|
Psych and neuropsych test & scoring by physician; first 30 min 96136
|
Professional
|
Both
|
$186.00
|
|
|
Service Code
|
CPT 96136
|
| Hospital Charge Code |
5454802
|
| Min. Negotiated Rate |
$52.97 |
| Max. Negotiated Rate |
$176.70 |
| Rate for Payer: Aetna Commercial |
$176.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$159.96
|
| Rate for Payer: Cash Price |
$55.80
|
| Rate for Payer: Cash Price |
$55.80
|
| Rate for Payer: Cigna Commercial |
$176.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$52.97
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$111.60
|
| Rate for Payer: Health EOS Commercial |
$169.26
|
| Rate for Payer: HFN Commercial |
$176.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$81.97
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$81.97
|
| Rate for Payer: Multiplan Commercial |
$148.80
|
| Rate for Payer: Preferred Network Access Commercial |
$176.70
|
| Rate for Payer: Quartz Beloit One Network |
$81.84
|
| Rate for Payer: Quartz Commercial |
$106.02
|
| Rate for Payer: The Alliance Commercial |
$93.00
|
| Rate for Payer: United Healthcare Medicaid |
$52.97
|
| Rate for Payer: WEA Trust Commercial |
$102.30
|
| Rate for Payer: WPS Commercial |
$137.77
|
|
|
Psych and neuropsych test & scoring by technician; each add 30 min 96139
|
Professional
|
Both
|
$154.00
|
|
|
Service Code
|
CPT 96139
|
| Hospital Charge Code |
5454803
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$42.58 |
| Max. Negotiated Rate |
$146.30 |
| Rate for Payer: Aetna Commercial |
$146.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$132.44
|
| Rate for Payer: Cash Price |
$46.20
|
| Rate for Payer: Cash Price |
$46.20
|
| Rate for Payer: Cigna Commercial |
$146.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$42.58
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$92.40
|
| Rate for Payer: Health EOS Commercial |
$140.14
|
| Rate for Payer: HFN Commercial |
$146.30
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$123.34
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$123.34
|
| Rate for Payer: Multiplan Commercial |
$123.20
|
| Rate for Payer: Preferred Network Access Commercial |
$146.30
|
| Rate for Payer: Quartz Beloit One Network |
$67.76
|
| Rate for Payer: Quartz Commercial |
$87.78
|
| Rate for Payer: The Alliance Commercial |
$77.00
|
| Rate for Payer: United Healthcare Medicaid |
$42.58
|
| Rate for Payer: WEA Trust Commercial |
$84.70
|
| Rate for Payer: WPS Commercial |
$114.07
|
|
|
Psych and neuropsych test & scoring by technician; first 30 min 96138
|
Professional
|
Both
|
$154.00
|
|
|
Service Code
|
CPT 96138
|
| Hospital Charge Code |
5454804
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$42.58 |
| Max. Negotiated Rate |
$146.30 |
| Rate for Payer: Aetna Commercial |
$146.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$132.44
|
| Rate for Payer: Cash Price |
$46.20
|
| Rate for Payer: Cash Price |
$46.20
|
| Rate for Payer: Cigna Commercial |
$146.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$42.58
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$92.40
|
| Rate for Payer: Health EOS Commercial |
$140.14
|
| Rate for Payer: HFN Commercial |
$146.30
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$123.34
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$123.34
|
| Rate for Payer: Multiplan Commercial |
$123.20
|
| Rate for Payer: Preferred Network Access Commercial |
$146.30
|
| Rate for Payer: Quartz Beloit One Network |
$67.76
|
| Rate for Payer: Quartz Commercial |
$87.78
|
| Rate for Payer: The Alliance Commercial |
$77.00
|
| Rate for Payer: United Healthcare Medicaid |
$42.58
|
| Rate for Payer: WEA Trust Commercial |
$84.70
|
| Rate for Payer: WPS Commercial |
$114.07
|
|
|
Psychiatric Diagnostic Eval/No Medical Services 90791
|
Professional
|
Both
|
$560.00
|
|
|
Service Code
|
CPT 90791
|
