|
PT Therapeutic Exercise Charges
|
Professional
|
Both
|
$236.00
|
|
|
Service Code
|
CPT 97110 GP
|
| Hospital Charge Code |
752356
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$106.68 |
| Max. Negotiated Rate |
$233.17 |
| Rate for Payer: Aetna Commercial |
$233.17
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$211.08
|
| Rate for Payer: Cash Price |
$70.80
|
| Rate for Payer: Cash Price |
$70.80
|
| Rate for Payer: Cash Price |
$70.80
|
| Rate for Payer: Cigna Commercial |
$233.17
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$122.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$147.26
|
| Rate for Payer: Health EOS Commercial |
$223.35
|
| Rate for Payer: HFN Commercial |
$233.17
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$106.68
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$106.68
|
| Rate for Payer: Multiplan Commercial |
$196.35
|
| Rate for Payer: Preferred Network Access Commercial |
$233.17
|
| Rate for Payer: Quartz Beloit One Network |
$107.99
|
| Rate for Payer: Quartz Commercial |
$139.90
|
| Rate for Payer: The Alliance Commercial |
$122.72
|
| Rate for Payer: WEA Trust Commercial |
$134.99
|
| Rate for Payer: WPS Commercial |
$181.79
|
|
|
PT Therapeutic Exercise Charges
|
Facility
|
IP
|
$236.00
|
|
|
Service Code
|
CPT 97110
|
| Hospital Charge Code |
5247104
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$120.27 |
| Max. Negotiated Rate |
$225.80 |
| Rate for Payer: Aetna Commercial |
$220.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$211.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$130.08
|
| Rate for Payer: Cash Price |
$70.80
|
| Rate for Payer: Cigna Commercial |
$225.80
|
| Rate for Payer: Health EOS Commercial |
$218.44
|
| Rate for Payer: HFN Commercial |
$225.80
|
| Rate for Payer: Multiplan Commercial |
$196.35
|
| Rate for Payer: Preferred Network Access Commercial |
$225.80
|
| Rate for Payer: Quartz Beloit One Network |
$120.27
|
| Rate for Payer: Quartz Commercial |
$147.26
|
| Rate for Payer: WEA Trust Commercial |
$134.99
|
| Rate for Payer: WPS Commercial |
$181.79
|
|
|
PT Therapeutic Exercise Charges
|
Facility
|
OP
|
$236.00
|
|
|
Service Code
|
CPT 97110 GP
|
| Hospital Charge Code |
752356
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$68.72 |
| Max. Negotiated Rate |
$362.96 |
| Rate for Payer: Aetna Commercial |
$220.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$211.08
|
| Rate for Payer: Aetna Managed Medicare |
$68.72
|
| 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 |
$130.08
|
| Rate for Payer: Cash Price |
$70.80
|
| Rate for Payer: Cash Price |
$70.80
|
| Rate for Payer: Cigna Commercial |
$225.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$137.35
|
| Rate for Payer: Health EOS Commercial |
$218.44
|
| Rate for Payer: HFN Commercial |
$225.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$210.08
|
| Rate for Payer: Multiplan Commercial |
$196.35
|
| Rate for Payer: NAPHCARE Commercial |
$147.26
|
| Rate for Payer: Preferred Network Access Commercial |
$225.80
|
| Rate for Payer: Quartz Beloit One Network |
$120.27
|
| Rate for Payer: Quartz Commercial |
$159.54
|
| Rate for Payer: Quartz Medicare Advantage |
$147.26
|
| Rate for Payer: The Alliance Commercial |
$122.72
|
| Rate for Payer: United Healthcare PPO |
$184.08
|
| Rate for Payer: WEA Trust Commercial |
$134.99
|
| Rate for Payer: WPS Commercial |
$181.79
|
|
|
PT Therapeutic Exercise Charges
|
Facility
|
IP
|
$236.00
|
|
|
Service Code
|
CPT 97110 GP
|
| Hospital Charge Code |
752356
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$120.27 |
| Max. Negotiated Rate |
$225.80 |
| Rate for Payer: Aetna Commercial |
$220.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$211.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$130.08
|
| Rate for Payer: Cash Price |
$70.80
|
| Rate for Payer: Cigna Commercial |
$225.80
|
| Rate for Payer: Health EOS Commercial |
$218.44
|
| Rate for Payer: HFN Commercial |
$225.80
|
| Rate for Payer: Multiplan Commercial |
$196.35
|
| Rate for Payer: Preferred Network Access Commercial |
$225.80
|
| Rate for Payer: Quartz Beloit One Network |
$120.27
|
| Rate for Payer: Quartz Commercial |
$147.26
|
| Rate for Payer: WEA Trust Commercial |
$134.99
|
| Rate for Payer: WPS Commercial |
