|
Diagnostic OAE
|
Facility
IP
|
$532.00
|
|
|
Service Code
|
CPT 92588
|
| Hospital Charge Code |
3203489
|
|
Hospital Revenue Code
|
470
|
| Min. Negotiated Rate |
$260.68 |
| Max. Negotiated Rate |
$489.44 |
| Rate for Payer: Aetna Commercial |
$478.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$281.96
|
| Rate for Payer: Cash Price |
$159.60
|
| Rate for Payer: Cigna Commercial |
$489.44
|
| Rate for Payer: Health EOS Commercial |
$473.48
|
| Rate for Payer: HFN Commercial |
$489.44
|
| Rate for Payer: Multiplan Commercial |
$425.60
|
| Rate for Payer: NAPHCARE Commercial |
$319.20
|
| Rate for Payer: Preferred Network Access Commercial |
$489.44
|
| Rate for Payer: Quartz Beloit One Network |
$260.68
|
| Rate for Payer: Quartz Commercial |
$319.20
|
| Rate for Payer: WEA Trust Commercial |
$292.60
|
| Rate for Payer: WPS Commercial |
$394.05
|
|
|
Diagnostic OAE
|
Facility
OP
|
$532.00
|
|
|
Service Code
|
CPT 92588
|
| Hospital Charge Code |
3203489
|
|
Hospital Revenue Code
|
470
|
| Min. Negotiated Rate |
$255.36 |
| Max. Negotiated Rate |
$1,154.09 |
| Rate for Payer: Aetna Commercial |
$478.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$457.52
|
| Rate for Payer: Aetna Managed Medicare |
$310.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$345.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$266.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$255.36
|
| Rate for Payer: Anthem Medicare Advantage |
$310.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$281.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$310.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$310.24
|
| Rate for Payer: Cash Price |
$159.60
|
| Rate for Payer: Cash Price |
$159.60
|
| Rate for Payer: Cigna Commercial |
$489.44
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$310.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$297.71
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$310.24
|
| Rate for Payer: Health EOS Commercial |
$473.48
|
| Rate for Payer: HFN Commercial |
$489.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,154.09
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$310.24
|
| Rate for Payer: Independent Care Health Plan Medicare |
$310.24
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$310.24
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$310.24
|
| Rate for Payer: Multiplan Commercial |
$425.60
|
| Rate for Payer: NAPHCARE Commercial |
$465.36
|
| Rate for Payer: Preferred Network Access Commercial |
$489.44
|
| Rate for Payer: Quartz Beloit One Network |
$260.68
|
| Rate for Payer: Quartz Commercial |
$345.80
|
| Rate for Payer: Quartz Medicare Advantage |
$310.24
|
| Rate for Payer: United Healthcare Medicare Advantage |
$310.24
|
| Rate for Payer: United Healthcare PPO |
$399.00
|
| Rate for Payer: WEA Trust Commercial |
$292.60
|
| Rate for Payer: Wellcare Medicare |
$310.24
|
| Rate for Payer: WPS Commercial |
$394.05
|
|
|
Diagnostic OAE
|
Professional
|
$532.00
|
|
|
Service Code
|
CPT 92588
|
| Hospital Charge Code |
3203489
|
|
Hospital Revenue Code
|
470
|
| Min. Negotiated Rate |
$77.96 |
| Max. Negotiated Rate |
$505.40 |
| Rate for Payer: Aetna Commercial |
$505.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$457.52
|
| Rate for Payer: Cash Price |
$159.60
|
| Rate for Payer: Cash Price |
$159.60
|
| Rate for Payer: Cigna Commercial |
$505.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$266.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$319.20
|
| Rate for Payer: Health EOS Commercial |
$484.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$117.20
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$117.20
|
| Rate for Payer: Multiplan Commercial |
$425.60
|
| Rate for Payer: Preferred Network Access Commercial |
$505.40
|
| Rate for Payer: Quartz Beloit One Network |
$234.08
|
| Rate for Payer: Quartz Commercial |
$303.24
|