| Hospital Charge Code |
2990618
|
|
Hospital Revenue Code
|
513
|
| Min. Negotiated Rate |
$246.40 |
| Max. Negotiated Rate |
$536.10 |
| Rate for Payer: Aetna Commercial |
$532.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$481.60
|
| Rate for Payer: Cash Price |
$168.00
|
| Rate for Payer: Cash Price |
$168.00
|
| Rate for Payer: Cigna Commercial |
$532.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$280.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$336.00
|
| Rate for Payer: Health EOS Commercial |
$509.60
|
| Rate for Payer: HFN Commercial |
$532.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$536.10
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$536.10
|
| Rate for Payer: Multiplan Commercial |
$448.00
|
| Rate for Payer: Preferred Network Access Commercial |
$532.00
|
| Rate for Payer: Quartz Beloit One Network |
$246.40
|
| Rate for Payer: Quartz Commercial |
$319.20
|
| Rate for Payer: The Alliance Commercial |
$280.00
|
| Rate for Payer: WEA Trust Commercial |
$308.00
|
| Rate for Payer: WPS Commercial |
$414.79
|
|
|
Psychological Testing Evaluation: each add hour 96131
|
Professional
|
Both
|
$328.00
|
|
|
Service Code
|
CPT 96131
|
| Hospital Charge Code |
5454798
|
| Min. Negotiated Rate |
$101.28 |
| Max. Negotiated Rate |
$311.60 |
| Rate for Payer: Aetna Commercial |
$311.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$282.08
|
| Rate for Payer: Cash Price |
$98.40
|
| Rate for Payer: Cash Price |
$98.40
|
| Rate for Payer: Cigna Commercial |
$311.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$101.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$196.80
|
| Rate for Payer: Health EOS Commercial |
$298.48
|
| Rate for Payer: HFN Commercial |
$311.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$278.34
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$278.34
|
| Rate for Payer: Multiplan Commercial |
$262.40
|
| Rate for Payer: Preferred Network Access Commercial |
$311.60
|
| Rate for Payer: Quartz Beloit One Network |
$144.32
|
| Rate for Payer: Quartz Commercial |
$186.96
|
| Rate for Payer: The Alliance Commercial |
$164.00
|
| Rate for Payer: United Healthcare Medicaid |
$101.28
|
| Rate for Payer: WEA Trust Commercial |
$180.40
|
| Rate for Payer: WPS Commercial |
$242.95
|
|
|
Psychological Testing Evaluation; first hour 96130
|
Professional
|
Both
|
$420.00
|
|
|
Service Code
|
CPT 96130
|
| Hospital Charge Code |
5454797
|
| Min. Negotiated Rate |
$132.92 |
| Max. Negotiated Rate |
$399.00 |
| Rate for Payer: Aetna Commercial |
$399.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$361.20
|
| Rate for Payer: Cash Price |
$126.00
|
| Rate for Payer: Cash Price |
$126.00
|
| Rate for Payer: Cigna Commercial |
$399.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$132.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$252.00
|
| Rate for Payer: Health EOS Commercial |
$382.20
|
| Rate for Payer: HFN Commercial |
$399.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$370.37
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$370.37
|
| Rate for Payer: Multiplan Commercial |
$336.00
|
| Rate for Payer: Preferred Network Access Commercial |
$399.00
|
| Rate for Payer: Quartz Beloit One Network |
$184.80
|
| Rate for Payer: Quartz Commercial |
$239.40
|
| Rate for Payer: The Alliance Commercial |
$210.00
|
| Rate for Payer: United Healthcare Medicaid |
$132.92
|
| Rate for Payer: WEA Trust Commercial |
$231.00
|
| Rate for Payer: WPS Commercial |
$311.09
|
|
|
PSYCHOSES
|
Facility
|
IP
|
$36,647.00
|
|
|
Service Code
|
MSDRG 885
|
| Min. Negotiated Rate |
$13,182.55 |
| Max. Negotiated Rate |
$36,647.00 |
| Rate for Payer: Aetna Managed Medicare |
$13,182.55
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$28,742.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$22,030.97
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$20,930.86
