|
PTH-Related Protein
|
Professional
|
Both
|
$729.00
|
|
|
Service Code
|
CPT 83519
|
| Hospital Charge Code |
983382
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$64.95 |
| Max. Negotiated Rate |
$692.55 |
| Rate for Payer: Aetna Commercial |
$692.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$626.94
|
| Rate for Payer: Cash Price |
$218.70
|
| Rate for Payer: Cash Price |
$218.70
|
| Rate for Payer: Cigna Commercial |
$692.55
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$364.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$437.40
|
| Rate for Payer: Health EOS Commercial |
$663.39
|
| Rate for Payer: HFN Commercial |
$692.55
|
| 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 |
$583.20
|
| Rate for Payer: Preferred Network Access Commercial |
$692.55
|
| Rate for Payer: Quartz Beloit One Network |
$320.76
|
| Rate for Payer: Quartz Commercial |
$415.53
|
| Rate for Payer: The Alliance Commercial |
$364.50
|
| Rate for Payer: WEA Trust Commercial |
$400.95
|
| Rate for Payer: WPS Commercial |
$539.97
|
|
|
PTH-Related Protein
|
Facility
|
OP
|
$729.00
|
|
|
Service Code
|
CPT 83519
|
| Hospital Charge Code |
983382
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.40 |
| Max. Negotiated Rate |
$670.68 |
| Rate for Payer: Aetna Commercial |
$656.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$626.94
|
| 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 |
$386.37
|
| 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 |
$218.70
|
| Rate for Payer: Cash Price |
$218.70
|
| Rate for Payer: Cigna Commercial |
$670.68
|
| 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 |
$407.95
|
| 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 |
$648.81
|
| Rate for Payer: HFN Commercial |
$670.68
|
| 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 |
$583.20
|
| Rate for Payer: NAPHCARE Commercial |
$27.60
|
| Rate for Payer: Preferred Network Access Commercial |
$670.68
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$19.00
|
| Rate for Payer: Quartz Beloit One Network |
$357.21
|
| Rate for Payer: Quartz Commercial |
$473.85
|
| 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 |
$546.75
|
| Rate for Payer: WEA Trust Commercial |
$400.95
|
| Rate for Payer: Wellcare Medicare |
$18.40
|
| Rate for Payer: WMAP Medicaid |
$19.00
|
| Rate for Payer: WPS Commercial |
$539.97
|
|
|
PTH-Related Protein
|
Facility
|
IP
|
$729.00
|
|
|
Service Code
|
CPT 83519
|
| Hospital Charge Code |
983382
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$357.21 |
| Max. Negotiated Rate |
$670.68 |
| Rate for Payer: Aetna Commercial |
$656.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$626.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$386.37
|
| Rate for Payer: Cash Price |
$218.70
|
| Rate for Payer: Cigna Commercial |
$670.68
|
| Rate for Payer: Health EOS Commercial |
$648.81
|
| Rate for Payer: HFN Commercial |
$670.68
|
| Rate for Payer: Multiplan Commercial |
$583.20
|
| Rate for Payer: NAPHCARE Commercial |
$437.40
|
| Rate for Payer: Preferred Network Access Commercial |
$670.68
|
| Rate for Payer: Quartz Beloit One Network |
$357.21
|
| Rate for Payer: Quartz Commercial |
$437.40
|
| Rate for Payer: WEA Trust Commercial |
$400.95
|
| Rate for Payer: WPS Commercial |
$539.97
|
|
|
PT Manual Therapy Charge Units
|
Professional
|
Both
|
$234.00
|
|
|
Service Code
|
CPT 97140 GP
|
| Hospital Charge Code |
2989847
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$102.96 |
| Max. Negotiated Rate |
$222.30 |
| Rate for Payer: Aetna Commercial |
$222.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$201.24
|
| Rate for Payer: Cash Price |
$70.20
|
| Rate for Payer: Cash Price |
$70.20
|
| Rate for Payer: Cigna Commercial |
$222.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$117.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$140.40
|
| Rate for Payer: Health EOS Commercial |
$212.94
|
| Rate for Payer: HFN Commercial |
$222.30
|