| Rate for Payer: The Alliance Commercial |
$266.00
|
| Rate for Payer: United Healthcare Medicaid |
$77.96
|
| Rate for Payer: WEA Trust Commercial |
$292.60
|
| Rate for Payer: WPS Commercial |
$394.05
|
|
|
Diagnostic Sigmoidoscopy 45330
|
Professional
|
$461.00
|
|
|
Service Code
|
CPT 45330
|
| Hospital Charge Code |
3983432
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$52.28 |
| Max. Negotiated Rate |
$437.95 |
| Rate for Payer: Aetna Commercial |
$437.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$396.46
|
| Rate for Payer: Aetna Managed Medicare |
$52.28
|
| Rate for Payer: Anthem Medicare Advantage |
$52.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$52.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$52.28
|
| Rate for Payer: Cash Price |
$138.30
|
| Rate for Payer: Cash Price |
$138.30
|
| Rate for Payer: Cigna Commercial |
$437.95
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$230.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$52.28
|
| Rate for Payer: Health EOS Commercial |
$419.51
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$185.22
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$185.22
|
| Rate for Payer: Independent Care Health Plan Medicare |
$52.28
|
| Rate for Payer: Multiplan Commercial |
$368.80
|
| Rate for Payer: Preferred Network Access Commercial |
$437.95
|
| Rate for Payer: Quartz Beloit One Network |
$202.84
|
| Rate for Payer: Quartz Commercial |
$262.77
|
| Rate for Payer: Quartz Medicare Advantage |
$52.28
|
| Rate for Payer: The Alliance Commercial |
$222.19
|
| Rate for Payer: United Healthcare Medicaid |
$67.21
|
| Rate for Payer: United Healthcare Medicare Advantage |
$52.28
|
| Rate for Payer: WEA Trust Commercial |
$253.55
|
| Rate for Payer: WPS Commercial |
$235.26
|
|
|
Dialysis Circuit Angio
|
Facility
IP
|
$2,380.00
|
|
|
Service Code
|
CPT 36901
|
| Hospital Charge Code |
5218689
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,166.20 |
| Max. Negotiated Rate |
$2,189.60 |
| Rate for Payer: Aetna Commercial |
$2,142.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,261.40
|
| Rate for Payer: Cash Price |
$714.00
|
| Rate for Payer: Cigna Commercial |
$2,189.60
|
| Rate for Payer: Health EOS Commercial |
$2,118.20
|
| Rate for Payer: HFN Commercial |
$2,189.60
|
| Rate for Payer: Multiplan Commercial |
$1,904.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,428.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,189.60
|
| Rate for Payer: Quartz Beloit One Network |
$1,166.20
|
| Rate for Payer: Quartz Commercial |
$1,428.00
|
| Rate for Payer: WEA Trust Commercial |
$1,309.00
|
| Rate for Payer: WPS Commercial |
$1,762.87
|
|
|
Dialysis Circuit Angio
|
Facility
OP
|
$2,380.00
|
|
|
Service Code
|
CPT 36901
|
| Hospital Charge Code |
5218689
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,166.20 |
| Max. Negotiated Rate |
$12,148.04 |
| Rate for Payer: Aetna Commercial |
$2,142.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,046.80
|
| Rate for Payer: Aetna Managed Medicare |
$1,582.97
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,496.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,871.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,726.00
|
| Rate for Payer: Anthem Medicare Advantage |
$1,582.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,261.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$1,582.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$1,582.97
|
| Rate for Payer: Cash Price |
$714.00
|
| Rate for Payer: Cash Price |
$714.00
|
| Rate for Payer: Cash Price |
$714.00
|
| Rate for Payer: Cigna Commercial |
$2,189.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$1,582.97
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$1,582.97
|
| Rate for Payer: Health EOS Commercial |
$2,118.20
|
| Rate for Payer: HFN Commercial |
$2,189.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,888.65
