|
PT Strapping/Unna Boot Charges
|
Professional
|
Both
|
$218.00
|
|
|
Service Code
|
CPT 29581 GP
|
| Hospital Charge Code |
2989838
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$95.92 |
| Max. Negotiated Rate |
$207.10 |
| Rate for Payer: Aetna Commercial |
$207.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$187.48
|
| Rate for Payer: Cash Price |
$65.40
|
| Rate for Payer: Cash Price |
$65.40
|
| Rate for Payer: Cigna Commercial |
$207.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$109.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$130.80
|
| Rate for Payer: Health EOS Commercial |
$198.38
|
| Rate for Payer: HFN Commercial |
$207.10
|
| Rate for Payer: Multiplan Commercial |
$174.40
|
| Rate for Payer: Preferred Network Access Commercial |
$207.10
|
| Rate for Payer: Quartz Beloit One Network |
$95.92
|
| Rate for Payer: Quartz Commercial |
$124.26
|
| Rate for Payer: The Alliance Commercial |
$109.00
|
| Rate for Payer: WEA Trust Commercial |
$119.90
|
| Rate for Payer: WPS Commercial |
$161.47
|
|
|
PT Therapeutic Activities Charge
|
Facility
|
IP
|
$231.00
|
|
|
Service Code
|
CPT 97530
|
| Hospital Charge Code |
5247111
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$113.19 |
| Max. Negotiated Rate |
$212.52 |
| Rate for Payer: Aetna Commercial |
$207.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$198.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$122.43
|
| Rate for Payer: Cash Price |
$69.30
|
| Rate for Payer: Cigna Commercial |
$212.52
|
| Rate for Payer: Health EOS Commercial |
$205.59
|
| Rate for Payer: HFN Commercial |
$212.52
|
| Rate for Payer: Multiplan Commercial |
$184.80
|
| Rate for Payer: NAPHCARE Commercial |
$138.60
|
| Rate for Payer: Preferred Network Access Commercial |
$212.52
|
| Rate for Payer: Quartz Beloit One Network |
$113.19
|
| Rate for Payer: Quartz Commercial |
$138.60
|
| Rate for Payer: WEA Trust Commercial |
$127.05
|
| Rate for Payer: WPS Commercial |
$171.10
|
|
|
PT Therapeutic Activities Charge
|
Facility
|
OP
|
$231.00
|
|
|
Service Code
|
CPT 97530
|
| Hospital Charge Code |
5247111
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$64.68 |
| Max. Negotiated Rate |
$924.00 |
| Rate for Payer: Aetna Commercial |
$207.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$198.66
|
| Rate for Payer: Aetna Managed Medicare |
$64.68
|
| 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 |
$122.43
|
| Rate for Payer: Cash Price |
$69.30
|
| Rate for Payer: Cash Price |
$69.30
|
| Rate for Payer: Cigna Commercial |
$212.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$129.27
|
| Rate for Payer: Health EOS Commercial |
$205.59
|
| Rate for Payer: HFN Commercial |
$212.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$202.00
|
| Rate for Payer: Multiplan Commercial |
$184.80
|
| Rate for Payer: NAPHCARE Commercial |
$138.60
|
| Rate for Payer: Preferred Network Access Commercial |
$212.52
|
| Rate for Payer: Quartz Beloit One Network |
$113.19
|
| Rate for Payer: Quartz Commercial |
$150.15
|
| Rate for Payer: Quartz Medicare Advantage |
$138.60
|
| Rate for Payer: The Alliance Commercial |
$924.00
|
| Rate for Payer: United Healthcare PPO |
$173.25
|
| Rate for Payer: WEA Trust Commercial |
$127.05
|
| Rate for Payer: WPS Commercial |
$171.10
|
|
|
PT Therapeutic Activities Charges
|
Professional
|
Both
|
$231.00
|
|
|
Service Code
|
CPT 97530 GP
|
| Hospital Charge Code |
2989844
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$101.64 |
| Max. Negotiated Rate |
$219.45 |
| Rate for Payer: Aetna Commercial |
$219.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$198.66
|
| Rate for Payer: Cash Price |
$69.30
|
| Rate for Payer: Cash Price |
$69.30
|
| Rate for Payer: Cigna Commercial |
$219.45
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$115.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$138.60
