|
Yes - PT Evaluation Low Charge
|
Professional
|
Both
|
$415.00
|
|
|
Service Code
|
CPT 97161 GP
|
| Hospital Charge Code |
5149519
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$182.60 |
| Max. Negotiated Rate |
$394.25 |
| Rate for Payer: Aetna Commercial |
$394.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$356.90
|
| Rate for Payer: Cash Price |
$124.50
|
| Rate for Payer: Cash Price |
$124.50
|
| Rate for Payer: Cash Price |
$124.50
|
| Rate for Payer: Cigna Commercial |
$394.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$207.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$249.00
|
| Rate for Payer: Health EOS Commercial |
$377.65
|
| Rate for Payer: HFN Commercial |
$394.25
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$345.83
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$345.83
|
| Rate for Payer: Multiplan Commercial |
$332.00
|
| Rate for Payer: Preferred Network Access Commercial |
$394.25
|
| Rate for Payer: Quartz Beloit One Network |
$182.60
|
| Rate for Payer: Quartz Commercial |
$236.55
|
| Rate for Payer: The Alliance Commercial |
$207.50
|
| Rate for Payer: WEA Trust Commercial |
$228.25
|
| Rate for Payer: WPS Commercial |
$307.39
|
|
|
Yes - PT Evaluation Low Charge
|
Facility
|
IP
|
$415.00
|
|
|
Service Code
|
CPT 97161 GP
|
| Hospital Charge Code |
5149519
|
|
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
|
|
|
Yes - PT Evaluation Low Charge
|
Facility
|
OP
|
$415.00
|
|
|
Service Code
|
CPT 97161 GP
|
| Hospital Charge Code |
5149519
|
|
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
|
|
|
Yes - PT Evaluation Moderate Charge
|
Facility
|
OP
|
$640.00
|
|
|
Service Code
|
CPT 97162 GP
|
| Hospital Charge Code |
5149520
|
|
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
|
|
|
Yes - PT Evaluation Moderate Charge
|
Facility
|
IP
|
$640.00
|
|
|
Service Code
|
CPT 97162 GP
|
| Hospital Charge Code |
5149520
|
|
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
|
|
|
Yes - PT Evaluation Moderate Charge
|
Professional
|
Both
|
$640.00
|
|
|
Service Code
|
CPT 97162 GP
|
| Hospital Charge Code |
5149520
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$281.60 |
| Max. Negotiated Rate |
$608.00 |
| Rate for Payer: Aetna Commercial |
$608.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$550.40
|
| Rate for Payer: Cash Price |
$192.00
|
| Rate for Payer: Cash Price |
$192.00
|
| Rate for Payer: Cash Price |
$192.00
|
| Rate for Payer: Cigna Commercial |
$608.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$320.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$384.00
|
| Rate for Payer: Health EOS Commercial |
$582.40
|
| Rate for Payer: HFN Commercial |
$608.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$345.83
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$345.83
|
| Rate for Payer: Multiplan Commercial |
$512.00
|
| Rate for Payer: Preferred Network Access Commercial |
$608.00
|
| Rate for Payer: Quartz Beloit One Network |
$281.60
|
| Rate for Payer: Quartz Commercial |
$364.80
|
| Rate for Payer: The Alliance Commercial |
$320.00
|
| Rate for Payer: WEA Trust Commercial |
$352.00
|
| Rate for Payer: WPS Commercial |
$474.05
|
|
|
Yes - PT Fluidotherapy Charge
|
Facility
|
IP
|
$186.00
|
|
|
Service Code
|
CPT 97022 GP
|
| Hospital Charge Code |
2987956
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$91.14 |
| Max. Negotiated Rate |
$171.12 |
| Rate for Payer: Aetna Commercial |
$167.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$159.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$98.58
|
| Rate for Payer: Cash Price |
$55.80
|
| Rate for Payer: Cigna Commercial |
$171.12
|
| Rate for Payer: Health EOS Commercial |
$165.54
|
| Rate for Payer: HFN Commercial |
$171.12
|
| Rate for Payer: Multiplan Commercial |
$148.80
|
| Rate for Payer: NAPHCARE Commercial |
$111.60
|