$181.79
|
|
|
PT TH Gait Training Chg
|
Facility
|
OP
|
$264.00
|
|
|
Service Code
|
CPT 97116 GP,95
|
| Hospital Charge Code |
5583090
|
|
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
|
|
|
PT TH Gait Training Chg
|
Facility
|
IP
|
$264.00
|
|
|
Service Code
|
CPT 97116 GP,95
|
| Hospital Charge Code |
5583090
|
|
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
|
|
|
PT TH Therapeutic Exercise Chg
|
Facility
|
IP
|
$270.00
|
|
|
Service Code
|
CPT 97110 GP,95
|
| Hospital Charge Code |
5583092
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$137.59 |
| Max. Negotiated Rate |
$258.34 |
| Rate for Payer: Aetna Commercial |
$252.72
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$241.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$148.82
|
| Rate for Payer: Cash Price |
$81.00
|
| Rate for Payer: Cigna Commercial |
$258.34
|
| Rate for Payer: Health EOS Commercial |
$249.91
|
| Rate for Payer: HFN Commercial |
$258.34
|
| Rate for Payer: Multiplan Commercial |
$224.64
|
| Rate for Payer: Preferred Network Access Commercial |
$258.34
|
| Rate for Payer: Quartz Beloit One Network |
$137.59
|
| Rate for Payer: Quartz Commercial |
$168.48
|
| Rate for Payer: WEA Trust Commercial |
$154.44
|
| Rate for Payer: WPS Commercial |
$207.98
|
|
|
PT TH Therapeutic Exercise Chg
|
Facility
|
OP
|
$270.00
|
|
|
Service Code
|
CPT 97110 GP,95
|
| Hospital Charge Code |
5583092
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$78.62 |
| Max. Negotiated Rate |
$362.96 |
| Rate for Payer: Aetna Commercial |
$252.72
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$241.49
|
| Rate for Payer: Aetna Managed Medicare |
$78.62
|
| 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 |
$148.82
|
| Rate for Payer: Cash Price |
$81.00
|
| Rate for Payer: Cash Price |
$81.00
|
| Rate for Payer: Cigna Commercial |
$258.34
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$157.14
|
| Rate for Payer: Health EOS Commercial |
$249.91
|
| Rate for Payer: HFN Commercial |
$258.34
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$210.08
|
| Rate for Payer: Multiplan Commercial |
$224.64
|
| Rate for Payer: NAPHCARE Commercial |
$168.48
|
| Rate for Payer: Preferred Network Access Commercial |
$258.34
|
| Rate for Payer: Quartz Beloit One Network |
$137.59
|
| Rate for Payer: Quartz Commercial |
$182.52
|
| Rate for Payer: Quartz Medicare Advantage |
$168.48
|
| Rate for Payer: The Alliance Commercial |
$140.40
|
| Rate for Payer: United Healthcare PPO |
$210.60
|
| Rate for Payer: WEA Trust Commercial |
$154.44
|
| Rate for Payer: WPS Commercial |
$207.98
|
|
|
PTT, Lupus
|
Facility
|
OP
|
$24.00
|
|
|
Service Code
|
CPT 85730
|
| Hospital Charge Code |
4586652
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.25 |
| Max. Negotiated Rate |
$25.00 |
| Rate for Payer: Aetna Commercial |
$22.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$21.47
|
| Rate for Payer: Aetna Managed Medicare |
$6.25
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$23.44
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$10.94
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$10.38
|
| Rate for Payer: Anthem Medicare Advantage |
$6.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$13.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$6.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$6.25
|
| Rate for Payer: Cash Price |
$7.20
|
| Rate for Payer: Cash Price |
$7.20
|
| Rate for Payer: Cigna Commercial |
$22.96
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$6.25
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$13.97
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$6.25
|
| Rate for Payer: Health EOS Commercial |
$22.21
|
| Rate for Payer: HFN Commercial |
$22.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$23.25
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$6.25
|
| Rate for Payer: Independent Care Health Plan Medicare |
$6.25
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$6.25
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$6.25
|
| Rate for Payer: Multiplan Commercial |
$19.97
|
| Rate for Payer: NAPHCARE Commercial |
$9.38
|
| Rate for Payer: Preferred Network Access Commercial |
$22.96
|
| Rate for Payer: Quartz Beloit One Network |
$12.23
|
| Rate for Payer: Quartz Commercial |