|
| Rate for Payer: Health EOS Commercial |
$210.21
|
| Rate for Payer: HFN Commercial |
$219.45
|
| Rate for Payer: Multiplan Commercial |
$184.80
|
| Rate for Payer: Preferred Network Access Commercial |
$219.45
|
| Rate for Payer: Quartz Beloit One Network |
$101.64
|
| Rate for Payer: Quartz Commercial |
$131.67
|
| Rate for Payer: The Alliance Commercial |
$115.50
|
| Rate for Payer: WEA Trust Commercial |
$127.05
|
| Rate for Payer: WPS Commercial |
$171.10
|
|
|
PT Therapeutic Activities Charges
|
Facility
|
IP
|
$231.00
|
|
|
Service Code
|
CPT 97530 GP
|
| Hospital Charge Code |
2989844
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$113.19 |
| Max. Negotiated Rate |
$212.52 |
| Rate for Payer: Aetna Commercial |
$207.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$198.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$122.43
|
| Rate for Payer: Cash Price |
$69.30
|
| Rate for Payer: Cigna Commercial |
$212.52
|
| Rate for Payer: Health EOS Commercial |
$205.59
|
| Rate for Payer: HFN Commercial |
$212.52
|
| Rate for Payer: Multiplan Commercial |
$184.80
|
| Rate for Payer: NAPHCARE Commercial |
$138.60
|
| Rate for Payer: Preferred Network Access Commercial |
$212.52
|
| Rate for Payer: Quartz Beloit One Network |
$113.19
|
| Rate for Payer: Quartz Commercial |
$138.60
|
| Rate for Payer: WEA Trust Commercial |
$127.05
|
| Rate for Payer: WPS Commercial |
$171.10
|
|
|
PT Therapeutic Activities Charges
|
Facility
|
OP
|
$231.00
|
|
|
Service Code
|
CPT 97530 GP
|
| Hospital Charge Code |
2989844
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$64.68 |
| Max. Negotiated Rate |
$924.00 |
| Rate for Payer: Aetna Commercial |
$207.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$198.66
|
| Rate for Payer: Aetna Managed Medicare |
$64.68
|
| 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 |
$122.43
|
| Rate for Payer: Cash Price |
$69.30
|
| Rate for Payer: Cash Price |
$69.30
|
| Rate for Payer: Cigna Commercial |
$212.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$129.27
|
| Rate for Payer: Health EOS Commercial |
$205.59
|
| Rate for Payer: HFN Commercial |
$212.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$202.00
|
| Rate for Payer: Multiplan Commercial |
$184.80
|
| Rate for Payer: NAPHCARE Commercial |
$138.60
|
| Rate for Payer: Preferred Network Access Commercial |
$212.52
|
| Rate for Payer: Quartz Beloit One Network |
$113.19
|
| Rate for Payer: Quartz Commercial |
$150.15
|
| Rate for Payer: Quartz Medicare Advantage |
$138.60
|
| Rate for Payer: The Alliance Commercial |
$924.00
|
| Rate for Payer: United Healthcare PPO |
$173.25
|
| Rate for Payer: WEA Trust Commercial |
$127.05
|
| Rate for Payer: WPS Commercial |
$171.10
|
|
|
PT Therapeutic Exercise Charges
|
Facility
|
OP
|
$236.00
|
|
|
Service Code
|
CPT 97110 GP
|
| Hospital Charge Code |
752356
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$66.08 |
| Max. Negotiated Rate |
$944.00 |
| Rate for Payer: Aetna Commercial |
$212.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$202.96
|
| Rate for Payer: Aetna Managed Medicare |
$66.08
|
| 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 |
$125.08
|
| Rate for Payer: Cash Price |
$70.80
|
| Rate for Payer: Cash Price |
$70.80
|
| Rate for Payer: Cigna Commercial |
$217.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$132.07
|
| Rate for Payer: Health EOS Commercial |
$210.04
|
| Rate for Payer: HFN Commercial |
$217.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$202.00
|
| Rate for Payer: Multiplan Commercial |
$188.80
|
| Rate for Payer: NAPHCARE Commercial |
$141.60
|
| Rate for Payer: Preferred Network Access Commercial |
$217.12
|
| Rate for Payer: Quartz Beloit One Network |
$115.64
|
| Rate for Payer: Quartz Commercial |
$153.40
|
| Rate for Payer: Quartz Medicare Advantage |
$141.60
|