| Rate for Payer: Preferred Network Access Commercial |
$171.12
|
| Rate for Payer: Quartz Beloit One Network |
$91.14
|
| Rate for Payer: Quartz Commercial |
$111.60
|
| Rate for Payer: WEA Trust Commercial |
$102.30
|
| Rate for Payer: WPS Commercial |
$137.77
|
|
|
Yes - PT Fluidotherapy Charge
|
Facility
|
OP
|
$186.00
|
|
|
Service Code
|
CPT 97022 GP
|
| Hospital Charge Code |
2987956
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$52.08 |
| Max. Negotiated Rate |
$744.00 |
| Rate for Payer: Aetna Commercial |
$167.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$159.96
|
| Rate for Payer: Aetna Managed Medicare |
$52.08
|
| 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 |
$98.58
|
| Rate for Payer: Cash Price |
$55.80
|
| Rate for Payer: Cash Price |
$55.80
|
| Rate for Payer: Cigna Commercial |
$171.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$104.09
|
| Rate for Payer: Health EOS Commercial |
$165.54
|
| Rate for Payer: HFN Commercial |
$171.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$202.00
|
| Rate for Payer: Multiplan Commercial |
$148.80
|
| Rate for Payer: NAPHCARE Commercial |
$111.60
|
| Rate for Payer: Preferred Network Access Commercial |
$171.12
|
| Rate for Payer: Quartz Beloit One Network |
$91.14
|
| Rate for Payer: Quartz Commercial |
$120.90
|
| Rate for Payer: Quartz Medicare Advantage |
$111.60
|
| Rate for Payer: The Alliance Commercial |
$744.00
|
| Rate for Payer: United Healthcare PPO |
$139.50
|
| Rate for Payer: WEA Trust Commercial |
$102.30
|
| Rate for Payer: WPS Commercial |
$137.77
|
|
|
Yes - PT Fluidotherapy Charge
|
Professional
|
Both
|
$186.00
|
|
|
Service Code
|
CPT 97022 GP
|
| Hospital Charge Code |
2987956
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$60.75 |
| Max. Negotiated Rate |
$176.70 |
| Rate for Payer: Aetna Commercial |
$176.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$159.96
|
| Rate for Payer: Cash Price |
$55.80
|
| Rate for Payer: Cash Price |
$55.80
|
| Rate for Payer: Cash Price |
$55.80
|
| Rate for Payer: Cigna Commercial |
$176.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$93.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$111.60
|
| Rate for Payer: Health EOS Commercial |
$169.26
|
| Rate for Payer: HFN Commercial |
$176.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$60.75
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$60.75
|
| Rate for Payer: Multiplan Commercial |
$148.80
|
| Rate for Payer: Preferred Network Access Commercial |
$176.70
|
| Rate for Payer: Quartz Beloit One Network |
$81.84
|
| Rate for Payer: Quartz Commercial |
$106.02
|
| Rate for Payer: The Alliance Commercial |
$93.00
|
| Rate for Payer: WEA Trust Commercial |
$102.30
|
| Rate for Payer: WPS Commercial |
$137.77
|
|
|
Yes - PT Group Therapy Charge
|
Facility
|
IP
|
$249.00
|
|
|
Service Code
|
CPT 97150 GP
|
| Hospital Charge Code |
2989695
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$122.01 |
| Max. Negotiated Rate |
$229.08 |
| Rate for Payer: Aetna Commercial |
$224.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$214.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$131.97
|
| Rate for Payer: Cash Price |
$74.70
|
| Rate for Payer: Cigna Commercial |
$229.08
|
| Rate for Payer: Health EOS Commercial |
$221.61
|
| Rate for Payer: HFN Commercial |
$229.08
|
| Rate for Payer: Multiplan Commercial |
$199.20
|
| Rate for Payer: NAPHCARE Commercial |
$149.40
|
| Rate for Payer: Preferred Network Access Commercial |
$229.08
|
| Rate for Payer: Quartz Beloit One Network |
$122.01
|
| Rate for Payer: Quartz Commercial |
$149.40
|
| Rate for Payer: WEA Trust Commercial |
$136.95
|
| Rate for Payer: WPS Commercial |
$184.43
|
|
|
Yes - PT Group Therapy Charge
|
Professional
|
Both
|
$249.00
|
|
|
Service Code
|
CPT 97150 GP
|
| Hospital Charge Code |
2989695
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$61.60 |