| Rate for Payer: Multiplan Commercial |
$187.20
|
| Rate for Payer: Preferred Network Access Commercial |
$222.30
|
| Rate for Payer: Quartz Beloit One Network |
$102.96
|
| Rate for Payer: Quartz Commercial |
$133.38
|
| Rate for Payer: The Alliance Commercial |
$117.00
|
| Rate for Payer: WEA Trust Commercial |
$128.70
|
| Rate for Payer: WPS Commercial |
$173.32
|
|
|
PT Manual Therapy Charge Units
|
Facility
|
IP
|
$234.00
|
|
|
Service Code
|
CPT 97140
|
| Hospital Charge Code |
5247108
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$114.66 |
| Max. Negotiated Rate |
$215.28 |
| Rate for Payer: Aetna Commercial |
$210.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$201.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$124.02
|
| Rate for Payer: Cash Price |
$70.20
|
| Rate for Payer: Cigna Commercial |
$215.28
|
| Rate for Payer: Health EOS Commercial |
$208.26
|
| Rate for Payer: HFN Commercial |
$215.28
|
| Rate for Payer: Multiplan Commercial |
$187.20
|
| Rate for Payer: NAPHCARE Commercial |
$140.40
|
| Rate for Payer: Preferred Network Access Commercial |
$215.28
|
| Rate for Payer: Quartz Beloit One Network |
$114.66
|
| Rate for Payer: Quartz Commercial |
$140.40
|
| Rate for Payer: WEA Trust Commercial |
$128.70
|
| Rate for Payer: WPS Commercial |
$173.32
|
|
|
PT Manual Therapy Charge Units
|
Facility
|
OP
|
$234.00
|
|
|
Service Code
|
CPT 97140 GP
|
| Hospital Charge Code |
2989847
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$65.52 |
| Max. Negotiated Rate |
$936.00 |
| Rate for Payer: Aetna Commercial |
$210.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$201.24
|
| Rate for Payer: Aetna Managed Medicare |
$65.52
|
| 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 |
$124.02
|
| Rate for Payer: Cash Price |
$70.20
|
| Rate for Payer: Cash Price |
$70.20
|
| Rate for Payer: Cigna Commercial |
$215.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$130.95
|
| Rate for Payer: Health EOS Commercial |
$208.26
|
| Rate for Payer: HFN Commercial |
$215.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$202.00
|
| Rate for Payer: Multiplan Commercial |
$187.20
|
| Rate for Payer: NAPHCARE Commercial |
$140.40
|
| Rate for Payer: Preferred Network Access Commercial |
$215.28
|
| Rate for Payer: Quartz Beloit One Network |
$114.66
|
| Rate for Payer: Quartz Commercial |
$152.10
|
| Rate for Payer: Quartz Medicare Advantage |
$140.40
|
| Rate for Payer: The Alliance Commercial |
$936.00
|
| Rate for Payer: United Healthcare PPO |
$175.50
|
| Rate for Payer: WEA Trust Commercial |
$128.70
|
| Rate for Payer: WPS Commercial |
$173.32
|
|
|
PT Manual Therapy Charge Units
|
Facility
|
OP
|
$234.00
|
|
|
Service Code
|
CPT 97140
|
| Hospital Charge Code |
5247108
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$65.52 |
| Max. Negotiated Rate |
$936.00 |
| Rate for Payer: Aetna Commercial |
$210.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$201.24
|
| Rate for Payer: Aetna Managed Medicare |
$65.52
|
| 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 |
$124.02
|
| Rate for Payer: Cash Price |
$70.20
|
| Rate for Payer: Cash Price |
$70.20
|
| Rate for Payer: Cigna Commercial |
$215.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$130.95
|
| Rate for Payer: Health EOS Commercial |
$208.26
|
| Rate for Payer: HFN Commercial |
$215.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$202.00
|
| Rate for Payer: Multiplan Commercial |
$187.20
|
| Rate for Payer: NAPHCARE Commercial |
$140.40
|
| Rate for Payer: Preferred Network Access Commercial |
$215.28
|
| Rate for Payer: Quartz Beloit One Network |
$114.66
|
| Rate for Payer: Quartz Commercial |
$152.10
|
| Rate for Payer: Quartz Medicare Advantage |
$140.40
|
| Rate for Payer: The Alliance Commercial |
$936.00
|
| Rate for Payer: United Healthcare PPO |
$175.50
|
| Rate for Payer: WEA Trust Commercial |
$128.70
|
| Rate for Payer: WPS Commercial |
$173.32
|
|
|
PT Manual Therapy Charge Units
|
Facility