| Rate for Payer: The Alliance Commercial |
$944.00
|
| Rate for Payer: United Healthcare PPO |
$177.00
|
| Rate for Payer: WEA Trust Commercial |
$129.80
|
| Rate for Payer: WPS Commercial |
$174.81
|
|
|
PT Therapeutic Exercise Charges
|
Facility
|
IP
|
$236.00
|
|
|
Service Code
|
CPT 97110 GP
|
| Hospital Charge Code |
752356
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$115.64 |
| Max. Negotiated Rate |
$217.12 |
| Rate for Payer: Aetna Commercial |
$212.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$202.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$125.08
|
| Rate for Payer: Cash Price |
$70.80
|
| Rate for Payer: Cigna Commercial |
$217.12
|
| Rate for Payer: Health EOS Commercial |
$210.04
|
| Rate for Payer: HFN Commercial |
$217.12
|
| Rate for Payer: Multiplan Commercial |
$188.80
|
| Rate for Payer: NAPHCARE Commercial |
$141.60
|
| Rate for Payer: Preferred Network Access Commercial |
$217.12
|
| Rate for Payer: Quartz Beloit One Network |
$115.64
|
| Rate for Payer: Quartz Commercial |
$141.60
|
| Rate for Payer: WEA Trust Commercial |
$129.80
|
| Rate for Payer: WPS Commercial |
$174.81
|
|
|
PT Therapeutic Exercise Charges
|
Facility
|
IP
|
$236.00
|
|
|
Service Code
|
CPT 97110
|
| Hospital Charge Code |
5247104
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$115.64 |
| Max. Negotiated Rate |
$217.12 |
| Rate for Payer: Aetna Commercial |
$212.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$202.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$125.08
|
| Rate for Payer: Cash Price |
$70.80
|
| Rate for Payer: Cigna Commercial |
$217.12
|
| Rate for Payer: Health EOS Commercial |
$210.04
|
| Rate for Payer: HFN Commercial |
$217.12
|
| Rate for Payer: Multiplan Commercial |
$188.80
|
| Rate for Payer: NAPHCARE Commercial |
$141.60
|
| Rate for Payer: Preferred Network Access Commercial |
$217.12
|
| Rate for Payer: Quartz Beloit One Network |
$115.64
|
| Rate for Payer: Quartz Commercial |
$141.60
|
| Rate for Payer: WEA Trust Commercial |
$129.80
|
| Rate for Payer: WPS Commercial |
$174.81
|
|
|
PT Therapeutic Exercise Charges
|
Facility
|
OP
|
$236.00
|
|
|
Service Code
|
CPT 97110
|
| Hospital Charge Code |
5247104
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$66.08 |
| Max. Negotiated Rate |
$944.00 |
| Rate for Payer: Aetna Commercial |
$212.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$202.96
|
| Rate for Payer: Aetna Managed Medicare |
$66.08
|
| 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 |
$125.08
|
| Rate for Payer: Cash Price |
$70.80
|
| Rate for Payer: Cash Price |
$70.80
|
| Rate for Payer: Cigna Commercial |
$217.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$132.07
|
| Rate for Payer: Health EOS Commercial |
$210.04
|
| Rate for Payer: HFN Commercial |
$217.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$202.00
|
| Rate for Payer: Multiplan Commercial |
$188.80
|
| Rate for Payer: NAPHCARE Commercial |
$141.60
|
| Rate for Payer: Preferred Network Access Commercial |
$217.12
|
| Rate for Payer: Quartz Beloit One Network |
$115.64
|
| Rate for Payer: Quartz Commercial |
$153.40
|
| Rate for Payer: Quartz Medicare Advantage |
$141.60
|
| Rate for Payer: The Alliance Commercial |
$944.00
|
| Rate for Payer: United Healthcare PPO |
$177.00
|
| Rate for Payer: WEA Trust Commercial |
$129.80
|
| Rate for Payer: WPS Commercial |
$174.81
|
|
|
PT Therapeutic Exercise Charges
|
Professional
|
Both
|
$236.00
|
|
|
Service Code
|
CPT 97110 GP
|
| Hospital Charge Code |
752356
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$103.84 |
| Max. Negotiated Rate |
$224.20 |
| Rate for Payer: Aetna Commercial |
$224.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$202.96
|
| Rate for Payer: Cash Price |
$70.80
|
| Rate for Payer: Cash Price |
$70.80
|
| Rate for Payer: Cigna Commercial |