| Max. Negotiated Rate |
$236.55 |
| Rate for Payer: Aetna Commercial |
$236.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$214.14
|
| Rate for Payer: Cash Price |
$74.70
|
| Rate for Payer: Cash Price |
$74.70
|
| Rate for Payer: Cash Price |
$74.70
|
| Rate for Payer: Cigna Commercial |
$236.55
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$124.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$149.40
|
| Rate for Payer: Health EOS Commercial |
$226.59
|
| Rate for Payer: HFN Commercial |
$236.55
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$61.60
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$61.60
|
| Rate for Payer: Multiplan Commercial |
$199.20
|
| Rate for Payer: Preferred Network Access Commercial |
$236.55
|
| Rate for Payer: Quartz Beloit One Network |
$109.56
|
| Rate for Payer: Quartz Commercial |
$141.93
|
| Rate for Payer: The Alliance Commercial |
$124.50
|
| Rate for Payer: WEA Trust Commercial |
$136.95
|
| Rate for Payer: WPS Commercial |
$184.43
|
|
|
Yes - PT Group Therapy Charge
|
Facility
|
OP
|
$249.00
|
|
|
Service Code
|
CPT 97150 GP
|
| Hospital Charge Code |
2989695
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$69.72 |
| Max. Negotiated Rate |
$996.00 |
| Rate for Payer: Aetna Commercial |
$224.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$214.14
|
| Rate for Payer: Aetna Managed Medicare |
$69.72
|
| 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 |
$131.97
|
| Rate for Payer: Cash Price |
$74.70
|
| Rate for Payer: Cash Price |
$74.70
|
| Rate for Payer: Cigna Commercial |
$229.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$139.34
|
| Rate for Payer: Health EOS Commercial |
$221.61
|
| Rate for Payer: HFN Commercial |
$229.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$202.00
|
| Rate for Payer: Multiplan Commercial |
$199.20
|
| Rate for Payer: NAPHCARE Commercial |
$149.40
|
| Rate for Payer: Preferred Network Access Commercial |
$229.08
|
| Rate for Payer: Quartz Beloit One Network |
$122.01
|
| Rate for Payer: Quartz Commercial |
$161.85
|
| Rate for Payer: Quartz Medicare Advantage |
$149.40
|
| Rate for Payer: The Alliance Commercial |
$996.00
|
| Rate for Payer: United Healthcare PPO |
$186.75
|
| Rate for Payer: WEA Trust Commercial |
$136.95
|
| Rate for Payer: WPS Commercial |
$184.43
|
|
|
Yes - PT Iontophoresis Charges
|
Professional
|
Both
|
$307.00
|
|
|
Service Code
|
CPT 97033 GP
|
| Hospital Charge Code |
2989866
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$69.51 |
| Max. Negotiated Rate |
$291.65 |
| Rate for Payer: Aetna Commercial |
$291.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$264.02
|
| Rate for Payer: Cash Price |
$92.10
|
| Rate for Payer: Cash Price |
$92.10
|
| Rate for Payer: Cash Price |
$92.10
|
| Rate for Payer: Cigna Commercial |
$291.65
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$153.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$184.20
|
| Rate for Payer: Health EOS Commercial |
$279.37
|
| Rate for Payer: HFN Commercial |
$291.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$69.51
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$69.51
|
| Rate for Payer: Multiplan Commercial |
$245.60
|
| Rate for Payer: Preferred Network Access Commercial |
$291.65
|
| Rate for Payer: Quartz Beloit One Network |
$135.08
|
| Rate for Payer: Quartz Commercial |
$174.99
|
| Rate for Payer: The Alliance Commercial |
$153.50
|
| Rate for Payer: WEA Trust Commercial |
$168.85
|
| Rate for Payer: WPS Commercial |
$227.39
|
|
|
Yes - PT Iontophoresis Charges
|
Facility
|
IP
|
$307.00
|
|
|
Service Code
|
CPT 97033 GP
|
| Hospital Charge Code |
2989866
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$150.43 |
| Max. Negotiated Rate |
$282.44 |
| Rate for Payer: Aetna Commercial |