|
| Rate for Payer: Anthem Medicare Advantage |
$13,182.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13,182.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13,182.55
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$13,182.55
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$23,235.17
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$13,182.55
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$26,644.80
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$13,182.55
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13,182.55
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$13,182.55
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$13,182.55
|
| Rate for Payer: NAPHCARE Commercial |
$19,773.82
|
| Rate for Payer: Quartz Medicare Advantage |
$13,182.55
|
| Rate for Payer: The Alliance Commercial |
$36,647.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13,182.55
|
| Rate for Payer: United Healthcare PPO |
$20,743.32
|
| Rate for Payer: Wellcare Medicare |
$13,182.55
|
|
|
Psychotherapy 30 min (16-37) 90832
|
Professional
|
Both
|
$333.00
|
|
|
Service Code
|
CPT 90832
|
| Hospital Charge Code |
2990620
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$146.52 |
| Max. Negotiated Rate |
$316.35 |
| Rate for Payer: Aetna Commercial |
$316.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$286.38
|
| Rate for Payer: Cash Price |
$99.90
|
| Rate for Payer: Cash Price |
$99.90
|
| Rate for Payer: Cigna Commercial |
$316.35
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$166.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$199.80
|
| Rate for Payer: Health EOS Commercial |
$303.03
|
| Rate for Payer: HFN Commercial |
$316.35
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$236.76
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$236.76
|
| Rate for Payer: Multiplan Commercial |
$266.40
|
| Rate for Payer: Preferred Network Access Commercial |
$316.35
|
| Rate for Payer: Quartz Beloit One Network |
$146.52
|
| Rate for Payer: Quartz Commercial |
$189.81
|
| Rate for Payer: The Alliance Commercial |
$166.50
|
| Rate for Payer: WEA Trust Commercial |
$183.15
|
| Rate for Payer: WPS Commercial |
$246.65
|
|
|
Psychotherapy 30 minutes w/ patient and/or family 90832
|
Professional
|
Both
|
$333.00
|
|
|
Service Code
|
CPT 90832
|
| Hospital Charge Code |
2990609
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$146.52 |
| Max. Negotiated Rate |
$316.35 |
| Rate for Payer: Aetna Commercial |
$316.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$286.38
|
| Rate for Payer: Cash Price |
$99.90
|
| Rate for Payer: Cash Price |
$99.90
|
| Rate for Payer: Cigna Commercial |
$316.35
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$166.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$199.80
|
| Rate for Payer: Health EOS Commercial |
$303.03
|
| Rate for Payer: HFN Commercial |
$316.35
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$236.76
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$236.76
|
| Rate for Payer: Multiplan Commercial |
$266.40
|
| Rate for Payer: Preferred Network Access Commercial |
$316.35
|
| Rate for Payer: Quartz Beloit One Network |
$146.52
|
| Rate for Payer: Quartz Commercial |
$189.81
|
| Rate for Payer: The Alliance Commercial |
$166.50
|
| Rate for Payer: WEA Trust Commercial |
$183.15
|
| Rate for Payer: WPS Commercial |
$246.65
|
|
|
Psychotherapy 45 minute w/ patient and/or family 90834
|
Professional
|
Both
|
$220.00
|
|
|
Service Code
|
CPT 90834
|
| Hospital Charge Code |
2990608
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$96.80 |
| Max. Negotiated Rate |
$311.66 |
| Rate for Payer: Aetna Commercial |
$209.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$189.20
|
| Rate for Payer: Cash Price |
$66.00
|
| Rate for Payer: Cash Price |
$66.00
|