$16.22
|
| Rate for Payer: Quartz Medicare Advantage |
$6.25
|
| Rate for Payer: The Alliance Commercial |
$25.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6.25
|
| Rate for Payer: United Healthcare PPO |
$18.72
|
| Rate for Payer: WEA Trust Commercial |
$13.73
|
| Rate for Payer: Wellcare Medicare |
$6.25
|
| Rate for Payer: WPS Commercial |
$18.49
|
|
|
PTT, Lupus
|
Professional
|
Both
|
$24.00
|
|
|
Service Code
|
CPT 85730
|
| Hospital Charge Code |
4586652
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.25 |
| Max. Negotiated Rate |
$27.50 |
| Rate for Payer: Aetna Commercial |
$23.71
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$21.47
|
| Rate for Payer: Aetna Managed Medicare |
$6.25
|
| Rate for Payer: Anthem Medicare Advantage |
$6.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$6.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$6.25
|
| Rate for Payer: Cash Price |
$7.20
|
| Rate for Payer: Cash Price |
$7.20
|
| Rate for Payer: Cigna Commercial |
$23.71
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$12.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6.25
|
| Rate for Payer: Health EOS Commercial |
$22.71
|
| Rate for Payer: HFN Commercial |
$23.71
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$22.07
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$22.07
|
| Rate for Payer: Independent Care Health Plan Medicare |
$6.25
|
| Rate for Payer: Multiplan Commercial |
$19.97
|
| Rate for Payer: NAPHCARE Commercial |
$9.38
|
| Rate for Payer: Preferred Network Access Commercial |
$23.71
|
| Rate for Payer: Quartz Beloit One Network |
$10.98
|
| Rate for Payer: Quartz Commercial |
$14.23
|
| Rate for Payer: Quartz Medicare Advantage |
$6.25
|
| Rate for Payer: The Alliance Commercial |
$24.69
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6.25
|
| Rate for Payer: WEA Trust Commercial |
$13.73
|
| Rate for Payer: WPS Commercial |
$27.50
|
|
|
PTT, Lupus
|
Facility
|
IP
|
$24.00
|
|
|
Service Code
|
CPT 85730
|
| Hospital Charge Code |
4586652
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.23 |
| Max. Negotiated Rate |
$22.96 |
| Rate for Payer: Aetna Commercial |
$22.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$21.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$13.23
|
| Rate for Payer: Cash Price |
$7.20
|
| Rate for Payer: Cigna Commercial |
$22.96
|
| Rate for Payer: Health EOS Commercial |
$22.21
|
| Rate for Payer: HFN Commercial |
$22.96
|
| Rate for Payer: Multiplan Commercial |
$19.97
|
| Rate for Payer: Preferred Network Access Commercial |
$22.96
|
| Rate for Payer: Quartz Beloit One Network |
$12.23
|
| Rate for Payer: Quartz Commercial |
$14.98
|
| Rate for Payer: WEA Trust Commercial |
$13.73
|
| Rate for Payer: WPS Commercial |
$18.49
|
|
|
PT Ultrasound Charges
|
Facility
|
IP
|
$167.00
|
|
|
Service Code
|
CPT 97035
|
| Hospital Charge Code |
5247103
|
|
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 Ultrasound Charges
|
Facility
|
OP
|
$167.00
|
|
|
Service Code
|
CPT 97035
|
| Hospital Charge Code |
5247103
|
|
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: 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 |
$57.57
|
| Rate for Payer: United Healthcare PPO |
$130.26
|
| Rate for Payer: WEA Trust Commercial |
$95.52
|
| Rate for Payer: WPS Commercial |
$128.64
|
|
|
PT Wheelchair Management Charges
|
Facility
|
OP
|
$216.00
|
|
|
Service Code
|
CPT 97542 GP
|
| Hospital Charge Code |
2989837
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$62.90 |
| Max. Negotiated Rate |
$362.96 |
| Rate for Payer: Aetna Commercial |
$202.18
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$193.19
|
| Rate for Payer: Aetna Managed Medicare |
$62.90
|
| 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 |
$119.06
|
| Rate for Payer: Cash Price |
$64.80
|
| Rate for Payer: Cash Price |
$64.80
|
| Rate for Payer: Cigna Commercial |
$206.67
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$125.71
|
| Rate for Payer: Health EOS Commercial |
$199.93
|
| Rate for Payer: HFN Commercial |
$206.67
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$210.08
|
| Rate for Payer: Multiplan Commercial |
$179.71
|
| Rate for Payer: NAPHCARE Commercial |
$134.78
|
| Rate for Payer: Preferred Network Access Commercial |