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,582.97
|
| Rate for Payer: Independent Care Health Plan Medicare |
$1,582.97
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$1,582.97
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$1,582.97
|
| Rate for Payer: Multiplan Commercial |
$1,904.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,374.46
|
| Rate for Payer: Preferred Network Access Commercial |
$2,189.60
|
| Rate for Payer: Quartz Beloit One Network |
$1,166.20
|
| Rate for Payer: Quartz Commercial |
$1,547.00
|
| Rate for Payer: Quartz Medicare Advantage |
$1,582.97
|
| Rate for Payer: The Alliance Commercial |
$12,148.04
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,582.97
|
| Rate for Payer: United Healthcare PPO |
$3,583.00
|
| Rate for Payer: WEA Trust Commercial |
$1,309.00
|
| Rate for Payer: Wellcare Medicare |
$1,582.97
|
| Rate for Payer: WPS Commercial |
$1,762.87
|
|
|
Dialysis Circuit Central PTA
|
Facility
OP
|
$1,370.00
|
|
|
Service Code
|
CPT 36907
|
| Hospital Charge Code |
5218695
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$383.60 |
| Max. Negotiated Rate |
$20,943.68 |
| Rate for Payer: Aetna Commercial |
$1,233.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,178.20
|
| Rate for Payer: Aetna Managed Medicare |
$383.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$890.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$685.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$657.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$726.10
|
| Rate for Payer: Cash Price |
$411.00
|
| Rate for Payer: Cash Price |
$411.00
|
| Rate for Payer: Cigna Commercial |
$1,260.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$11,874.87
|
| Rate for Payer: Health EOS Commercial |
$1,219.30
|
| Rate for Payer: HFN Commercial |
$1,260.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,027.50
|
| Rate for Payer: Multiplan Commercial |
$1,096.00
|
| Rate for Payer: NAPHCARE Commercial |
$822.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,260.40
|
| Rate for Payer: Quartz Beloit One Network |
$671.30
|
| Rate for Payer: Quartz Commercial |
$890.50
|
| Rate for Payer: Quartz Medicare Advantage |
$822.00
|
| Rate for Payer: The Alliance Commercial |
$20,943.68
|
| Rate for Payer: WEA Trust Commercial |
$753.50
|
| Rate for Payer: WPS Commercial |
$1,014.76
|
|
|
Dialysis Circuit Central PTA
|
Facility
IP
|
$1,370.00
|
|
|
Service Code
|
CPT 36907
|
| Hospital Charge Code |
5218695
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$671.30 |
| Max. Negotiated Rate |
$1,260.40 |
| Rate for Payer: Aetna Commercial |
$1,233.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$726.10
|
| Rate for Payer: Cash Price |
$411.00
|
| Rate for Payer: Cigna Commercial |
$1,260.40
|
| Rate for Payer: Health EOS Commercial |
$1,219.30
|
| Rate for Payer: HFN Commercial |
$1,260.40
|
| Rate for Payer: Multiplan Commercial |
$1,096.00
|
| Rate for Payer: NAPHCARE Commercial |
$822.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,260.40
|
| Rate for Payer: Quartz Beloit One Network |
$671.30
|
| Rate for Payer: Quartz Commercial |
$822.00
|
| Rate for Payer: WEA Trust Commercial |
$753.50
|
| Rate for Payer: WPS Commercial |
$1,014.76
|
|
|
Dialysis Circuit Central Stent
|
Facility
OP
|
$6,182.00
|
|
|
Service Code
|
CPT 36908
|
| Hospital Charge Code |
5218696
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,730.96 |
| Max. Negotiated Rate |
$12,148.04 |
| Rate for Payer: Aetna Commercial |
$5,563.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,316.52
|
| Rate for Payer: Aetna Managed Medicare |
$1,730.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,018.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,091.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,967.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,276.46
|
| Rate for Payer: Cash Price |
$1,854.60
