare PPO |
$182.52
|
| Rate for Payer: WEA Trust Commercial |
$133.85
|
| Rate for Payer: WPS Commercial |
$180.25
|
|
|
PT Manual Therapy Charge Units
|
Facility
|
IP
|
$234.00
|
|
|
Service Code
|
CPT 97140 GP
|
| Hospital Charge Code |
2989847
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$119.25 |
| Max. Negotiated Rate |
$223.89 |
| Rate for Payer: Aetna Commercial |
$219.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$209.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$128.98
|
| Rate for Payer: Cash Price |
$70.20
|
| Rate for Payer: Cigna Commercial |
$223.89
|
| Rate for Payer: Health EOS Commercial |
$216.59
|
| Rate for Payer: HFN Commercial |
$223.89
|
| Rate for Payer: Multiplan Commercial |
$194.69
|
| Rate for Payer: Preferred Network Access Commercial |
$223.89
|
| Rate for Payer: Quartz Beloit One Network |
$119.25
|
| Rate for Payer: Quartz Commercial |
$146.02
|
| Rate for Payer: WEA Trust Commercial |
$133.85
|
| Rate for Payer: WPS Commercial |
$180.25
|
|
|
PT Manual Therapy Charge Units
|
Facility
|
IP
|
$234.00
|
|
|
Service Code
|
CPT 97140
|
| Hospital Charge Code |
5247108
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$119.25 |
| Max. Negotiated Rate |
$223.89 |
| Rate for Payer: Aetna Commercial |
$219.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$209.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$128.98
|
| Rate for Payer: Cash Price |
$70.20
|
| Rate for Payer: Cigna Commercial |
$223.89
|
| Rate for Payer: Health EOS Commercial |
$216.59
|
| Rate for Payer: HFN Commercial |
$223.89
|
| Rate for Payer: Multiplan Commercial |
$194.69
|
| Rate for Payer: Preferred Network Access Commercial |
$223.89
|
| Rate for Payer: Quartz Beloit One Network |
$119.25
|
| Rate for Payer: Quartz Commercial |
$146.02
|
| Rate for Payer: WEA Trust Commercial |
$133.85
|
| Rate for Payer: WPS Commercial |
$180.25
|
|
