|
PT Cognitive Function Intervention Chrg
|
Facility
|
IP
|
$214.00
|
|
|
Service Code
|
CPT 97129 GP
|
| Hospital Charge Code |
5344658
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$104.86 |
| Max. Negotiated Rate |
$196.88 |
| Rate for Payer: Aetna Commercial |
$192.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$184.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$113.42
|
| Rate for Payer: Cash Price |
$64.20
|
| Rate for Payer: Cigna Commercial |
$196.88
|
| Rate for Payer: Health EOS Commercial |
$190.46
|
| Rate for Payer: HFN Commercial |
$196.88
|
| Rate for Payer: Multiplan Commercial |
$171.20
|
| Rate for Payer: NAPHCARE Commercial |
$128.40
|
| Rate for Payer: Preferred Network Access Commercial |
$196.88
|
| Rate for Payer: Quartz Beloit One Network |
$104.86
|
| Rate for Payer: Quartz Commercial |
$128.40
|
| Rate for Payer: WEA Trust Commercial |
$117.70
|
| Rate for Payer: WPS Commercial |
$158.51
|
|
|
PT Community/ Work Reintegration Charges
|
Facility
|
IP
|
$223.00
|
|
|
Service Code
|
CPT 97537 GP
|
| Hospital Charge Code |
2989843
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$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
|
|
|
PT Community/ Work Reintegration Charges
|
Facility
|
OP
|
$223.00
|
|
|
Service Code
|
CPT 97537 GP
|
| Hospital Charge Code |
2989843
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$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
|
|
|
PTEN Deletion/Duplication
|
Facility
|
IP
|
$396.00
|
|
|
Service Code
|
CPT 81323
|
| Hospital Charge Code |
5484797
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$194.04 |
| Max. Negotiated Rate |
$364.32 |
| Rate for Payer: Aetna Commercial |
$356.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$340.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$209.88
|
| Rate for Payer: Cash Price |
$118.80
|
| Rate for Payer: Cigna Commercial |
$364.32
|
| Rate for Payer: Health EOS Commercial |
$352.44
|
| Rate for Payer: HFN Commercial |
$364.32
|
| Rate for Payer: Multiplan Commercial |
$316.80
|
| Rate for Payer: NAPHCARE Commercial |
$237.60
|
| Rate for Payer: Preferred Network Access Commercial |
$364.32
|
| Rate for Payer: Quartz Beloit One Network |
$194.04
|
| Rate for Payer: Quartz Commercial |
$237.60
|
| Rate for Payer: WEA Trust Commercial |
$217.80
|
| Rate for Payer: WPS Commercial |
$293.32
|
|
|
PTEN Deletion/Duplication
|
Facility
|
OP
|
$396.00
|
|
|
Service Code
|
CPT 81323
|
| Hospital Charge Code |
5484797
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$70.08 |
| Max. Negotiated Rate |
$1,200.00 |
| Rate for Payer: Aetna Commercial |
$356.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$340.56
|
| Rate for Payer: Aetna Managed Medicare |
$300.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,125.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$525.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$498.00
|
| Rate for Payer: Anthem Medicaid |
$70.08
|
| Rate for Payer: Anthem Medicare Advantage |
$300.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$209.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$300.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$300.00
|
| Rate for Payer: Cash Price |
$118.80
|
| Rate for Payer: Cash Price |
$118.80
|
| Rate for Payer: Cigna Commercial |
$364.32
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$300.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$70.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$221.60
|
| Rate for Payer: Dean Health Medicaid |
$70.08
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$300.00
|
| Rate for Payer: Health EOS Commercial |
$352.44
|
| Rate for Payer: HFN Commercial |
$364.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,116.00
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$300.00
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$70.08