|
| Rate for Payer: Cash Price |
$1,854.60
|
| Rate for Payer: Cigna Commercial |
$5,687.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$11,874.87
|
| Rate for Payer: Health EOS Commercial |
$5,501.98
|
| Rate for Payer: HFN Commercial |
$5,687.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,636.50
|
| Rate for Payer: Multiplan Commercial |
$4,945.60
|
| Rate for Payer: NAPHCARE Commercial |
$3,709.20
|
| Rate for Payer: Preferred Network Access Commercial |
$5,687.44
|
| Rate for Payer: Quartz Beloit One Network |
$3,029.18
|
| Rate for Payer: Quartz Commercial |
$4,018.30
|
| Rate for Payer: Quartz Medicare Advantage |
$3,709.20
|
| Rate for Payer: The Alliance Commercial |
$12,148.04
|
| Rate for Payer: WEA Trust Commercial |
$3,400.10
|
| Rate for Payer: WPS Commercial |
$4,579.01
|
|
|
Dialysis Circuit Central Stent
|
Facility
IP
|
$6,182.00
|
|
|
Service Code
|
CPT 36908
|
| Hospital Charge Code |
5218696
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$3,029.18 |
| Max. Negotiated Rate |
$5,687.44 |
| Rate for Payer: Aetna Commercial |
$5,563.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,276.46
|
| Rate for Payer: Cash Price |
$1,854.60
|
| Rate for Payer: Cigna Commercial |
$5,687.44
|
| Rate for Payer: Health EOS Commercial |
$5,501.98
|
| Rate for Payer: HFN Commercial |
$5,687.44
|
| Rate for Payer: Multiplan Commercial |
$4,945.60
|
| Rate for Payer: NAPHCARE Commercial |
$3,709.20
|
| Rate for Payer: Preferred Network Access Commercial |
$5,687.44
|
| Rate for Payer: Quartz Beloit One Network |
$3,029.18
|
| Rate for Payer: Quartz Commercial |
$3,709.20
|
| Rate for Payer: WEA Trust Commercial |
$3,400.10
|
| Rate for Payer: WPS Commercial |
$4,579.01
|
|
|
Dialysis Circuit Embolization
|
Facility
IP
|
$4,600.00
|
|
|
Service Code
|
CPT 36909
|
| Hospital Charge Code |
5218697
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,254.00 |
| Max. Negotiated Rate |
$4,232.00 |
| Rate for Payer: Aetna Commercial |
$4,140.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,438.00
|
| Rate for Payer: Cash Price |
$1,380.00
|
| Rate for Payer: Cigna Commercial |
$4,232.00
|
| Rate for Payer: Health EOS Commercial |
$4,094.00
|
| Rate for Payer: HFN Commercial |
$4,232.00
|
| Rate for Payer: Multiplan Commercial |
$3,680.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,760.00
|
| Rate for Payer: Preferred Network Access Commercial |
$4,232.00
|
| Rate for Payer: Quartz Beloit One Network |
$2,254.00
|
| Rate for Payer: Quartz Commercial |
$2,760.00
|
| Rate for Payer: WEA Trust Commercial |
$2,530.00
|
| Rate for Payer: WPS Commercial |
$3,407.22
|
|
|
Dialysis Circuit Embolization
|
Facility
OP
|
$4,600.00
|
|
|
Service Code
|
CPT 36909
|
| Hospital Charge Code |
5218697
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,288.00 |
| Max. Negotiated Rate |
$12,148.04 |
| Rate for Payer: Aetna Commercial |
$4,140.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,956.00
|
| Rate for Payer: Aetna Managed Medicare |
$1,288.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,990.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,300.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,208.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,438.00
|
| Rate for Payer: Cash Price |
$1,380.00
|
| Rate for Payer: Cash Price |
$1,380.00
|
| Rate for Payer: Cigna Commercial |
$4,232.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$11,874.87
|
| Rate for Payer: Health EOS Commercial |
$4,094.00
|
| Rate for Payer: HFN Commercial |
$4,232.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,450.00
|
| Rate for Payer: Multiplan Commercial |
$3,680.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,760.00
|
| Rate for Payer: Preferred Network Access Commercial |
$4,232.00
|
| Rate for Payer: Quartz Beloit One Network |
$2,254.00
|
| Rate for Payer: Quartz Commercial |
$2,990.00
|