| Rate for Payer: Cigna Commercial |
$209.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$110.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$132.00
|
| Rate for Payer: Health EOS Commercial |
$200.20
|
| Rate for Payer: HFN Commercial |
$209.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$311.66
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$311.66
|
| Rate for Payer: Multiplan Commercial |
$176.00
|
| Rate for Payer: Preferred Network Access Commercial |
$209.00
|
| Rate for Payer: Quartz Beloit One Network |
$96.80
|
| Rate for Payer: Quartz Commercial |
$125.40
|
| Rate for Payer: The Alliance Commercial |
$110.00
|
| Rate for Payer: WEA Trust Commercial |
$121.00
|
| Rate for Payer: WPS Commercial |
$162.95
|
|
|
Psychotherapy 60 min w/ patient and/or family 90837
|
Professional
|
Both
|
$485.00
|
|
|
Service Code
|
CPT 90837
|
| Hospital Charge Code |
2990607
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$213.40 |
| Max. Negotiated Rate |
$461.16 |
| Rate for Payer: Aetna Commercial |
$460.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$417.10
|
| Rate for Payer: Cash Price |
$145.50
|
| Rate for Payer: Cash Price |
$145.50
|
| Rate for Payer: Cigna Commercial |
$460.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$242.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$291.00
|
| Rate for Payer: Health EOS Commercial |
$441.35
|
| Rate for Payer: HFN Commercial |
$460.75
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$461.16
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$461.16
|
| Rate for Payer: Multiplan Commercial |
$388.00
|
| Rate for Payer: Preferred Network Access Commercial |
$460.75
|
| Rate for Payer: Quartz Beloit One Network |
$213.40
|
| Rate for Payer: Quartz Commercial |
$276.45
|
| Rate for Payer: The Alliance Commercial |
$242.50
|
| Rate for Payer: WEA Trust Commercial |
$266.75
|
| Rate for Payer: WPS Commercial |
$359.24
|
|
|
PTA ADL/Training 15 min Charge
|
Facility
|
OP
|
$251.00
|
|
|
Service Code
|
CPT 97535 GP,CQ
|
| Hospital Charge Code |
5565419
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$70.28 |
| Max. Negotiated Rate |
$1,004.00 |
| Rate for Payer: Aetna Commercial |
$225.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$215.86
|
| Rate for Payer: Aetna Managed Medicare |
$70.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$349.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$287.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$272.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$133.03
|
| Rate for Payer: Cash Price |
$75.30
|
| Rate for Payer: Cash Price |
$75.30
|
| Rate for Payer: Cigna Commercial |
$230.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$140.46
|
| Rate for Payer: Health EOS Commercial |
$223.39
|
| Rate for Payer: HFN Commercial |
$230.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$202.00
|
| Rate for Payer: Multiplan Commercial |
$200.80
|
| Rate for Payer: NAPHCARE Commercial |
$150.60
|
| Rate for Payer: Preferred Network Access Commercial |
$230.92
|
| Rate for Payer: Quartz Beloit One Network |
$122.99
|
| Rate for Payer: Quartz Commercial |
$163.15
|
| Rate for Payer: Quartz Medicare Advantage |
$150.60
|
| Rate for Payer: The Alliance Commercial |
$1,004.00
|
| Rate for Payer: United Healthcare PPO |
$188.25
|
| Rate for Payer: WEA Trust Commercial |
$138.05
|
| Rate for Payer: WPS Commercial |
$185.92
|
|
|
PTA ADL/Training 15 min Charge
|
Facility
|
IP
|
$251.00
|
|
|
Service Code
|
CPT 97535 GP,CQ
|
| Hospital Charge Code |
5565419
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$122.99 |
| Max. Negotiated Rate |
$230.92 |
| Rate for Payer: Aetna Commercial |
$225.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$215.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$133.03
|
| Rate for Payer: Cash Price |
$75.30
|
| Rate for Payer: Cigna Commercial |