$276.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$264.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$162.71
|
| Rate for Payer: Cash Price |
$92.10
|
| Rate for Payer: Cigna Commercial |
$282.44
|
| Rate for Payer: Health EOS Commercial |
$273.23
|
| Rate for Payer: HFN Commercial |
$282.44
|
| Rate for Payer: Multiplan Commercial |
$245.60
|
| Rate for Payer: NAPHCARE Commercial |
$184.20
|
| Rate for Payer: Preferred Network Access Commercial |
$282.44
|
| Rate for Payer: Quartz Beloit One Network |
$150.43
|
| Rate for Payer: Quartz Commercial |
$184.20
|
| Rate for Payer: WEA Trust Commercial |
$168.85
|
| Rate for Payer: WPS Commercial |
$227.39
|
|
|
Yes - PT Iontophoresis Charges
|
Facility
|
OP
|
$307.00
|
|
|
Service Code
|
CPT 97033 GP
|
| Hospital Charge Code |
2989866
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$85.96 |
| Max. Negotiated Rate |
$1,228.00 |
| Rate for Payer: Aetna Commercial |
$276.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$264.02
|
| Rate for Payer: Aetna Managed Medicare |
$85.96
|
| 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 |
$162.71
|
| Rate for Payer: Cash Price |
$92.10
|
| Rate for Payer: Cash Price |
$92.10
|
| Rate for Payer: Cigna Commercial |
$282.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$171.80
|
| Rate for Payer: Health EOS Commercial |
$273.23
|
| Rate for Payer: HFN Commercial |
$282.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$202.00
|
| Rate for Payer: Multiplan Commercial |
$245.60
|
| Rate for Payer: NAPHCARE Commercial |
$184.20
|
| Rate for Payer: Preferred Network Access Commercial |
$282.44
|
| Rate for Payer: Quartz Beloit One Network |
$150.43
|
| Rate for Payer: Quartz Commercial |
$199.55
|
| Rate for Payer: Quartz Medicare Advantage |
$184.20
|
| Rate for Payer: The Alliance Commercial |
$1,228.00
|
| Rate for Payer: United Healthcare PPO |
$230.25
|
| Rate for Payer: WEA Trust Commercial |
$168.85
|
| Rate for Payer: WPS Commercial |
$227.39
|
|
|
Yes - PT Paraffin Bath Charge
|
Facility
|
IP
|
$170.00
|
|
|
Service Code
|
CPT 97018 GP
|
| Hospital Charge Code |
2959232
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$83.30 |
| Max. Negotiated Rate |
$156.40 |
| Rate for Payer: Aetna Commercial |
$153.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$146.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$90.10
|
| Rate for Payer: Cash Price |
$51.00
|
| Rate for Payer: Cigna Commercial |
$156.40
|
| Rate for Payer: Health EOS Commercial |
$151.30
|
| Rate for Payer: HFN Commercial |
$156.40
|
| Rate for Payer: Multiplan Commercial |
$136.00
|
| Rate for Payer: NAPHCARE Commercial |
$102.00
|
| Rate for Payer: Preferred Network Access Commercial |
$156.40
|
| Rate for Payer: Quartz Beloit One Network |
$83.30
|
| Rate for Payer: Quartz Commercial |
$102.00
|
| Rate for Payer: WEA Trust Commercial |
$93.50
|
| Rate for Payer: WPS Commercial |
$125.92
|
|
|
Yes - PT Paraffin Bath Charge
|
Facility
|
OP
|
$170.00
|
|
|
Service Code
|
CPT 97018 GP
|
| Hospital Charge Code |
2959232
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$47.60 |
| Max. Negotiated Rate |
$680.00 |
| Rate for Payer: Aetna Commercial |
$153.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$146.20
|
| Rate for Payer: Aetna Managed Medicare |
$47.60
|
| 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 |
$90.10
|
| Rate for Payer: Cash Price |
$51.00
|
| Rate for Payer: Cash Price |
$51.00
|
| Rate for Payer: Cigna Commercial |
$156.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$95.13
|
| Rate for Payer: Health EOS Commercial |
$151.30
|
| Rate for Payer: HFN Commercial |
$156.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$202.00
|
| Rate for Payer: Multiplan Commercial |
$136.00
|
| Rate for Payer: NAPHCARE Commercial |
$102.00
|
| Rate for Payer: Preferred Network Access Commercial |
$156.40
|
| Rate for Payer: Quartz Beloit One Network |