|
| Rate for Payer: Independent Care Health Plan Medicare |
$300.00
|
| Rate for Payer: Managed Health Services Medicaid |
$72.88
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$300.00
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$300.00
|
| Rate for Payer: Multiplan Commercial |
$316.80
|
| Rate for Payer: NAPHCARE Commercial |
$450.00
|
| Rate for Payer: Preferred Network Access Commercial |
$364.32
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$70.08
|
| Rate for Payer: Quartz Beloit One Network |
$194.04
|
| Rate for Payer: Quartz Commercial |
$257.40
|
| Rate for Payer: Quartz Medicare Advantage |
$300.00
|
| Rate for Payer: The Alliance Commercial |
$1,200.00
|
| Rate for Payer: United Healthcare Medicaid |
$70.08
|
| Rate for Payer: United Healthcare Medicare Advantage |
$300.00
|
| Rate for Payer: United Healthcare PPO |
$297.00
|
| Rate for Payer: WEA Trust Commercial |
$217.80
|
| Rate for Payer: Wellcare Medicare |
$300.00
|
| Rate for Payer: WMAP Medicaid |
$70.08
|
| Rate for Payer: WPS Commercial |
$293.32
|
|
|
PTEN Deletion/Duplication
|
Professional
|
Both
|
$396.00
|
|
|
Service Code
|
CPT 81323
|
| Hospital Charge Code |
5484797
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$174.24 |
| Max. Negotiated Rate |
$1,059.00 |
| Rate for Payer: Aetna Commercial |
$376.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$340.56
|
| Rate for Payer: Cash Price |
$118.80
|
| Rate for Payer: Cash Price |
$118.80
|
| Rate for Payer: Cigna Commercial |
$376.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$198.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$237.60
|
| Rate for Payer: Health EOS Commercial |
$360.36
|
| Rate for Payer: HFN Commercial |
$376.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,059.00
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,059.00
|
| Rate for Payer: Multiplan Commercial |
$316.80
|
| Rate for Payer: Preferred Network Access Commercial |
$376.20
|
| Rate for Payer: Quartz Beloit One Network |
$174.24
|
| Rate for Payer: Quartz Commercial |
$225.72
|
| Rate for Payer: The Alliance Commercial |
$198.00
|
| Rate for Payer: WEA Trust Commercial |
$217.80
|
| Rate for Payer: WPS Commercial |
$293.32
|
|
|
PTEN Sequencing and Deletion/Duplication
|
Facility
|
OP
|
$396.00
|
|
|
Service Code
|
CPT 81321
|
| Hospital Charge Code |
5484744
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$194.04 |
| Max. Negotiated Rate |
$2,400.00 |
| Rate for Payer: Aetna Commercial |
$356.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$340.56
|
| Rate for Payer: Aetna Managed Medicare |
$600.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,250.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,050.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$996.00
|
| Rate for Payer: Anthem Medicaid |
$480.56
|
| Rate for Payer: Anthem Medicare Advantage |
$600.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$209.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$600.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$600.00
|
| Rate for Payer: Cash Price |
$118.80
|
| Rate for Payer: Cash Price |
$118.80
|
| Rate for Payer: Cigna Commercial |
$364.32
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$600.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$480.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$221.60
|
| Rate for Payer: Dean Health Medicaid |
$480.56
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$600.00
|
| Rate for Payer: Health EOS Commercial |
$352.44
|
| Rate for Payer: HFN Commercial |
$364.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,232.00
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$600.00
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$480.56
|
| Rate for Payer: Independent Care Health Plan Medicare |
$600.00
|
| Rate for Payer: Managed Health Services Medicaid |