$224.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$118.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$141.60
|
| Rate for Payer: Health EOS Commercial |
$214.76
|
| Rate for Payer: HFN Commercial |
$224.20
|
| Rate for Payer: Multiplan Commercial |
$188.80
|
| Rate for Payer: Preferred Network Access Commercial |
$224.20
|
| Rate for Payer: Quartz Beloit One Network |
$103.84
|
| Rate for Payer: Quartz Commercial |
$134.52
|
| Rate for Payer: The Alliance Commercial |
$118.00
|
| Rate for Payer: WEA Trust Commercial |
$129.80
|
| Rate for Payer: WPS Commercial |
$174.81
|
|
|
PT TH Gait Training Chg
|
Facility
|
IP
|
$264.00
|
|
|
Service Code
|
CPT 97116 GP,95
|
| Hospital Charge Code |
5583090
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$129.36 |
| Max. Negotiated Rate |
$242.88 |
| Rate for Payer: Aetna Commercial |
$237.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$227.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$139.92
|
| Rate for Payer: Cash Price |
$79.20
|
| Rate for Payer: Cigna Commercial |
$242.88
|
| Rate for Payer: Health EOS Commercial |
$234.96
|
| Rate for Payer: HFN Commercial |
$242.88
|
| Rate for Payer: Multiplan Commercial |
$211.20
|
| Rate for Payer: NAPHCARE Commercial |
$158.40
|
| Rate for Payer: Preferred Network Access Commercial |
$242.88
|
| Rate for Payer: Quartz Beloit One Network |
$129.36
|
| Rate for Payer: Quartz Commercial |
$158.40
|
| Rate for Payer: WEA Trust Commercial |
$145.20
|
| Rate for Payer: WPS Commercial |
$195.54
|
|
|
PT TH Gait Training Chg
|
Facility
|
OP
|
$264.00
|
|
|
Service Code
|
CPT 97116 GP,95
|
| Hospital Charge Code |
5583090
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$73.92 |
| Max. Negotiated Rate |
$1,056.00 |
| Rate for Payer: Aetna Commercial |
$237.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$227.04
|
| Rate for Payer: Aetna Managed Medicare |
$73.92
|
| 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 |
$139.92
|
| Rate for Payer: Cash Price |
$79.20
|
| Rate for Payer: Cash Price |
$79.20
|
| Rate for Payer: Cigna Commercial |
$242.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$147.73
|
| Rate for Payer: Health EOS Commercial |
$234.96
|
| Rate for Payer: HFN Commercial |
$242.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$202.00
|
| Rate for Payer: Multiplan Commercial |
$211.20
|
| Rate for Payer: NAPHCARE Commercial |
$158.40
|
| Rate for Payer: Preferred Network Access Commercial |
$242.88
|
| Rate for Payer: Quartz Beloit One Network |
$129.36
|
| Rate for Payer: Quartz Commercial |
$171.60
|
| Rate for Payer: Quartz Medicare Advantage |
$158.40
|
| Rate for Payer: The Alliance Commercial |
$1,056.00
|
| Rate for Payer: United Healthcare PPO |
$198.00
|
| Rate for Payer: WEA Trust Commercial |
$145.20
|
| Rate for Payer: WPS Commercial |
$195.54
|
|
|
PT TH Therapeutic Exercise Chg
|
Facility
|
IP
|
$270.00
|
|
|
Service Code
|
CPT 97110 GP,95
|
| Hospital Charge Code |
5583092
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$132.30 |
| Max. Negotiated Rate |
$248.40 |
| Rate for Payer: Aetna Commercial |
$243.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$232.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$143.10
|
| Rate for Payer: Cash Price |
$81.00
|
| Rate for Payer: Cigna Commercial |
$248.40
|
| Rate for Payer: Health EOS Commercial |
$240.30
|
| Rate for Payer: HFN Commercial |
$248.40
|
| Rate for Payer: Multiplan Commercial |
$216.00
|
| Rate for Payer: NAPHCARE Commercial |
$162.00
|
| Rate for Payer: Preferred Network Access Commercial |
$248.40
|
| Rate for Payer: Quartz Beloit One Network |
$132.30
|
| Rate for Payer: Quartz Commercial |
$162.00
|
| Rate for Payer: WEA Trust Commercial |
$148.50
|
| Rate for Payer: WPS Commercial |
$199.99
|
|
|
PT TH Therapeutic Exercise Chg
|
Facility
|
OP
|
$270.00
|
|
|
Service Code
|
CPT 97110 GP,95
|