$83.30
|
| Rate for Payer: Quartz Commercial |
$110.50
|
| Rate for Payer: Quartz Medicare Advantage |
$102.00
|
| Rate for Payer: The Alliance Commercial |
$680.00
|
| Rate for Payer: United Healthcare PPO |
$127.50
|
| Rate for Payer: WEA Trust Commercial |
$93.50
|
| Rate for Payer: WPS Commercial |
$125.92
|
|
|
Yes - PT Reevaluation Charge
|
Professional
|
Both
|
$287.00
|
|
|
Service Code
|
CPT 97164 GP
|
| Hospital Charge Code |
2989812
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$126.28 |
| Max. Negotiated Rate |
$272.65 |
| Rate for Payer: Aetna Commercial |
$272.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$246.82
|
| Rate for Payer: Cash Price |
$86.10
|
| Rate for Payer: Cash Price |
$86.10
|
| Rate for Payer: Cash Price |
$86.10
|
| Rate for Payer: Cigna Commercial |
$272.65
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$143.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$172.20
|
| Rate for Payer: Health EOS Commercial |
$261.17
|
| Rate for Payer: HFN Commercial |
$272.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$235.73
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$235.73
|
| Rate for Payer: Multiplan Commercial |
$229.60
|
| Rate for Payer: Preferred Network Access Commercial |
$272.65
|
| Rate for Payer: Quartz Beloit One Network |
$126.28
|
| Rate for Payer: Quartz Commercial |
$163.59
|
| Rate for Payer: The Alliance Commercial |
$143.50
|
| Rate for Payer: WEA Trust Commercial |
$157.85
|
| Rate for Payer: WPS Commercial |
$212.58
|
|
|
Yes - PT Reevaluation Charge
|
Facility
|
IP
|
$287.00
|
|
|
Service Code
|
CPT 97164 GP
|
| Hospital Charge Code |
2989812
|
|
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
|
|
|
Yes - PT Reevaluation Charge
|
Facility
|
OP
|
$287.00
|
|
|
Service Code
|
CPT 97164 GP
|
| Hospital Charge Code |
2989812
|
|
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
|
|
|
Yes - PT Telemed Est Patient 11-20 min Chg
|
Facility
|
OP
|
$147.00
|
|
|
Service Code
|
CPT 98971 GP,95
|
| Hospital Charge Code |
5583145
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$41.16 |
| Max. Negotiated Rate |
$588.00 |
| Rate for Payer: Aetna Commercial |
$132.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$126.42
|
| Rate for Payer: Aetna Managed Medicare |
$41.16
|
| 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 |
$77.91
|
| Rate for Payer: Cash Price |
$44.10
|
| Rate for Payer: Cash Price |
$44.10
|
| Rate for Payer: Cigna Commercial |
$135.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$82.26
|
| Rate for Payer: Health EOS Commercial |
$130.83
|
| Rate for Payer: HFN Commercial |
$135.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$202.00
|
| Rate for Payer: Multiplan Commercial |
$117.60
|
| Rate for Payer: NAPHCARE Commercial |
$88.20
|
| Rate for Payer: Preferred Network Access Commercial |
$135.24
|
| Rate for Payer: Quartz Beloit One Network |
$72.03
|
| Rate for Payer: Quartz Commercial |
$95.55
|
| Rate for Payer: Quartz Medicare Advantage |
$88.20
|
| Rate for Payer: The Alliance Commercial |
$588.00
|
| Rate for Payer: United Healthcare PPO |
$110.25
|
| Rate for Payer: WEA Trust Commercial |
$80.85
|
| Rate for Payer: WPS Commercial |
$108.88
|
|
|
Yes - PT Telemed Est Patient 11-20 min Chg
|
Facility
|
IP
|
$147.00
|
|
|
Service Code
|
CPT 98971 GP,95
|
| Hospital Charge Code |
5583145
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$72.03 |
| Max. Negotiated Rate |
$135.24 |
| Rate for Payer: Aetna Commercial |
$132.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$126.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$77.91
|
| Rate for Payer: Cash Price |
$44.10
|
| Rate for Payer: Cigna Commercial |
$135.24
|
| Rate for Payer: Health EOS Commercial |
$130.83
|
| Rate for Payer: HFN Commercial |
$135.24
|
| Rate for Payer: Multiplan Commercial |
$117.60
|