$499.78
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$600.00
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$600.00
|
| Rate for Payer: Multiplan Commercial |
$316.80
|
| Rate for Payer: NAPHCARE Commercial |
$900.00
|
| Rate for Payer: Preferred Network Access Commercial |
$364.32
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$480.56
|
| Rate for Payer: Quartz Beloit One Network |
$194.04
|
| Rate for Payer: Quartz Commercial |
$257.40
|
| Rate for Payer: Quartz Medicare Advantage |
$600.00
|
| Rate for Payer: The Alliance Commercial |
$2,400.00
|
| Rate for Payer: United Healthcare Medicaid |
$480.56
|
| Rate for Payer: United Healthcare Medicare Advantage |
$600.00
|
| Rate for Payer: United Healthcare PPO |
$297.00
|
| Rate for Payer: WEA Trust Commercial |
$217.80
|
| Rate for Payer: Wellcare Medicare |
$600.00
|
| Rate for Payer: WMAP Medicaid |
$480.56
|
| Rate for Payer: WPS Commercial |
$293.32
|
|
|
PTEN Sequencing and Deletion/Duplication
|
Professional
|
Both
|
$396.00
|
|
|
Service Code
|
CPT 81321
|
| Hospital Charge Code |
5484744
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$174.24 |
| Max. Negotiated Rate |
$2,118.00 |
| Rate for Payer: Aetna Commercial |
$376.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$340.56
|
| Rate for Payer: Cash Price |
$118.80
|
| Rate for Payer: Cash Price |
$118.80
|
| Rate for Payer: Cigna Commercial |
$376.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$198.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$237.60
|
| Rate for Payer: Health EOS Commercial |
$360.36
|
| Rate for Payer: HFN Commercial |
$376.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,118.00
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$2,118.00
|
| Rate for Payer: Multiplan Commercial |
$316.80
|
| Rate for Payer: Preferred Network Access Commercial |
$376.20
|
| Rate for Payer: Quartz Beloit One Network |
$174.24
|
| Rate for Payer: Quartz Commercial |
$225.72
|
| Rate for Payer: The Alliance Commercial |
$198.00
|
| Rate for Payer: WEA Trust Commercial |
$217.80
|
| Rate for Payer: WPS Commercial |
$293.32
|
|
|
PTEN Sequencing and Deletion/Duplication
|
Facility
|
IP
|
$396.00
|
|
|
Service Code
|
CPT 81321
|
| Hospital Charge Code |
5484744
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$194.04 |
| Max. Negotiated Rate |
$364.32 |
| Rate for Payer: Aetna Commercial |
$356.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$340.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$209.88
|
| Rate for Payer: Cash Price |
$118.80
|
| Rate for Payer: Cigna Commercial |
$364.32
|
| Rate for Payer: Health EOS Commercial |
$352.44
|
| Rate for Payer: HFN Commercial |
$364.32
|
| Rate for Payer: Multiplan Commercial |
$316.80
|
| Rate for Payer: NAPHCARE Commercial |
$237.60
|
| Rate for Payer: Preferred Network Access Commercial |
$364.32
|
| Rate for Payer: Quartz Beloit One Network |
$194.04
|
| Rate for Payer: Quartz Commercial |
$237.60
|
| Rate for Payer: WEA Trust Commercial |
$217.80
|
| Rate for Payer: WPS Commercial |
$293.32
|
|
|
PTERYGIUM
|
Facility
|
IP
|
$3,879.00
|
|
| Hospital Charge Code |
2950491
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,900.71 |
| Max. Negotiated Rate |
$3,568.68 |
| Rate for Payer: Aetna Commercial |
$3,491.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,335.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,055.87
|
| Rate for Payer: Cash Price |
$1,163.70
|
| Rate for Payer: Cigna Commercial |
$3,568.68
|
| Rate for Payer: Health EOS Commercial |
$3,452.31
|
| Rate for Payer: HFN Commercial |
$3,568.68
|
| Rate for Payer: Multiplan Commercial |
$3,103.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,327.40
|
| Rate for Payer: Preferred Network Access Commercial |
$3,568.68
|
| Rate for Payer: Quartz Beloit One Network |
$1,900.71
|
| Rate for Payer: Quartz Commercial |