| Hospital Charge Code |
5583092
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$75.60 |
| Max. Negotiated Rate |
$1,080.00 |
| Rate for Payer: Aetna Commercial |
$243.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$232.20
|
| Rate for Payer: Aetna Managed Medicare |
$75.60
|
| 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 |
$143.10
|
| Rate for Payer: Cash Price |
$81.00
|
| Rate for Payer: Cash Price |
$81.00
|
| Rate for Payer: Cigna Commercial |
$248.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$151.09
|
| Rate for Payer: Health EOS Commercial |
$240.30
|
| Rate for Payer: HFN Commercial |
$248.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$202.00
|
| Rate for Payer: Multiplan Commercial |
$216.00
|
| Rate for Payer: NAPHCARE Commercial |
$162.00
|
| Rate for Payer: Preferred Network Access Commercial |
$248.40
|
| Rate for Payer: Quartz Beloit One Network |
$132.30
|
| Rate for Payer: Quartz Commercial |
$175.50
|
| Rate for Payer: Quartz Medicare Advantage |
$162.00
|
| Rate for Payer: The Alliance Commercial |
$1,080.00
|
| Rate for Payer: United Healthcare PPO |
$202.50
|
| Rate for Payer: WEA Trust Commercial |
$148.50
|
| Rate for Payer: WPS Commercial |
$199.99
|
|
|
PTT, Lupus
|
Professional
|
Both
|
$24.00
|
|
|
Service Code
|
CPT 85730
|
| Hospital Charge Code |
4586652
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.56 |
| Max. Negotiated Rate |
$22.80 |
| Rate for Payer: Aetna Commercial |
$22.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$20.64
|
| Rate for Payer: Cash Price |
$7.20
|
| Rate for Payer: Cash Price |
$7.20
|
| Rate for Payer: Cigna Commercial |
$22.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$12.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$14.40
|
| Rate for Payer: Health EOS Commercial |
$21.84
|
| Rate for Payer: HFN Commercial |
$22.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$21.22
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$21.22
|
| Rate for Payer: Multiplan Commercial |
$19.20
|
| Rate for Payer: Preferred Network Access Commercial |
$22.80
|
| Rate for Payer: Quartz Beloit One Network |
$10.56
|
| Rate for Payer: Quartz Commercial |
$13.68
|
| Rate for Payer: The Alliance Commercial |
$12.00
|
| Rate for Payer: WEA Trust Commercial |
$13.20
|
| Rate for Payer: WPS Commercial |
$17.78
|
|
|
PTT, Lupus
|
Facility
|
OP
|
$24.00
|
|
|
Service Code
|
CPT 85730
|
| Hospital Charge Code |
4586652
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.01 |
| Max. Negotiated Rate |
$24.04 |
| Rate for Payer: Aetna Commercial |
$21.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$20.64
|
| Rate for Payer: Aetna Managed Medicare |
$6.01
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$22.54
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$10.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$9.98
|
| Rate for Payer: Anthem Medicaid |
$6.21
|
| Rate for Payer: Anthem Medicare Advantage |
$6.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$12.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$6.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$6.01
|
| Rate for Payer: Cash Price |
$7.20
|
| Rate for Payer: Cash Price |
$7.20
|
| Rate for Payer: Cigna Commercial |
$22.08
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$6.01
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$6.21
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$13.43
|
| Rate for Payer: Dean Health Medicaid |
$6.21
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$6.01
|
| Rate for Payer: Health EOS Commercial |
$21.36
|
| Rate for Payer: HFN Commercial |
$22.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$22.36
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$6.01
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$6.21
|
| Rate for Payer: Independent Care Health Plan Medicare |