| Rate for Payer: Quartz Medicare Advantage |
$2,760.00
|
| Rate for Payer: The Alliance Commercial |
$12,148.04
|
| Rate for Payer: WEA Trust Commercial |
$2,530.00
|
| Rate for Payer: WPS Commercial |
$3,407.22
|
|
|
Dialysis Circuit Mech Thrombectomy
|
Facility
IP
|
$4,568.00
|
|
|
Service Code
|
CPT 36904
|
| Hospital Charge Code |
5218692
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,238.32 |
| Max. Negotiated Rate |
$4,202.56 |
| Rate for Payer: Aetna Commercial |
$4,111.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,421.04
|
| Rate for Payer: Cash Price |
$1,370.40
|
| Rate for Payer: Cigna Commercial |
$4,202.56
|
| Rate for Payer: Health EOS Commercial |
$4,065.52
|
| Rate for Payer: HFN Commercial |
$4,202.56
|
| Rate for Payer: Multiplan Commercial |
$3,654.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,740.80
|
| Rate for Payer: Preferred Network Access Commercial |
$4,202.56
|
| Rate for Payer: Quartz Beloit One Network |
$2,238.32
|
| Rate for Payer: Quartz Commercial |
$2,740.80
|
| Rate for Payer: WEA Trust Commercial |
$2,512.40
|
| Rate for Payer: WPS Commercial |
$3,383.52
|
|
|
Dialysis Circuit Mech Thrombectomy
|
Facility
OP
|
$4,568.00
|
|
|
Service Code
|
CPT 36904
|
| Hospital Charge Code |
5218692
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,238.32 |
| Max. Negotiated Rate |
$21,015.81 |
| Rate for Payer: Aetna Commercial |
$4,111.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,928.48
|
| Rate for Payer: Aetna Managed Medicare |
$5,649.41
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$16,318.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$13,785.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$13,096.00
|
| Rate for Payer: Anthem Medicare Advantage |
$5,649.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,421.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5,649.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5,649.41
|
| Rate for Payer: Cash Price |
$1,370.40
|
| Rate for Payer: Cash Price |
$1,370.40
|
| Rate for Payer: Cash Price |
$1,370.40
|
| Rate for Payer: Cigna Commercial |
$4,202.56
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$5,649.41
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$5,649.41
|
| Rate for Payer: Health EOS Commercial |
$4,065.52
|
| Rate for Payer: HFN Commercial |
$4,202.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$21,015.81
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$5,649.41
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5,649.41
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$5,649.41
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$5,649.41
|
| Rate for Payer: Multiplan Commercial |
$3,654.40
|
| Rate for Payer: NAPHCARE Commercial |
$8,474.12
|
| Rate for Payer: Preferred Network Access Commercial |
$4,202.56
|
| Rate for Payer: Quartz Beloit One Network |
$2,238.32
|
| Rate for Payer: Quartz Commercial |
$2,969.20
|
| Rate for Payer: Quartz Medicare Advantage |
$5,649.41
|
| Rate for Payer: The Alliance Commercial |
$20,943.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5,649.41
|
| Rate for Payer: United Healthcare PPO |
$6,154.00
|
| Rate for Payer: WEA Trust Commercial |
$2,512.40
|
| Rate for Payer: Wellcare Medicare |
$5,649.41
|
| Rate for Payer: WPS Commercial |
$3,383.52
|
|
|
Dialysis Circuit Peripheral PTA
|
Facility
IP
|
$5,559.00
|
|
|
Service Code
|
CPT 36902
|
| Hospital Charge Code |
5218690
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,723.91 |
| Max. Negotiated Rate |
$5,114.28 |
| Rate for Payer: Aetna Commercial |
$5,003.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,946.27
|
| Rate for Payer: Cash Price |
$1,667.70
|
| Rate for Payer: Cigna Commercial |
$5,114.28
|
| Rate for Payer: Health EOS Commercial |
$4,947.51
|
| Rate for Payer: HFN Commercial |
$5,114.28
|
| Rate for Payer: Multiplan Commercial |
$4,447.20
|
| Rate for Payer: NAPHCARE Commercial |