$2,327.40
|
| Rate for Payer: WEA Trust Commercial |
$2,133.45
|
| Rate for Payer: WPS Commercial |
$2,873.18
|
|
|
PTERYGIUM
|
Facility
|
OP
|
$3,879.00
|
|
| Hospital Charge Code |
2950491
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,086.12 |
| Max. Negotiated Rate |
$15,516.00 |
| Rate for Payer: Aetna Commercial |
$3,491.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,335.94
|
| Rate for Payer: Aetna Managed Medicare |
$1,086.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,521.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,939.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,861.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,055.87
|
| Rate for Payer: Cash Price |
$1,163.70
|
| Rate for Payer: Cigna Commercial |
$3,568.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,170.69
|
| Rate for Payer: Health EOS Commercial |
$3,452.31
|
| Rate for Payer: HFN Commercial |
$3,568.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,909.25
|
| Rate for Payer: Multiplan Commercial |
$3,103.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,327.40
|
| Rate for Payer: Preferred Network Access Commercial |
$3,568.68
|
| Rate for Payer: Quartz Beloit One Network |
$1,900.71
|
| Rate for Payer: Quartz Commercial |
$2,521.35
|
| Rate for Payer: Quartz Medicare Advantage |
$2,327.40
|
| Rate for Payer: The Alliance Commercial |
$15,516.00
|
| Rate for Payer: WEA Trust Commercial |
$2,133.45
|
| Rate for Payer: WPS Commercial |
$2,873.18
|
|
|
PT E-Stim Unattended Charge
|
Facility
|
IP
|
$167.00
|
|
|
Service Code
|
CPT 97014
|
| Hospital Charge Code |
5254609
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$81.83 |
| Max. Negotiated Rate |
$153.64 |
| Rate for Payer: Aetna Commercial |
$150.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$143.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$88.51
|
| Rate for Payer: Cash Price |
$50.10
|
| Rate for Payer: Cigna Commercial |
$153.64
|
| Rate for Payer: Health EOS Commercial |
$148.63
|
| Rate for Payer: HFN Commercial |
$153.64
|
| Rate for Payer: Multiplan Commercial |
$133.60
|
| Rate for Payer: NAPHCARE Commercial |
$100.20
|
| Rate for Payer: Preferred Network Access Commercial |
$153.64
|
| Rate for Payer: Quartz Beloit One Network |
$81.83
|
| Rate for Payer: Quartz Commercial |
$100.20
|
| Rate for Payer: WEA Trust Commercial |
$91.85
|
| Rate for Payer: WPS Commercial |
$123.70
|
|
|
PT E-Stim Unattended Charge
|
Facility
|
OP
|
$167.00
|
|
|
Service Code
|
CPT 97014
|
| Hospital Charge Code |
5254609
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$46.76 |
| Max. Negotiated Rate |
$668.00 |
| Rate for Payer: Aetna Commercial |
$150.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$143.62
|
| Rate for Payer: Aetna Managed Medicare |
$46.76
|
| 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 |
$88.51
|
| Rate for Payer: Cash Price |
$50.10
|
| Rate for Payer: Cash Price |
$50.10
|
| Rate for Payer: Cigna Commercial |
$153.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$93.45
|
| Rate for Payer: Health EOS Commercial |
$148.63
|
| Rate for Payer: HFN Commercial |
$153.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$202.00
|
| Rate for Payer: Multiplan Commercial |
$133.60
|
| Rate for Payer: NAPHCARE Commercial |
$100.20
|
| Rate for Payer: Preferred Network Access Commercial |
$153.64
|
| Rate for Payer: Quartz Beloit One Network |
$81.83
|
| Rate for Payer: Quartz Commercial |
$108.55
|
| Rate for Payer: Quartz Medicare Advantage |
$100.20
|
| Rate for Payer: The Alliance Commercial |
$668.00
|
| Rate for Payer: United Healthcare PPO |
$125.25
|
| Rate for Payer: WEA Trust Commercial |
$91.85
|
| Rate for Payer: WPS Commercial |
$123.70
|
|
|
PT Evaluation High Complexity
|
Facility
|
OP
|
$702.00
|
|
|
Service Code
|
CPT 97163
|
| Hospital Charge Code |
5250656