|
IP
|
$234.00
|
|
|
Service Code
|
CPT 97140 GP
|
| Hospital Charge Code |
2989847
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$114.66 |
| Max. Negotiated Rate |
$215.28 |
| Rate for Payer: Aetna Commercial |
$210.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$201.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$124.02
|
| Rate for Payer: Cash Price |
$70.20
|
| Rate for Payer: Cigna Commercial |
$215.28
|
| Rate for Payer: Health EOS Commercial |
$208.26
|
| Rate for Payer: HFN Commercial |
$215.28
|
| Rate for Payer: Multiplan Commercial |
$187.20
|
| Rate for Payer: NAPHCARE Commercial |
$140.40
|
| Rate for Payer: Preferred Network Access Commercial |
$215.28
|
| Rate for Payer: Quartz Beloit One Network |
$114.66
|
| Rate for Payer: Quartz Commercial |
$140.40
|
| Rate for Payer: WEA Trust Commercial |
$128.70
|
| Rate for Payer: WPS Commercial |
$173.32
|
|
|
PT Massage Charge Units
|
Professional
|
Both
|
$90.00
|
|
|
Service Code
|
CPT 97124 GP
|
| Hospital Charge Code |
750912
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$39.60 |
| Max. Negotiated Rate |
$85.50 |
| Rate for Payer: Aetna Commercial |
$85.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$77.40
|
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Cigna Commercial |
$85.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$45.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$54.00
|
| Rate for Payer: Health EOS Commercial |
$81.90
|
| Rate for Payer: HFN Commercial |
$85.50
|
| Rate for Payer: Multiplan Commercial |
$72.00
|
| Rate for Payer: Preferred Network Access Commercial |
$85.50
|
| Rate for Payer: Quartz Beloit One Network |
$39.60
|
| Rate for Payer: Quartz Commercial |
$51.30
|
| Rate for Payer: The Alliance Commercial |
$45.00
|
| Rate for Payer: WEA Trust Commercial |
$49.50
|
| Rate for Payer: WPS Commercial |
$66.66
|
|
|
PT Massage Charge Units
|
Facility
|
OP
|
$90.00
|
|
|
Service Code
|
CPT 97124 GP
|
| Hospital Charge Code |
750912
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$25.20 |
| Max. Negotiated Rate |
$360.00 |
| Rate for Payer: Aetna Commercial |
$81.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$77.40
|
| Rate for Payer: Aetna Managed Medicare |
$25.20
|
| 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 |
$47.70
|
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Cigna Commercial |
$82.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$50.36
|
| Rate for Payer: Health EOS Commercial |
$80.10
|
| Rate for Payer: HFN Commercial |
$82.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$202.00
|
| Rate for Payer: Multiplan Commercial |
$72.00
|
| Rate for Payer: NAPHCARE Commercial |
$54.00
|
| Rate for Payer: Preferred Network Access Commercial |
$82.80
|
| Rate for Payer: Quartz Beloit One Network |
$44.10
|
| Rate for Payer: Quartz Commercial |
$58.50
|
| Rate for Payer: Quartz Medicare Advantage |
$54.00
|
| Rate for Payer: The Alliance Commercial |
$360.00
|
| Rate for Payer: United Healthcare PPO |
$67.50
|
| Rate for Payer: WEA Trust Commercial |
$49.50
|
| Rate for Payer: WPS Commercial |
$66.66
|
|
|
PT Massage Charge Units
|
Facility
|
IP
|
$90.00
|
|
|
Service Code
|
CPT 97124 GP
|
| Hospital Charge Code |
750912
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$44.10 |
| Max. Negotiated Rate |
$82.80 |
| Rate for Payer: Aetna Commercial |
$81.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$77.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$47.70
|
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Cigna Commercial |
$82.80
|
| Rate for Payer: Health EOS Commercial |
$80.10
|
| Rate for Payer: HFN Commercial |
$82.80
|
| Rate for Payer: Multiplan Commercial |
$72.00
|
| Rate for Payer: NAPHCARE Commercial |
$54.00
|
| Rate for Payer: Preferred Network Access Commercial |
$82.80
|
| Rate for Payer: Quartz Beloit One Network |
$44.10
|
| Rate for Payer: Quartz Commercial |
$54.00
|
| Rate for Payer: WEA Trust Commercial |