$230.92
|
| Rate for Payer: Health EOS Commercial |
$223.39
|
| Rate for Payer: HFN Commercial |
$230.92
|
| Rate for Payer: Multiplan Commercial |
$200.80
|
| Rate for Payer: NAPHCARE Commercial |
$150.60
|
| Rate for Payer: Preferred Network Access Commercial |
$230.92
|
| Rate for Payer: Quartz Beloit One Network |
$122.99
|
| Rate for Payer: Quartz Commercial |
$150.60
|
| Rate for Payer: WEA Trust Commercial |
$138.05
|
| Rate for Payer: WPS Commercial |
$185.92
|
|
|
PTA Aquatic Therapy Charge
|
Facility
|
OP
|
$235.00
|
|
|
Service Code
|
CPT 97113 GP,CQ
|
| Hospital Charge Code |
5565399
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$65.80 |
| Max. Negotiated Rate |
$940.00 |
| Rate for Payer: Aetna Commercial |
$211.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$202.10
|
| Rate for Payer: Aetna Managed Medicare |
$65.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$349.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$287.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$272.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$124.55
|
| Rate for Payer: Cash Price |
$70.50
|
| Rate for Payer: Cash Price |
$70.50
|
| Rate for Payer: Cigna Commercial |
$216.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$131.51
|
| Rate for Payer: Health EOS Commercial |
$209.15
|
| Rate for Payer: HFN Commercial |
$216.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$202.00
|
| Rate for Payer: Multiplan Commercial |
$188.00
|
| Rate for Payer: NAPHCARE Commercial |
$141.00
|
| Rate for Payer: Preferred Network Access Commercial |
$216.20
|
| Rate for Payer: Quartz Beloit One Network |
$115.15
|
| Rate for Payer: Quartz Commercial |
$152.75
|
| Rate for Payer: Quartz Medicare Advantage |
$141.00
|
| Rate for Payer: The Alliance Commercial |
$940.00
|
| Rate for Payer: United Healthcare PPO |
$176.25
|
| Rate for Payer: WEA Trust Commercial |
$129.25
|
| Rate for Payer: WPS Commercial |
$174.06
|
|
|
PTA Aquatic Therapy Charge
|
Professional
|
Both
|
$235.00
|
|
|
Service Code
|
CPT 97113 GP,CQ
|
| Hospital Charge Code |
5565399
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$103.40 |
| Max. Negotiated Rate |
$223.25 |
| Rate for Payer: Aetna Commercial |
$223.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$202.10
|
| Rate for Payer: Cash Price |
$70.50
|
| Rate for Payer: Cash Price |
$70.50
|
| Rate for Payer: Cigna Commercial |
$223.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$117.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$141.00
|
| Rate for Payer: Health EOS Commercial |
$213.85
|
| Rate for Payer: HFN Commercial |
$223.25
|
| Rate for Payer: Multiplan Commercial |
$188.00
|
| Rate for Payer: Preferred Network Access Commercial |
$223.25
|
| Rate for Payer: Quartz Beloit One Network |
$103.40
|
| Rate for Payer: Quartz Commercial |
$133.95
|
| Rate for Payer: The Alliance Commercial |
$117.50
|
| Rate for Payer: WEA Trust Commercial |
$129.25
|
| Rate for Payer: WPS Commercial |
$174.06
|
|
|
PTA Aquatic Therapy Charge
|
Facility
|
IP
|
$235.00
|
|
|
Service Code
|
CPT 97113 GP,CQ
|
| Hospital Charge Code |
5565399
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$115.15 |
| Max. Negotiated Rate |
$216.20 |
| Rate for Payer: Aetna Commercial |
$211.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$202.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$124.55
|
| Rate for Payer: Cash Price |
$70.50
|
| Rate for Payer: Cigna Commercial |
$216.20
|
| Rate for Payer: Health EOS Commercial |
$209.15
|
| Rate for Payer: HFN Commercial |
$216.20
|
| Rate for Payer: Multiplan Commercial |
$188.00
|
| Rate for Payer: NAPHCARE Commercial |
$141.00
|
| Rate for Payer: Preferred Network Access Commercial |
$216.20
|
| Rate for Payer: Quartz Beloit One Network |
$115.15
|
| Rate for Payer: Quartz Commercial |
$141.00
|