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$196.56 |
| Max. Negotiated Rate |
$2,808.00 |
| Rate for Payer: Aetna Commercial |
$631.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$603.72
|
| Rate for Payer: Aetna Managed Medicare |
$196.56
|
| 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 |
$372.06
|
| Rate for Payer: Cash Price |
$210.60
|
| Rate for Payer: Cash Price |
$210.60
|
| Rate for Payer: Cigna Commercial |
$645.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$392.84
|
| Rate for Payer: Health EOS Commercial |
$624.78
|
| Rate for Payer: HFN Commercial |
$645.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$202.00
|
| Rate for Payer: Multiplan Commercial |
$561.60
|
| Rate for Payer: NAPHCARE Commercial |
$421.20
|
| Rate for Payer: Preferred Network Access Commercial |
$645.84
|
| Rate for Payer: Quartz Beloit One Network |
$343.98
|
| Rate for Payer: Quartz Commercial |
$456.30
|
| Rate for Payer: Quartz Medicare Advantage |
$421.20
|
| Rate for Payer: The Alliance Commercial |
$2,808.00
|
| Rate for Payer: United Healthcare PPO |
$526.50
|
| Rate for Payer: WEA Trust Commercial |
$386.10
|
| Rate for Payer: WPS Commercial |
$519.97
|
|
|
PT Evaluation High Complexity
|
Facility
|
IP
|
$702.00
|
|
|
Service Code
|
CPT 97163
|
| Hospital Charge Code |
5250656
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$343.98 |
| Max. Negotiated Rate |
$645.84 |
| Rate for Payer: Aetna Commercial |
$631.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$603.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$372.06
|
| Rate for Payer: Cash Price |
$210.60
|
| Rate for Payer: Cigna Commercial |
$645.84
|
| Rate for Payer: Health EOS Commercial |
$624.78
|
| Rate for Payer: HFN Commercial |
$645.84
|
| Rate for Payer: Multiplan Commercial |
$561.60
|
| Rate for Payer: NAPHCARE Commercial |
$421.20
|
| Rate for Payer: Preferred Network Access Commercial |
$645.84
|
| Rate for Payer: Quartz Beloit One Network |
$343.98
|
| Rate for Payer: Quartz Commercial |
$421.20
|
| Rate for Payer: WEA Trust Commercial |
$386.10
|
| Rate for Payer: WPS Commercial |
$519.97
|
|
|
PT Evaluation Low Complexity
|
Facility
|
OP
|
$415.00
|
|
|
Service Code
|
CPT 97161
|
| Hospital Charge Code |
5250655
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$116.20 |
| Max. Negotiated Rate |
$1,660.00 |
| Rate for Payer: Aetna Commercial |
$373.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$356.90
|
| Rate for Payer: Aetna Managed Medicare |
$116.20
|
| 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 |
$219.95
|
| Rate for Payer: Cash Price |
$124.50
|
| Rate for Payer: Cash Price |
$124.50
|
| Rate for Payer: Cigna Commercial |
$381.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$232.23
|
| Rate for Payer: Health EOS Commercial |
$369.35
|
| Rate for Payer: HFN Commercial |
$381.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$202.00
|
| Rate for Payer: Multiplan Commercial |
$332.00
|
| Rate for Payer: NAPHCARE Commercial |
$249.00
|
| Rate for Payer: Preferred Network Access Commercial |
$381.80
|
| Rate for Payer: Quartz Beloit One Network |
$203.35
|
| Rate for Payer: Quartz Commercial |
$269.75
|
| Rate for Payer: Quartz Medicare Advantage |
$249.00
|
| Rate for Payer: The Alliance Commercial |
$1,660.00
|
| Rate for Payer: United Healthcare PPO |
$311.25
|
| Rate for Payer: WEA Trust Commercial |
$228.25
|
| Rate for Payer: WPS Commercial |
$307.39
|
|
|
PT Evaluation Low Complexity
|
Facility
|
IP
|
$415.00
|
|
|
Service Code
|
CPT 97161
|
| Hospital Charge Code |
5250655
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$203.35 |
| Max. Negotiated Rate |
$381.80 |
| Rate for Payer: Aetna Commercial |
$373.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$356.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$219.95
|
| Rate for Payer: Cash Price |
$124.50
|