$49.50
|
| Rate for Payer: WPS Commercial |
$66.66
|
|
|
PT Neuromuscular Reeducation Charges
|
Facility
|
OP
|
$228.00
|
|
|
Service Code
|
CPT 97112 GP
|
| Hospital Charge Code |
2989840
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$63.84 |
| Max. Negotiated Rate |
$912.00 |
| Rate for Payer: Aetna Commercial |
$205.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$196.08
|
| Rate for Payer: Aetna Managed Medicare |
$63.84
|
| 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 |
$120.84
|
| Rate for Payer: Cash Price |
$68.40
|
| Rate for Payer: Cash Price |
$68.40
|
| Rate for Payer: Cigna Commercial |
$209.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$127.59
|
| Rate for Payer: Health EOS Commercial |
$202.92
|
| Rate for Payer: HFN Commercial |
$209.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$202.00
|
| Rate for Payer: Multiplan Commercial |
$182.40
|
| Rate for Payer: NAPHCARE Commercial |
$136.80
|
| Rate for Payer: Preferred Network Access Commercial |
$209.76
|
| Rate for Payer: Quartz Beloit One Network |
$111.72
|
| Rate for Payer: Quartz Commercial |
$148.20
|
| Rate for Payer: Quartz Medicare Advantage |
$136.80
|
| Rate for Payer: The Alliance Commercial |
$912.00
|
| Rate for Payer: United Healthcare PPO |
$171.00
|
| Rate for Payer: WEA Trust Commercial |
$125.40
|
| Rate for Payer: WPS Commercial |
$168.88
|
|
|
PT Neuromuscular Reeducation Charges
|
Facility
|
IP
|
$228.00
|
|
|
Service Code
|
CPT 97112 GP
|
| Hospital Charge Code |
2989840
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$111.72 |
| Max. Negotiated Rate |
$209.76 |
| Rate for Payer: Aetna Commercial |
$205.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$196.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$120.84
|
| Rate for Payer: Cash Price |
$68.40
|
| Rate for Payer: Cigna Commercial |
$209.76
|
| Rate for Payer: Health EOS Commercial |
$202.92
|
| Rate for Payer: HFN Commercial |
$209.76
|
| Rate for Payer: Multiplan Commercial |
$182.40
|
| Rate for Payer: NAPHCARE Commercial |
$136.80
|
| Rate for Payer: Preferred Network Access Commercial |
$209.76
|
| Rate for Payer: Quartz Beloit One Network |
$111.72
|
| Rate for Payer: Quartz Commercial |
$136.80
|
| Rate for Payer: WEA Trust Commercial |
$125.40
|
| Rate for Payer: WPS Commercial |
$168.88
|
|
|
PT Neuromuscular Reeducation Charges
|
Facility
|
IP
|
$251.00
|
|
|
Service Code
|
CPT 97112
|
| Hospital Charge Code |
5247105
|
|
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
|
|
|
PT Neuromuscular Reeducation Charges
|
Facility
|
OP
|
$251.00
|
|
|
Service Code
|
CPT 97112
|
| Hospital Charge Code |
5247105
|
|
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 Neuromuscular Reeducation Charges
|
Professional
|
Both
|
$228.00
|
|
|
Service Code
|
CPT 97112 GP
|
| Hospital Charge Code |
2989840
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$100.32 |
| Max. Negotiated Rate |
$216.60 |
| Rate for Payer: Aetna Commercial |
$216.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$196.08
|
| Rate for Payer: Cash Price |
$68.40
|
| Rate for Payer: Cash Price |
$68.40
|
| Rate for Payer: Cigna Commercial |
$216.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$114.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$136.80
|
| Rate for Payer: Health EOS Commercial |
$207.48
|
| Rate for Payer: HFN Commercial |
$216.60
|
| Rate for Payer: Multiplan Commercial |
$182.40
|
| Rate for Payer: Preferred Network Access Commercial |
$216.60
|
| Rate for Payer: Quartz Beloit One Network |
$100.32
|
| Rate for Payer: Quartz Commercial |
$129.96
|
| Rate for Payer: The Alliance Commercial |
$114.00
|
| Rate for Payer: WEA Trust Commercial |
$125.40
|
| Rate for Payer: WPS Commercial |
$168.88
|
|
|
PT Orthotic Training Charges
|
Facility
|
OP
|
$213.00
|
|
|
Service Code
|
CPT 97760 GP
|
| Hospital Charge Code |
752352
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$59.64 |
| Max. Negotiated Rate |
$852.00 |