$206.67
|
| Rate for Payer: Quartz Beloit One Network |
$110.07
|
| Rate for Payer: Quartz Commercial |
$146.02
|
| Rate for Payer: Quartz Medicare Advantage |
$134.78
|
| Rate for Payer: The Alliance Commercial |
$112.32
|
| Rate for Payer: United Healthcare PPO |
$168.48
|
| Rate for Payer: WEA Trust Commercial |
$123.55
|
| Rate for Payer: WPS Commercial |
$166.38
|
|
|
PT Wheelchair Management Charges
|
Facility
|
IP
|
$216.00
|
|
|
Service Code
|
CPT 97542 GP
|
| Hospital Charge Code |
2989837
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$110.07 |
| Max. Negotiated Rate |
$206.67 |
| Rate for Payer: Aetna Commercial |
$202.18
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$193.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$119.06
|
| Rate for Payer: Cash Price |
$64.80
|
| Rate for Payer: Cigna Commercial |
$206.67
|
| Rate for Payer: Health EOS Commercial |
$199.93
|
| Rate for Payer: HFN Commercial |
$206.67
|
| Rate for Payer: Multiplan Commercial |
$179.71
|
| Rate for Payer: Preferred Network Access Commercial |
$206.67
|
| Rate for Payer: Quartz Beloit One Network |
$110.07
|
| Rate for Payer: Quartz Commercial |
$134.78
|
| Rate for Payer: WEA Trust Commercial |
$123.55
|
| Rate for Payer: WPS Commercial |
$166.38
|
|
|
PT Wheelchair Management Charges
|
Professional
|
Both
|
$216.00
|
|
|
Service Code
|
CPT 97542 GP
|
| Hospital Charge Code |
2989837
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$98.84 |
| Max. Negotiated Rate |
$213.41 |
| Rate for Payer: Aetna Commercial |
$213.41
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$193.19
|
| Rate for Payer: Cash Price |
$64.80
|
| Rate for Payer: Cash Price |
$64.80
|
| Rate for Payer: Cash Price |
$64.80
|
| Rate for Payer: Cigna Commercial |
$213.41
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$112.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$134.78
|
| Rate for Payer: Health EOS Commercial |
$204.42
|
| Rate for Payer: HFN Commercial |
$213.41
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$115.35
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$115.35
|
| Rate for Payer: Multiplan Commercial |
$179.71
|
| Rate for Payer: Preferred Network Access Commercial |
$213.41
|
| Rate for Payer: Quartz Beloit One Network |
$98.84
|
| Rate for Payer: Quartz Commercial |
$128.04
|
| Rate for Payer: The Alliance Commercial |
$112.32
|
| Rate for Payer: WEA Trust Commercial |
$123.55
|
| Rate for Payer: WPS Commercial |
$166.38
|
|
|
PULL LOOPS #ACM-9156
|
Facility
|
OP
|
$293.00
|
|
| Hospital Charge Code |
2970889
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$85.32 |
| Max. Negotiated Rate |
$280.34 |
| Rate for Payer: Aetna Commercial |
$274.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$262.06
|
| Rate for Payer: Aetna Managed Medicare |
$85.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$198.07
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$152.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$146.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$161.50
|
| Rate for Payer: Cash Price |
$87.90
|
| Rate for Payer: Cigna Commercial |
$280.34
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$170.53
|
| Rate for Payer: Health EOS Commercial |
$271.20
|
| Rate for Payer: HFN Commercial |
$280.34
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$228.54
|
| Rate for Payer: Multiplan Commercial |
$243.78
|
| Rate for Payer: NAPHCARE Commercial |
$182.83
|
| Rate for Payer: Preferred Network Access Commercial |
$280.34
|
| Rate for Payer: Quartz Beloit One Network |
$149.31
|
| Rate for Payer: Quartz Commercial |
$198.07
|
| Rate for Payer: Quartz Medicare Advantage |
$182.83
|
| Rate for Payer: The Alliance Commercial |
$152.36
|
| Rate for Payer: WEA Trust Commercial |
$167.60
|
| Rate for Payer: WPS Commercial |
$225.70
|
|
|
PULL LOOPS #ACM-9156
|
Facility
|
IP
|
$293.00
|
|
| Hospital Charge Code |
2970889
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$149.31 |
| Max. Negotiated Rate |
$280.34 |
| Rate for Payer: Aetna Commercial |
$274.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$262.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$161.50
|
| Rate for Payer: Cash Price |
$87.90
|
| Rate for Payer: Cigna Commercial |
$280.34
|