| Rate for Payer: Cigna Commercial |
$381.80
|
| Rate for Payer: Health EOS Commercial |
$369.35
|
| Rate for Payer: HFN Commercial |
$381.80
|
| Rate for Payer: Multiplan Commercial |
$332.00
|
| Rate for Payer: NAPHCARE Commercial |
$249.00
|
| Rate for Payer: Preferred Network Access Commercial |
$381.80
|
| Rate for Payer: Quartz Beloit One Network |
$203.35
|
| Rate for Payer: Quartz Commercial |
$249.00
|
| Rate for Payer: WEA Trust Commercial |
$228.25
|
| Rate for Payer: WPS Commercial |
$307.39
|
|
|
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 |
$179.20 |
| Max. Negotiated Rate |
$2,560.00 |
| Rate for Payer: Aetna Commercial |
$576.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$550.40
|
| Rate for Payer: Aetna Managed Medicare |
$179.20
|
| 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 |
$339.20
|
| Rate for Payer: Cash Price |
$192.00
|
| Rate for Payer: Cash Price |
$192.00
|
| Rate for Payer: Cigna Commercial |
$588.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$358.14
|
| Rate for Payer: Health EOS Commercial |
$569.60
|
| Rate for Payer: HFN Commercial |
$588.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$202.00
|
| Rate for Payer: Multiplan Commercial |
$512.00
|
| Rate for Payer: NAPHCARE Commercial |
$384.00
|
| Rate for Payer: Preferred Network Access Commercial |
$588.80
|
| Rate for Payer: Quartz Beloit One Network |
$313.60
|
| Rate for Payer: Quartz Commercial |
$416.00
|
| Rate for Payer: Quartz Medicare Advantage |
$384.00
|
| Rate for Payer: The Alliance Commercial |
$2,560.00
|
| Rate for Payer: United Healthcare PPO |
$480.00
|
| Rate for Payer: WEA Trust Commercial |
$352.00
|
| Rate for Payer: WPS Commercial |
$474.05
|
|
|
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 |
$313.60 |
| Max. Negotiated Rate |
$588.80 |
| Rate for Payer: Aetna Commercial |
$576.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$550.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$339.20
|
| Rate for Payer: Cash Price |
$192.00
|
| Rate for Payer: Cigna Commercial |
$588.80
|
| Rate for Payer: Health EOS Commercial |
$569.60
|
| Rate for Payer: HFN Commercial |
$588.80
|
| Rate for Payer: Multiplan Commercial |
$512.00
|
| Rate for Payer: NAPHCARE Commercial |
$384.00
|
| Rate for Payer: Preferred Network Access Commercial |
$588.80
|
| Rate for Payer: Quartz Beloit One Network |
$313.60
|
| Rate for Payer: Quartz Commercial |
$384.00
|
| Rate for Payer: WEA Trust Commercial |
$352.00
|
| Rate for Payer: WPS Commercial |
$474.05
|
|
|
PT Finger
|
Professional
|
Both
|
$52.00
|
|
|
Service Code
|
CPT 85610
|
| Hospital Charge Code |
979846
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.14 |
| Max. Negotiated Rate |
$49.40 |
| Rate for Payer: Aetna Commercial |
$49.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$44.72
|
| Rate for Payer: Cash Price |
$15.60
|
| Rate for Payer: Cash Price |
$15.60
|
| Rate for Payer: Cigna Commercial |
$49.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$26.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$31.20
|
| Rate for Payer: Health EOS Commercial |
$47.32
|
| Rate for Payer: HFN Commercial |
$49.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$15.14
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$15.14
|
| Rate for Payer: Multiplan Commercial |
$41.60
|
| Rate for Payer: Preferred Network Access Commercial |
$49.40
|
| Rate for Payer: Quartz Beloit One Network |
$22.88
|
| Rate for Payer: Quartz Commercial |
$29.64
|
| Rate for Payer: The Alliance Commercial |
$26.00
|
| Rate for Payer: WEA Trust Commercial |
$28.60
|
| Rate for Payer: WPS Commercial |
$38.52
|
|
|
PT Finger
|
Facility
|
IP
|
$52.00
|
|
|
Service Code
|
CPT 85610
|
| Hospital Charge Code |
979846
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$25.48 |
| Max. Negotiated Rate |
$47.84 |
| Rate for Payer: Aetna Commercial |