| Rate for Payer: NAPHCARE Commercial |
$88.20
|
| Rate for Payer: Preferred Network Access Commercial |
$135.24
|
| Rate for Payer: Quartz Beloit One Network |
$72.03
|
| Rate for Payer: Quartz Commercial |
$88.20
|
| Rate for Payer: WEA Trust Commercial |
$80.85
|
| Rate for Payer: WPS Commercial |
$108.88
|
|
|
Yes - PT Telemed Est Patient 21>min Chg
|
Facility
|
OP
|
$147.00
|
|
|
Service Code
|
CPT 98972 GP,95
|
| Hospital Charge Code |
5583146
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$41.16 |
| Max. Negotiated Rate |
$588.00 |
| Rate for Payer: Aetna Commercial |
$132.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$126.42
|
| Rate for Payer: Aetna Managed Medicare |
$41.16
|
| 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 |
$77.91
|
| Rate for Payer: Cash Price |
$44.10
|
| Rate for Payer: Cash Price |
$44.10
|
| Rate for Payer: Cigna Commercial |
$135.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$82.26
|
| Rate for Payer: Health EOS Commercial |
$130.83
|
| Rate for Payer: HFN Commercial |
$135.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$202.00
|
| Rate for Payer: Multiplan Commercial |
$117.60
|
| Rate for Payer: NAPHCARE Commercial |
$88.20
|
| Rate for Payer: Preferred Network Access Commercial |
$135.24
|
| Rate for Payer: Quartz Beloit One Network |
$72.03
|
| Rate for Payer: Quartz Commercial |
$95.55
|
| Rate for Payer: Quartz Medicare Advantage |
$88.20
|
| Rate for Payer: The Alliance Commercial |
$588.00
|
| Rate for Payer: United Healthcare PPO |
$110.25
|
| Rate for Payer: WEA Trust Commercial |
$80.85
|
| Rate for Payer: WPS Commercial |
$108.88
|
|
|
Yes - PT Telemed Est Patient 21>min Chg
|
Facility
|
IP
|
$147.00
|
|
|
Service Code
|
CPT 98972 GP,95
|
| Hospital Charge Code |
5583146
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$72.03 |
| Max. Negotiated Rate |
$135.24 |
| Rate for Payer: Aetna Commercial |
$132.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$126.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$77.91
|
| Rate for Payer: Cash Price |
$44.10
|
| Rate for Payer: Cigna Commercial |
$135.24
|
| Rate for Payer: Health EOS Commercial |
$130.83
|
| Rate for Payer: HFN Commercial |
$135.24
|
| Rate for Payer: Multiplan Commercial |
$117.60
|
| Rate for Payer: NAPHCARE Commercial |
$88.20
|
| Rate for Payer: Preferred Network Access Commercial |
$135.24
|
| Rate for Payer: Quartz Beloit One Network |
$72.03
|
| Rate for Payer: Quartz Commercial |
$88.20
|
| Rate for Payer: WEA Trust Commercial |
$80.85
|
| Rate for Payer: WPS Commercial |
$108.88
|
|
|
Yes - PT Telemed Est Patient 5-10 min Chg
|
Facility
|
OP
|
$61.00
|
|
|
Service Code
|
CPT 98970 GP,95
|
| Hospital Charge Code |
5583147
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$17.08 |
| Max. Negotiated Rate |
$349.00 |
| Rate for Payer: Aetna Commercial |
$54.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$52.46
|
| Rate for Payer: Aetna Managed Medicare |
$17.08
|
| 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 |
$32.33
|
| Rate for Payer: Cash Price |
$18.30
|
| Rate for Payer: Cash Price |
$18.30
|
| Rate for Payer: Cigna Commercial |
$56.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$34.14
|
| Rate for Payer: Health EOS Commercial |
$54.29
|
| Rate for Payer: HFN Commercial |
$56.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$202.00
|
| Rate for Payer: Multiplan Commercial |
$48.80
|
| Rate for Payer: NAPHCARE Commercial |
$36.60
|
| Rate for Payer: Preferred Network Access Commercial |
$56.12
|
| Rate for Payer: Quartz Beloit One Network |
$29.89
|
| Rate for Payer: Quartz Commercial |
$39.65
|
| Rate for Payer: Quartz Medicare Advantage |
$36.60
|
| Rate for Payer: The Alliance Commercial |
$244.00
|
| Rate for Payer: United Healthcare PPO |
$45.75
|
| Rate for Payer: WEA Trust Commercial |
$33.55
|
| Rate for Payer: WPS Commercial |
$45.18
|
|