$6.01
|
| Rate for Payer: Managed Health Services Medicaid |
$6.46
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$6.01
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$6.01
|
| Rate for Payer: Multiplan Commercial |
$19.20
|
| Rate for Payer: NAPHCARE Commercial |
$9.02
|
| Rate for Payer: Preferred Network Access Commercial |
$22.08
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$6.21
|
| Rate for Payer: Quartz Beloit One Network |
$11.76
|
| Rate for Payer: Quartz Commercial |
$15.60
|
| Rate for Payer: Quartz Medicare Advantage |
$6.01
|
| Rate for Payer: The Alliance Commercial |
$24.04
|
| Rate for Payer: United Healthcare Medicaid |
$6.21
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6.01
|
| Rate for Payer: United Healthcare PPO |
$18.00
|
| Rate for Payer: WEA Trust Commercial |
$13.20
|
| Rate for Payer: Wellcare Medicare |
$6.01
|
| Rate for Payer: WMAP Medicaid |
$6.21
|
| Rate for Payer: WPS Commercial |
$17.78
|
|
|
PTT, Lupus
|
Facility
|
IP
|
$24.00
|
|
|
Service Code
|
CPT 85730
|
| Hospital Charge Code |
4586652
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.76 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$21.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$20.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$12.72
|
| Rate for Payer: Cash Price |
$7.20
|
| Rate for Payer: Cigna Commercial |
$22.08
|
| Rate for Payer: Health EOS Commercial |
$21.36
|
| Rate for Payer: HFN Commercial |
$22.08
|
| Rate for Payer: Multiplan Commercial |
$19.20
|
| Rate for Payer: NAPHCARE Commercial |
$14.40
|
| Rate for Payer: Preferred Network Access Commercial |
$22.08
|
| Rate for Payer: Quartz Beloit One Network |
$11.76
|
| Rate for Payer: Quartz Commercial |
$14.40
|
| Rate for Payer: WEA Trust Commercial |
$13.20
|
| Rate for Payer: WPS Commercial |
$17.78
|
|
|
PT Ultrasound Charges
|
Facility
|
OP
|
$167.00
|
|
|
Service Code
|
CPT 97035
|
| Hospital Charge Code |
5247103
|
|
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 Ultrasound Charges
|
Facility
|
IP
|
$167.00
|
|
|
Service Code
|
CPT 97035
|
| Hospital Charge Code |
5247103
|
|
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 Wheelchair Management Charges
|
Facility
|
IP
|
$216.00
|
|
|
Service Code
|
CPT 97542 GP
|
| Hospital Charge Code |
2989837
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$105.84 |
| Max. Negotiated Rate |
$198.72 |
| Rate for Payer: Aetna Commercial |
$194.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$185.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$114.48
|
| Rate for Payer: Cash Price |
$64.80
|
| Rate for Payer: Cigna Commercial |
$198.72
|
| Rate for Payer: Health EOS Commercial |
$192.24
|
| Rate for Payer: HFN Commercial |
$198.72
|
| Rate for Payer: Multiplan Commercial |
$172.80
|
| Rate for Payer: NAPHCARE Commercial |
$129.60
|
| Rate for Payer: Preferred Network Access Commercial |
$198.72
|
| Rate for Payer: Quartz Beloit One Network |
$105.84
|
| Rate for Payer: Quartz Commercial |
$129.60
|
| Rate for Payer: WEA Trust Commercial |
$118.80
|
| Rate for Payer: WPS Commercial |
$159.99
|
|
|
PT Wheelchair Management Charges
|
Professional
|
Both
|
$216.00
|
|
|
Service Code
|
CPT 97542 GP
|
| Hospital Charge Code |
2989837
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$95.04 |
| Max. Negotiated Rate |
$205.20 |
| Rate for Payer: Aetna Commercial |
$205.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$185.76
|
| Rate for Payer: Cash Price |
$64.80
|
| Rate for Payer: Cash Price |
$64.80
|
| Rate for Payer: Cigna Commercial |
$205.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$108.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$129.60
|
| Rate for Payer: Health EOS Commercial |
$196.56
|
| Rate for Payer: HFN Commercial |
$205.20
|
| Rate for Payer: Multiplan Commercial |
$172.80
|