| Rate for Payer: Health EOS Commercial |
$271.20
|
| Rate for Payer: HFN Commercial |
$280.34
|
| Rate for Payer: Multiplan Commercial |
$243.78
|
| Rate for Payer: Preferred Network Access Commercial |
$280.34
|
| Rate for Payer: Quartz Beloit One Network |
$149.31
|
| Rate for Payer: Quartz Commercial |
$182.83
|
| Rate for Payer: WEA Trust Commercial |
$167.60
|
| Rate for Payer: WPS Commercial |
$225.70
|
|
|
Pulm funct tst plethysmograp 9472626
|
Professional
|
Both
|
$246.00
|
|
|
Service Code
|
CPT 94726 26
|
| Hospital Charge Code |
3015457
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$9.85 |
| Max. Negotiated Rate |
$243.05 |
| Rate for Payer: Aetna Commercial |
$243.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$220.02
|
| Rate for Payer: Aetna Managed Medicare |
$12.12
|
| Rate for Payer: Anthem Medicare Advantage |
$12.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12.12
|
| Rate for Payer: Cash Price |
$73.80
|
| Rate for Payer: Cash Price |
$73.80
|
| Rate for Payer: Cigna Commercial |
$243.05
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$9.85
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12.12
|
| Rate for Payer: Health EOS Commercial |
$232.81
|
| Rate for Payer: HFN Commercial |
$243.05
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$43.36
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$43.36
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12.12
|
| Rate for Payer: Multiplan Commercial |
$204.67
|
| Rate for Payer: NAPHCARE Commercial |
$18.17
|
| Rate for Payer: Preferred Network Access Commercial |
$243.05
|
| Rate for Payer: Quartz Beloit One Network |
$112.57
|
| Rate for Payer: Quartz Commercial |
$145.83
|
| Rate for Payer: Quartz Medicare Advantage |
$12.12
|
| Rate for Payer: The Alliance Commercial |
$30.29
|
| Rate for Payer: United Healthcare Medicaid |
$9.85
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.12
|
| Rate for Payer: WEA Trust Commercial |
$140.71
|
| Rate for Payer: WPS Commercial |
$48.46
|
|
|
Pulmicort - Additional Unit Dose Medicaiton
|
Facility
|
IP
|
$36.00
|
|
| Hospital Charge Code |
5516921
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$18.35 |
| Max. Negotiated Rate |
$34.44 |
| Rate for Payer: Aetna Commercial |
$33.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$32.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$19.84
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Cigna Commercial |
$34.44
|
| Rate for Payer: Health EOS Commercial |
$33.32
|
| Rate for Payer: HFN Commercial |
$34.44
|
| Rate for Payer: Multiplan Commercial |
$29.95
|
| Rate for Payer: Preferred Network Access Commercial |
$34.44
|
| Rate for Payer: Quartz Beloit One Network |
$18.35
|
| Rate for Payer: Quartz Commercial |
$22.46
|
| Rate for Payer: WEA Trust Commercial |
$20.59
|
| Rate for Payer: WPS Commercial |
$27.73
|
|
|
Pulmicort - Additional Unit Dose Medicaiton
|
Facility
|
OP
|
$36.00
|
|
| Hospital Charge Code |
5516921
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.48 |
| Max. Negotiated Rate |
$34.44 |
| Rate for Payer: Aetna Commercial |
$33.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$32.20
|
| Rate for Payer: Aetna Managed Medicare |
$10.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$24.34
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$18.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$17.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$19.84
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Cigna Commercial |
$34.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$20.95
|
| Rate for Payer: Health EOS Commercial |
$33.32
|
| Rate for Payer: HFN Commercial |
$34.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$28.08
|
| Rate for Payer: Multiplan Commercial |
$29.95
|
| Rate for Payer: NAPHCARE Commercial |
$22.46
|
| Rate for Payer: Preferred Network Access Commercial |
$34.44
|
| Rate for Payer: Quartz Beloit One Network |
$18.35
|
| Rate for Payer: Quartz Commercial |
$24.34
|
| Rate for Payer: Quartz Medicare Advantage |
$22.46
|
| Rate for Payer: The Alliance Commercial |
$18.72
|
| Rate for Payer: WEA Trust Commercial |
$20.59
|
| Rate for Payer: WPS Commercial |
$27.73
|
|
|
Pulmocare Ready To Hang 1000 mL
|
Facility
|
IP
|
$76.00
|
|
|
Service Code
|
HCPCS B4154
|