$46.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$44.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$27.56
|
| Rate for Payer: Cash Price |
$15.60
|
| Rate for Payer: Cigna Commercial |
$47.84
|
| Rate for Payer: Health EOS Commercial |
$46.28
|
| Rate for Payer: HFN Commercial |
$47.84
|
| Rate for Payer: Multiplan Commercial |
$41.60
|
| Rate for Payer: NAPHCARE Commercial |
$31.20
|
| Rate for Payer: Preferred Network Access Commercial |
$47.84
|
| Rate for Payer: Quartz Beloit One Network |
$25.48
|
| Rate for Payer: Quartz Commercial |
$31.20
|
| Rate for Payer: WEA Trust Commercial |
$28.60
|
| Rate for Payer: WPS Commercial |
$38.52
|
|
|
PT Finger
|
Facility
|
OP
|
$52.00
|
|
|
Service Code
|
CPT 85610
|
| Hospital Charge Code |
979846
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.29 |
| Max. Negotiated Rate |
$47.84 |
| Rate for Payer: Aetna Commercial |
$46.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$44.72
|
| Rate for Payer: Aetna Managed Medicare |
$4.29
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$16.09
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$7.51
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7.12
|
| Rate for Payer: Anthem Medicaid |
$4.43
|
| Rate for Payer: Anthem Medicare Advantage |
$4.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$27.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$4.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$4.29
|
| Rate for Payer: Cash Price |
$15.60
|
| Rate for Payer: Cash Price |
$15.60
|
| Rate for Payer: Cigna Commercial |
$47.84
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$4.29
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$4.43
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$29.10
|
| Rate for Payer: Dean Health Medicaid |
$4.43
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$4.29
|
| Rate for Payer: Health EOS Commercial |
$46.28
|
| Rate for Payer: HFN Commercial |
$47.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$15.96
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$4.29
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$4.43
|
| Rate for Payer: Independent Care Health Plan Medicare |
$4.29
|
| Rate for Payer: Managed Health Services Medicaid |
$4.61
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$4.29
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$4.29
|
| Rate for Payer: Multiplan Commercial |
$41.60
|
| Rate for Payer: NAPHCARE Commercial |
$6.44
|
| Rate for Payer: Preferred Network Access Commercial |
$47.84
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$4.43
|
| Rate for Payer: Quartz Beloit One Network |
$25.48
|
| Rate for Payer: Quartz Commercial |
$33.80
|
| Rate for Payer: Quartz Medicare Advantage |
$4.29
|
| Rate for Payer: The Alliance Commercial |
$17.16
|
| Rate for Payer: United Healthcare Medicaid |
$4.43
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4.29
|
| Rate for Payer: United Healthcare PPO |
$39.00
|
| Rate for Payer: WEA Trust Commercial |
$28.60
|
| Rate for Payer: Wellcare Medicare |
$4.29
|
| Rate for Payer: WMAP Medicaid |
$4.43
|
| Rate for Payer: WPS Commercial |
$38.52
|
|
|
PTH Antibody
|
Facility
|
OP
|
$379.00
|
|
|
Service Code
|
CPT 83519
|
| Hospital Charge Code |
983380
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.40 |
| Max. Negotiated Rate |
$348.68 |
| Rate for Payer: Aetna Commercial |
$341.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$325.94
|
| Rate for Payer: Aetna Managed Medicare |
$18.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$69.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$32.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$30.54
|
| Rate for Payer: Anthem Medicaid |
$19.00
|
| Rate for Payer: Anthem Medicare Advantage |
$18.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$200.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$18.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$18.40