| Rate for Payer: WEA Trust Commercial |
$129.25
|
| Rate for Payer: WPS Commercial |
$174.06
|
|
|
PTA Community/Work Reintegration Charge
|
Facility
|
IP
|
$223.00
|
|
|
Service Code
|
CPT 97537 GP,CQ
|
| Hospital Charge Code |
5565387
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$109.27 |
| Max. Negotiated Rate |
$205.16 |
| Rate for Payer: Aetna Commercial |
$200.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$191.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$118.19
|
| Rate for Payer: Cash Price |
$66.90
|
| Rate for Payer: Cigna Commercial |
$205.16
|
| Rate for Payer: Health EOS Commercial |
$198.47
|
| Rate for Payer: HFN Commercial |
$205.16
|
| Rate for Payer: Multiplan Commercial |
$178.40
|
| Rate for Payer: NAPHCARE Commercial |
$133.80
|
| Rate for Payer: Preferred Network Access Commercial |
$205.16
|
| Rate for Payer: Quartz Beloit One Network |
$109.27
|
| Rate for Payer: Quartz Commercial |
$133.80
|
| Rate for Payer: WEA Trust Commercial |
$122.65
|
| Rate for Payer: WPS Commercial |
$165.18
|
|
|
PTA Community/Work Reintegration Charge
|
Facility
|
OP
|
$223.00
|
|
|
Service Code
|
CPT 97537 GP,CQ
|
| Hospital Charge Code |
5565387
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$62.44 |
| Max. Negotiated Rate |
$892.00 |
| Rate for Payer: Aetna Commercial |
$200.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$191.78
|
| Rate for Payer: Aetna Managed Medicare |
$62.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$349.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$287.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$272.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$118.19
|
| Rate for Payer: Cash Price |
$66.90
|
| Rate for Payer: Cash Price |
$66.90
|
| Rate for Payer: Cigna Commercial |
$205.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$124.79
|
| Rate for Payer: Health EOS Commercial |
$198.47
|
| Rate for Payer: HFN Commercial |
$205.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$202.00
|
| Rate for Payer: Multiplan Commercial |
$178.40
|
| Rate for Payer: NAPHCARE Commercial |
$133.80
|
| Rate for Payer: Preferred Network Access Commercial |
$205.16
|
| Rate for Payer: Quartz Beloit One Network |
$109.27
|
| Rate for Payer: Quartz Commercial |
$144.95
|
| Rate for Payer: Quartz Medicare Advantage |
$133.80
|
| Rate for Payer: The Alliance Commercial |
$892.00
|
| Rate for Payer: United Healthcare PPO |
$167.25
|
| Rate for Payer: WEA Trust Commercial |
$122.65
|
| Rate for Payer: WPS Commercial |
$165.18
|
|
|
PT ADL Training/15 Min Charges
|
Facility
|
OP
|
$251.00
|
|
|
Service Code
|
CPT 97535 GP
|
| Hospital Charge Code |
2989839
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$70.28 |
| Max. Negotiated Rate |
$1,004.00 |
| Rate for Payer: Aetna Commercial |
$225.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$215.86
|
| Rate for Payer: Aetna Managed Medicare |
$70.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$349.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$287.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$272.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$133.03
|
| Rate for Payer: Cash Price |
$75.30
|
| Rate for Payer: Cash Price |
$75.30
|
| Rate for Payer: Cigna Commercial |
$230.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$140.46
|
| Rate for Payer: Health EOS Commercial |
$223.39
|
| Rate for Payer: HFN Commercial |
$230.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$202.00
|
| Rate for Payer: Multiplan Commercial |
$200.80
|
| Rate for Payer: NAPHCARE Commercial |
$150.60
|
| Rate for Payer: Preferred Network Access Commercial |
$230.92
|
| Rate for Payer: Quartz Beloit One Network |
$122.99
|
| Rate for Payer: Quartz Commercial |
$163.15
|
| Rate for Payer: Quartz Medicare Advantage |
$150.60
|
| Rate for Payer: The Alliance Commercial |
$1,004.00
|