| Hospital Charge Code |
3031453
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$38.73 |
| Max. Negotiated Rate |
$72.72 |
| Rate for Payer: Aetna Commercial |
$71.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$67.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$41.89
|
| Rate for Payer: Cash Price |
$22.80
|
| Rate for Payer: Cigna Commercial |
$72.72
|
| Rate for Payer: Health EOS Commercial |
$70.35
|
| Rate for Payer: HFN Commercial |
$72.72
|
| Rate for Payer: Multiplan Commercial |
$63.23
|
| Rate for Payer: Preferred Network Access Commercial |
$72.72
|
| Rate for Payer: Quartz Beloit One Network |
$38.73
|
| Rate for Payer: Quartz Commercial |
$47.42
|
| Rate for Payer: WEA Trust Commercial |
$43.47
|
| Rate for Payer: WPS Commercial |
$58.54
|
|
|
Pulmocare Ready To Hang 1000 mL
|
Facility
|
OP
|
$76.00
|
|
|
Service Code
|
HCPCS B4154
|
| Hospital Charge Code |
3031453
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$22.13 |
| Max. Negotiated Rate |
$72.72 |
| Rate for Payer: Aetna Commercial |
$71.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$67.97
|
| Rate for Payer: Aetna Managed Medicare |
$22.13
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$51.38
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$39.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$37.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$41.89
|
| Rate for Payer: Cash Price |
$22.80
|
| Rate for Payer: Cigna Commercial |
$72.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$44.23
|
| Rate for Payer: Health EOS Commercial |
$70.35
|
| Rate for Payer: HFN Commercial |
$72.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$59.28
|
| Rate for Payer: Multiplan Commercial |
$63.23
|
| Rate for Payer: NAPHCARE Commercial |
$47.42
|
| Rate for Payer: Preferred Network Access Commercial |
$72.72
|
| Rate for Payer: Quartz Beloit One Network |
$38.73
|
| Rate for Payer: Quartz Commercial |
$51.38
|
| Rate for Payer: Quartz Medicare Advantage |
$47.42
|
| Rate for Payer: The Alliance Commercial |
$39.52
|
| Rate for Payer: WEA Trust Commercial |
$43.47
|
| Rate for Payer: WPS Commercial |
$58.54
|
|
|
PULMONARY EDEMA AND RESPIRATORY FAILURE
|
Facility
|
IP
|
$34,396.96
|
|
|
Service Code
|
MSDRG 189
|
| Min. Negotiated Rate |
$9,967.71 |
| Max. Negotiated Rate |
$34,396.96 |
| Rate for Payer: Aetna Managed Medicare |
$9,967.71
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$26,955.44
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$20,661.13
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$19,629.42
|
| Rate for Payer: Anthem Medicare Advantage |
$9,967.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$9,967.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$9,967.71
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$9,967.71
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$21,790.45
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$9,967.71
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$24,984.96
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$9,967.71
|
| Rate for Payer: Independent Care Health Plan Medicare |
$9,967.71
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$9,967.71
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$9,967.71
|
| Rate for Payer: NAPHCARE Commercial |
$14,951.57
|
| Rate for Payer: Quartz Medicare Advantage |
$9,967.71
|
| Rate for Payer: The Alliance Commercial |
$34,396.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$9,967.71
|
| Rate for Payer: United Healthcare PPO |
$19,451.11
|
| Rate for Payer: Wellcare Medicare |
$9,967.71
|
|
|
PULMONARY EMBOLISM
|
Facility
|
IP
|
$17,361.25
|
|
|
Service Code
|
APR-DRG 1344
|
| Min. Negotiated Rate |
$15,421.35 |
| Max. Negotiated Rate |
$17,361.25 |
| Rate for Payer: Anthem Medicaid |
$16,624.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$16,624.36
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$16,624.36
|
| Rate for Payer: Dean Health Medicaid |
$16,624.36
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$15,421.35
|
| Rate for Payer: Managed Health Services Medicaid |
$17,361.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$16,624.36
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$16,624.36
|
| Rate for Payer: United Healthcare Medicaid |
$16,624.36
|
|