| Rate for Payer: Aetna Commercial |
$191.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$183.18
|
| Rate for Payer: Aetna Managed Medicare |
$59.64
|
| 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 |
$112.89
|
| Rate for Payer: Cash Price |
$63.90
|
| Rate for Payer: Cash Price |
$63.90
|
| Rate for Payer: Cigna Commercial |
$195.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$119.19
|
| Rate for Payer: Health EOS Commercial |
$189.57
|
| Rate for Payer: HFN Commercial |
$195.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$202.00
|
| Rate for Payer: Multiplan Commercial |
$170.40
|
| Rate for Payer: NAPHCARE Commercial |
$127.80
|
| Rate for Payer: Preferred Network Access Commercial |
$195.96
|
| Rate for Payer: Quartz Beloit One Network |
$104.37
|
| Rate for Payer: Quartz Commercial |
$138.45
|
| Rate for Payer: Quartz Medicare Advantage |
$127.80
|
| Rate for Payer: The Alliance Commercial |
$852.00
|
| Rate for Payer: United Healthcare PPO |
$159.75
|
| Rate for Payer: WEA Trust Commercial |
$117.15
|
| Rate for Payer: WPS Commercial |
$157.77
|
|
|
PT Orthotic Training Charges
|
Facility
|
IP
|
$213.00
|
|
|
Service Code
|
CPT 97760 GP
|
| Hospital Charge Code |
752352
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$104.37 |
| Max. Negotiated Rate |
$195.96 |
| Rate for Payer: Aetna Commercial |
$191.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$183.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$112.89
|
| Rate for Payer: Cash Price |
$63.90
|
| Rate for Payer: Cigna Commercial |
$195.96
|
| Rate for Payer: Health EOS Commercial |
$189.57
|
| Rate for Payer: HFN Commercial |
$195.96
|
| Rate for Payer: Multiplan Commercial |
$170.40
|
| Rate for Payer: NAPHCARE Commercial |
$127.80
|
| Rate for Payer: Preferred Network Access Commercial |
$195.96
|
| Rate for Payer: Quartz Beloit One Network |
$104.37
|
| Rate for Payer: Quartz Commercial |
$127.80
|
| Rate for Payer: WEA Trust Commercial |
$117.15
|
| Rate for Payer: WPS Commercial |
$157.77
|
|
|
PT Orthotic Training Charges
|
Professional
|
Both
|
$213.00
|
|
|
Service Code
|
CPT 97760 GP
|
| Hospital Charge Code |
752352
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$93.72 |
| Max. Negotiated Rate |
$202.35 |
| Rate for Payer: Aetna Commercial |
$202.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$183.18
|
| Rate for Payer: Cash Price |
$63.90
|
| Rate for Payer: Cash Price |
$63.90
|
| Rate for Payer: Cigna Commercial |
$202.35
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$106.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$127.80
|
| Rate for Payer: Health EOS Commercial |
$193.83
|
| Rate for Payer: HFN Commercial |
$202.35
|
| Rate for Payer: Multiplan Commercial |
$170.40
|
| Rate for Payer: Preferred Network Access Commercial |
$202.35
|
| Rate for Payer: Quartz Beloit One Network |
$93.72
|
| Rate for Payer: Quartz Commercial |
$121.41
|
| Rate for Payer: The Alliance Commercial |
$106.50
|
| Rate for Payer: WEA Trust Commercial |
$117.15
|
| Rate for Payer: WPS Commercial |
$157.77
|
|
|
PT Prosthetic Training Charges
|
Facility
|
IP
|
$251.00
|
|
|
Service Code
|
CPT 97761 GP
|
| Hospital Charge Code |
2989848
|
|
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
|
|
|
PT Prosthetic Training Charges
|
Facility
|
OP
|
$251.00
|
|
|
Service Code
|
CPT 97761 GP
|
| Hospital Charge Code |
2989848
|
|
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 Re-Eval Established Plan Care
|
Facility
|
IP
|
$287.00
|
|
|
Service Code
|
CPT 97164
|
| Hospital Charge Code |
5247110
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$140.63 |
| Max. Negotiated Rate |
$264.04 |
| Rate for Payer: Aetna Commercial |
$258.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$246.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$152.11
|
| Rate for Payer: Cash Price |
$86.10
|
| Rate for Payer: Cigna Commercial |
$264.04
|
| Rate for Payer: Health EOS Commercial |
$255.43
|