| Rate for Payer: United Healthcare PPO |
$188.25
|
| Rate for Payer: WEA Trust Commercial |
$138.05
|
| Rate for Payer: WPS Commercial |
$185.92
|
|
|
PT ADL Training/15 Min Charges
|
Facility
|
IP
|
$251.00
|
|
|
Service Code
|
CPT 97535 GP
|
| Hospital Charge Code |
2989839
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$122.99 |
| Max. Negotiated Rate |
$230.92 |
| Rate for Payer: Aetna Commercial |
$225.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$215.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$133.03
|
| Rate for Payer: Cash Price |
$75.30
|
| Rate for Payer: Cigna Commercial |
$230.92
|
| Rate for Payer: Health EOS Commercial |
$223.39
|
| Rate for Payer: HFN Commercial |
$230.92
|
| Rate for Payer: Multiplan Commercial |
$200.80
|
| Rate for Payer: NAPHCARE Commercial |
$150.60
|
| Rate for Payer: Preferred Network Access Commercial |
$230.92
|
| Rate for Payer: Quartz Beloit One Network |
$122.99
|
| Rate for Payer: Quartz Commercial |
$150.60
|
| Rate for Payer: WEA Trust Commercial |
$138.05
|
| Rate for Payer: WPS Commercial |
$185.92
|
|
|
PTA Except (Le,Cere,Cor,Pulm,Dialysis)
|
Facility
|
OP
|
$8,220.00
|
|
|
Service Code
|
CPT 37246
|
| Hospital Charge Code |
5238882
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$4,027.80 |
| Max. Negotiated Rate |
$22,597.64 |
| Rate for Payer: Aetna Commercial |
$7,398.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,069.20
|
| Rate for Payer: Aetna Managed Medicare |
$5,649.41
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$16,318.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$13,785.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$13,096.00
|
| Rate for Payer: Anthem Medicare Advantage |
$5,649.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,356.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5,649.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5,649.41
|
| Rate for Payer: Cash Price |
$2,466.00
|
| Rate for Payer: Cash Price |
$2,466.00
|
| Rate for Payer: Cash Price |
$2,466.00
|
| Rate for Payer: Cigna Commercial |
$7,562.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$5,649.41
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$11,874.87
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$5,649.41
|
| Rate for Payer: Health EOS Commercial |
$7,315.80
|
| Rate for Payer: HFN Commercial |
$7,562.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$21,015.81
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$5,649.41
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5,649.41
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$5,649.41
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$5,649.41
|
| Rate for Payer: Multiplan Commercial |
$6,576.00
|
| Rate for Payer: NAPHCARE Commercial |
$8,474.12
|
| Rate for Payer: Preferred Network Access Commercial |
$7,562.40
|
| Rate for Payer: Quartz Beloit One Network |
$4,027.80
|
| Rate for Payer: Quartz Commercial |
$5,343.00
|
| Rate for Payer: Quartz Medicare Advantage |
$5,649.41
|
| Rate for Payer: The Alliance Commercial |
$22,597.64
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5,649.41
|
| Rate for Payer: United Healthcare PPO |
$6,154.00
|
| Rate for Payer: WEA Trust Commercial |
$4,521.00
|
| Rate for Payer: Wellcare Medicare |
$5,649.41
|
| Rate for Payer: WPS Commercial |
$6,088.55
|
|
|
PTA Except (Le,Cere,Cor,Pulm,Dialysis)
|
Facility
|
IP
|
$8,220.00
|
|
|
Service Code
|
CPT 37246
|
| Hospital Charge Code |
5238882
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$4,027.80 |
| Max. Negotiated Rate |
$7,562.40 |
| Rate for Payer: Aetna Commercial |
$7,398.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,069.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,356.60
|
| Rate for Payer: Cash Price |
$2,466.00
|
| Rate for Payer: Cigna Commercial |
$7,562.40
|
| Rate for Payer: Health EOS Commercial |