| Rate for Payer: Preferred Network Access Commercial |
$205.20
|
| Rate for Payer: Quartz Beloit One Network |
$95.04
|
| Rate for Payer: Quartz Commercial |
$123.12
|
| Rate for Payer: The Alliance Commercial |
$108.00
|
| Rate for Payer: WEA Trust Commercial |
$118.80
|
| Rate for Payer: WPS Commercial |
$159.99
|
|
|
PT Wheelchair Management Charges
|
Facility
|
OP
|
$216.00
|
|
|
Service Code
|
CPT 97542 GP
|
| Hospital Charge Code |
2989837
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$60.48 |
| Max. Negotiated Rate |
$864.00 |
| Rate for Payer: Aetna Commercial |
$194.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$185.76
|
| Rate for Payer: Aetna Managed Medicare |
$60.48
|
| 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 |
$114.48
|
| Rate for Payer: Cash Price |
$64.80
|
| Rate for Payer: Cash Price |
$64.80
|
| Rate for Payer: Cigna Commercial |
$198.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$120.87
|
| Rate for Payer: Health EOS Commercial |
$192.24
|
| Rate for Payer: HFN Commercial |
$198.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$202.00
|
| Rate for Payer: Multiplan Commercial |
$172.80
|
| Rate for Payer: NAPHCARE Commercial |
$129.60
|
| Rate for Payer: Preferred Network Access Commercial |
$198.72
|
| Rate for Payer: Quartz Beloit One Network |
$105.84
|
| Rate for Payer: Quartz Commercial |
$140.40
|
| Rate for Payer: Quartz Medicare Advantage |
$129.60
|
| Rate for Payer: The Alliance Commercial |
$864.00
|
| Rate for Payer: United Healthcare PPO |
$162.00
|
| Rate for Payer: WEA Trust Commercial |
$118.80
|
| Rate for Payer: WPS Commercial |
$159.99
|
|
|
PULL LOOPS #ACM-9156
|
Facility
|
IP
|
$293.00
|
|
| Hospital Charge Code |
2970889
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$143.57 |
| Max. Negotiated Rate |
$269.56 |
| Rate for Payer: Aetna Commercial |
$263.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$251.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$155.29
|
| Rate for Payer: Cash Price |
$87.90
|
| Rate for Payer: Cigna Commercial |
$269.56
|
| Rate for Payer: Health EOS Commercial |
$260.77
|
| Rate for Payer: HFN Commercial |
$269.56
|
| Rate for Payer: Multiplan Commercial |
$234.40
|
| Rate for Payer: NAPHCARE Commercial |
$175.80
|
| Rate for Payer: Preferred Network Access Commercial |
$269.56
|
| Rate for Payer: Quartz Beloit One Network |
$143.57
|
| Rate for Payer: Quartz Commercial |
$175.80
|
| Rate for Payer: WEA Trust Commercial |
$161.15
|
| Rate for Payer: WPS Commercial |
$217.03
|
|
|
PULL LOOPS #ACM-9156
|
Facility
|
OP
|
$293.00
|
|
| Hospital Charge Code |
2970889
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$82.04 |
| Max. Negotiated Rate |
$1,172.00 |
| Rate for Payer: Aetna Commercial |
$263.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$251.98
|
| Rate for Payer: Aetna Managed Medicare |
$82.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$190.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$146.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$140.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$155.29
|
| Rate for Payer: Cash Price |
$87.90
|
| Rate for Payer: Cigna Commercial |
$269.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$163.96
|
| Rate for Payer: Health EOS Commercial |
$260.77
|
| Rate for Payer: HFN Commercial |
$269.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$219.75
|
| Rate for Payer: Multiplan Commercial |
$234.40
|
| Rate for Payer: NAPHCARE Commercial |
$175.80
|
| Rate for Payer: Preferred Network Access Commercial |
$269.56
|
| Rate for Payer: Quartz Beloit One Network |
$143.57
|
| Rate for Payer: Quartz Commercial |
$190.45
|
| Rate for Payer: Quartz Medicare Advantage |
$175.80
|
| Rate for Payer: The Alliance Commercial |
$1,172.00
|
| Rate for Payer: WEA Trust Commercial |
$161.15
|
| Rate for Payer: WPS Commercial |
$217.03
|
|