|
| Rate for Payer: Cash Price |
$113.70
|
| Rate for Payer: Cash Price |
$113.70
|
| Rate for Payer: Cigna Commercial |
$348.68
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$18.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$19.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$212.09
|
| Rate for Payer: Dean Health Medicaid |
$19.00
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$18.40
|
| Rate for Payer: Health EOS Commercial |
$337.31
|
| Rate for Payer: HFN Commercial |
$348.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$68.45
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$18.40
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$19.00
|
| Rate for Payer: Independent Care Health Plan Medicare |
$18.40
|
| Rate for Payer: Managed Health Services Medicaid |
$19.76
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$18.40
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$18.40
|
| Rate for Payer: Multiplan Commercial |
$303.20
|
| Rate for Payer: NAPHCARE Commercial |
$27.60
|
| Rate for Payer: Preferred Network Access Commercial |
$348.68
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$19.00
|
| Rate for Payer: Quartz Beloit One Network |
$185.71
|
| Rate for Payer: Quartz Commercial |
$246.35
|
| Rate for Payer: Quartz Medicare Advantage |
$18.40
|
| Rate for Payer: The Alliance Commercial |
$73.60
|
| Rate for Payer: United Healthcare Medicaid |
$19.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18.40
|
| Rate for Payer: United Healthcare PPO |
$284.25
|
| Rate for Payer: WEA Trust Commercial |
$208.45
|
| Rate for Payer: Wellcare Medicare |
$18.40
|
| Rate for Payer: WMAP Medicaid |
$19.00
|
| Rate for Payer: WPS Commercial |
$280.73
|
|
|
PTH Antibody
|
Facility
|
IP
|
$379.00
|
|
|
Service Code
|
CPT 83519
|
| Hospital Charge Code |
983380
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$185.71 |
| Max. Negotiated Rate |
$348.68 |
| Rate for Payer: Aetna Commercial |
$341.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$325.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$200.87
|
| Rate for Payer: Cash Price |
$113.70
|
| Rate for Payer: Cigna Commercial |
$348.68
|
| Rate for Payer: Health EOS Commercial |
$337.31
|
| Rate for Payer: HFN Commercial |
$348.68
|
| Rate for Payer: Multiplan Commercial |
$303.20
|
| Rate for Payer: NAPHCARE Commercial |
$227.40
|
| Rate for Payer: Preferred Network Access Commercial |
$348.68
|
| Rate for Payer: Quartz Beloit One Network |
$185.71
|
| Rate for Payer: Quartz Commercial |
$227.40
|
| Rate for Payer: WEA Trust Commercial |
$208.45
|
| Rate for Payer: WPS Commercial |
$280.73
|
|
|
PTH Antibody
|
Professional
|
Both
|
$379.00
|
|
|
Service Code
|
CPT 83519
|
| Hospital Charge Code |
983380
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$64.95 |
| Max. Negotiated Rate |
$360.05 |
| Rate for Payer: Aetna Commercial |
$360.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$325.94
|
| Rate for Payer: Cash Price |
$113.70
|
| Rate for Payer: Cash Price |
$113.70
|
| Rate for Payer: Cigna Commercial |
$360.05
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$189.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$227.40
|
| Rate for Payer: Health EOS Commercial |
$344.89
|
| Rate for Payer: HFN Commercial |
$360.05
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$64.95
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$64.95
|
| Rate for Payer: Multiplan Commercial |
$303.20
|
| Rate for Payer: Preferred Network Access Commercial |
$360.05
|
| Rate for Payer: Quartz Beloit One Network |
$166.76
|
| Rate for Payer: Quartz Commercial |
$216.03
|
| Rate for Payer: The Alliance Commercial |
$189.50
|
| Rate for Payer: WEA Trust Commercial |
$208.45
|
| Rate for Payer: WPS Commercial |
$280.73
|
|