$7,315.80
|
| Rate for Payer: HFN Commercial |
$7,562.40
|
| Rate for Payer: Multiplan Commercial |
$6,576.00
|
| Rate for Payer: NAPHCARE Commercial |
$4,932.00
|
| Rate for Payer: Preferred Network Access Commercial |
$7,562.40
|
| Rate for Payer: Quartz Beloit One Network |
$4,027.80
|
| Rate for Payer: Quartz Commercial |
$4,932.00
|
| Rate for Payer: WEA Trust Commercial |
$4,521.00
|
| Rate for Payer: WPS Commercial |
$6,088.55
|
|
|
PTA Except (Le,Cere,Cor,Pulm,Dialysis) Ea Add Artery +
|
Facility
|
IP
|
$3,246.00
|
|
|
Service Code
|
CPT 37247
|
| Hospital Charge Code |
5238881
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,590.54 |
| Max. Negotiated Rate |
$2,986.32 |
| Rate for Payer: Aetna Commercial |
$2,921.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,791.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,720.38
|
| Rate for Payer: Cash Price |
$973.80
|
| Rate for Payer: Cigna Commercial |
$2,986.32
|
| Rate for Payer: Health EOS Commercial |
$2,888.94
|
| Rate for Payer: HFN Commercial |
$2,986.32
|
| Rate for Payer: Multiplan Commercial |
$2,596.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,947.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,986.32
|
| Rate for Payer: Quartz Beloit One Network |
$1,590.54
|
| Rate for Payer: Quartz Commercial |
$1,947.60
|
| Rate for Payer: WEA Trust Commercial |
$1,785.30
|
| Rate for Payer: WPS Commercial |
$2,404.31
|
|
|
PTA Except (Le,Cere,Cor,Pulm,Dialysis) Ea Add Artery +
|
Facility
|
OP
|
$3,246.00
|
|
|
Service Code
|
CPT 37247
|
| Hospital Charge Code |
5238881
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$908.88 |
| Max. Negotiated Rate |
$12,984.00 |
| Rate for Payer: Aetna Commercial |
$2,921.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,791.56
|
| Rate for Payer: Aetna Managed Medicare |
$908.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,109.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,623.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,558.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,720.38
|
| Rate for Payer: Cash Price |
$973.80
|
| Rate for Payer: Cash Price |
$973.80
|
| Rate for Payer: Cigna Commercial |
$2,986.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$11,874.87
|
| Rate for Payer: Health EOS Commercial |
$2,888.94
|
| Rate for Payer: HFN Commercial |
$2,986.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,434.50
|
| Rate for Payer: Multiplan Commercial |
$2,596.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,947.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,986.32
|
| Rate for Payer: Quartz Beloit One Network |
$1,590.54
|
| Rate for Payer: Quartz Commercial |
$2,109.90
|
| Rate for Payer: Quartz Medicare Advantage |
$1,947.60
|
| Rate for Payer: The Alliance Commercial |
$12,984.00
|
| Rate for Payer: WEA Trust Commercial |
$1,785.30
|
| Rate for Payer: WPS Commercial |
$2,404.31
|
|
|
PTA Fem/Pop
|
Facility
|
IP
|
$8,238.00
|
|
|
Service Code
|
CPT 37224
|
| Hospital Charge Code |
3052445
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$4,036.62 |
| Max. Negotiated Rate |
$7,578.96 |
| Rate for Payer: Aetna Commercial |
$7,414.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,084.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,366.14
|
| Rate for Payer: Cash Price |
$2,471.40
|
| Rate for Payer: Cigna Commercial |
$7,578.96
|
| Rate for Payer: Health EOS Commercial |
$7,331.82
|
| Rate for Payer: HFN Commercial |
$7,578.96
|
| Rate for Payer: Multiplan Commercial |
$6,590.40
|
| Rate for Payer: NAPHCARE Commercial |
$4,942.80
|
| Rate for Payer: Preferred Network Access Commercial |
$7,578.96
|
| Rate for Payer: Quartz Beloit One Network |
$4,036.62
|
| Rate for Payer: Quartz Commercial |
$4,942.80
|
| Rate for Payer: WEA Trust Commercial |
$4,530.90
|
| Rate for Payer: WPS Commercial |
$6,101.89
|
|