| Rate for Payer: HFN Commercial |
$264.04
|
| Rate for Payer: Multiplan Commercial |
$229.60
|
| Rate for Payer: NAPHCARE Commercial |
$172.20
|
| Rate for Payer: Preferred Network Access Commercial |
$264.04
|
| Rate for Payer: Quartz Beloit One Network |
$140.63
|
| Rate for Payer: Quartz Commercial |
$172.20
|
| Rate for Payer: WEA Trust Commercial |
$157.85
|
| Rate for Payer: WPS Commercial |
$212.58
|
|
|
PT Re-Eval Established Plan Care
|
Facility
|
OP
|
$287.00
|
|
|
Service Code
|
CPT 97164
|
| Hospital Charge Code |
5247110
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$80.36 |
| Max. Negotiated Rate |
$1,148.00 |
| Rate for Payer: Aetna Commercial |
$258.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$246.82
|
| Rate for Payer: Aetna Managed Medicare |
$80.36
|
| 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 |
$152.11
|
| Rate for Payer: Cash Price |
$86.10
|
| Rate for Payer: Cash Price |
$86.10
|
| Rate for Payer: Cigna Commercial |
$264.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$160.61
|
| Rate for Payer: Health EOS Commercial |
$255.43
|
| Rate for Payer: HFN Commercial |
$264.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$202.00
|
| Rate for Payer: Multiplan Commercial |
$229.60
|
| Rate for Payer: NAPHCARE Commercial |
$172.20
|
| Rate for Payer: Preferred Network Access Commercial |
$264.04
|
| Rate for Payer: Quartz Beloit One Network |
$140.63
|
| Rate for Payer: Quartz Commercial |
$186.55
|
| Rate for Payer: Quartz Medicare Advantage |
$172.20
|
| Rate for Payer: The Alliance Commercial |
$1,148.00
|
| Rate for Payer: United Healthcare PPO |
$215.25
|
| Rate for Payer: WEA Trust Commercial |
$157.85
|
| Rate for Payer: WPS Commercial |
$212.58
|
|
|
PT Strapping/Unna Boot Charges
|
Facility
|
IP
|
$218.00
|
|
|
Service Code
|
CPT 29581 GP
|
| Hospital Charge Code |
2989838
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$106.82 |
| Max. Negotiated Rate |
$200.56 |
| Rate for Payer: Aetna Commercial |
$196.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$187.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$115.54
|
| Rate for Payer: Cash Price |
$65.40
|
| Rate for Payer: Cigna Commercial |
$200.56
|
| Rate for Payer: Health EOS Commercial |
$194.02
|
| Rate for Payer: HFN Commercial |
$200.56
|
| Rate for Payer: Multiplan Commercial |
$174.40
|
| Rate for Payer: NAPHCARE Commercial |
$130.80
|
| Rate for Payer: Preferred Network Access Commercial |
$200.56
|
| Rate for Payer: Quartz Beloit One Network |
$106.82
|
| Rate for Payer: Quartz Commercial |
$130.80
|
| Rate for Payer: WEA Trust Commercial |
$119.90
|
| Rate for Payer: WPS Commercial |
$161.47
|
|
|
PT Strapping/Unna Boot Charges
|
Facility
|
OP
|
$218.00
|
|
|
Service Code
|
CPT 29581 GP
|
| Hospital Charge Code |
2989838
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$61.04 |
| Max. Negotiated Rate |
$872.00 |
| Rate for Payer: Aetna Commercial |
$196.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$187.48
|
| Rate for Payer: Aetna Managed Medicare |
$61.04
|
| 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 |
$115.54
|
| Rate for Payer: Cash Price |
$65.40
|
| Rate for Payer: Cash Price |
$65.40
|
| Rate for Payer: Cigna Commercial |
$200.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$121.99
|
| Rate for Payer: Health EOS Commercial |
$194.02
|
| Rate for Payer: HFN Commercial |
$200.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$202.00
|
| Rate for Payer: Multiplan Commercial |
$174.40
|
| Rate for Payer: NAPHCARE Commercial |
$130.80
|
| Rate for Payer: Preferred Network Access Commercial |
$200.56
|
| Rate for Payer: Quartz Beloit One Network |
$106.82
|
| Rate for Payer: Quartz Commercial |
$141.70
|
| Rate for Payer: Quartz Medicare Advantage |
$130.80
|
| Rate for Payer: The Alliance Commercial |
$872.00
|
| Rate for Payer: United Healthcare PPO |
$163.50
|
| Rate for Payer: WEA Trust Commercial |
$119.90
|
| Rate for Payer: WPS Commercial |
$161.47
|
|