$3,335.40
|
| Rate for Payer: Preferred Network Access Commercial |
$5,114.28
|
| Rate for Payer: Quartz Beloit One Network |
$2,723.91
|
| Rate for Payer: Quartz Commercial |
$3,335.40
|
| Rate for Payer: WEA Trust Commercial |
$3,057.45
|
| Rate for Payer: WPS Commercial |
$4,117.55
|
|
|
Dialysis Circuit Peripheral PTA
|
Facility
OP
|
$5,559.00
|
|
|
Service Code
|
CPT 36902
|
| Hospital Charge Code |
5218690
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,723.91 |
| Max. Negotiated Rate |
$21,015.81 |
| Rate for Payer: Aetna Commercial |
$5,003.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,780.74
|
| Rate for Payer: Aetna Managed Medicare |
$5,649.41
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$16,318.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$13,785.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$13,096.00
|
| Rate for Payer: Anthem Medicare Advantage |
$5,649.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,946.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5,649.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5,649.41
|
| Rate for Payer: Cash Price |
$1,667.70
|
| Rate for Payer: Cash Price |
$1,667.70
|
| Rate for Payer: Cash Price |
$1,667.70
|
| Rate for Payer: Cigna Commercial |
$5,114.28
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$5,649.41
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$5,649.41
|
| Rate for Payer: Health EOS Commercial |
$4,947.51
|
| Rate for Payer: HFN Commercial |
$5,114.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$21,015.81
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$5,649.41
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5,649.41
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$5,649.41
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$5,649.41
|
| Rate for Payer: Multiplan Commercial |
$4,447.20
|
| Rate for Payer: NAPHCARE Commercial |
$8,474.12
|
| Rate for Payer: Preferred Network Access Commercial |
$5,114.28
|
| Rate for Payer: Quartz Beloit One Network |
$2,723.91
|
| Rate for Payer: Quartz Commercial |
$3,613.35
|
| Rate for Payer: Quartz Medicare Advantage |
$5,649.41
|
| Rate for Payer: The Alliance Commercial |
$5,162.92
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5,649.41
|
| Rate for Payer: United Healthcare PPO |
$6,154.00
|
| Rate for Payer: WEA Trust Commercial |
$3,057.45
|
| Rate for Payer: Wellcare Medicare |
$5,649.41
|
| Rate for Payer: WPS Commercial |
$4,117.55
|
|
|
Dialysis Circuit Peripheral Stent
|
Facility
IP
|
$12,657.00
|
|
|
Service Code
|
CPT 36903
|
| Hospital Charge Code |
5218691
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$6,201.93 |
| Max. Negotiated Rate |
$11,644.44 |
| Rate for Payer: Aetna Commercial |
$11,391.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,708.21
|
| Rate for Payer: Cash Price |
$3,797.10
|
| Rate for Payer: Cigna Commercial |
$11,644.44
|
| Rate for Payer: Health EOS Commercial |
$11,264.73
|
| Rate for Payer: HFN Commercial |
$11,644.44
|
| Rate for Payer: Multiplan Commercial |
$10,125.60
|
| Rate for Payer: NAPHCARE Commercial |
$7,594.20
|
| Rate for Payer: Preferred Network Access Commercial |
$11,644.44
|
| Rate for Payer: Quartz Beloit One Network |
$6,201.93
|
| Rate for Payer: Quartz Commercial |
$7,594.20
|
| Rate for Payer: WEA Trust Commercial |
$6,961.35
|
| Rate for Payer: WPS Commercial |
$9,375.04
|
|
|
Dialysis Circuit Peripheral Stent
|
Facility
OP
|
$12,657.00
|
|
|
Service Code
|
CPT 36903
|
| Hospital Charge Code |
5218691
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$4,218.22 |
| Max. Negotiated Rate |
$40,449.87 |
| Rate for Payer: Aetna Commercial |
$11,391.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,885.02
|
| Rate for Payer: Aetna Managed Medicare |
$10,873.62
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$18,649.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$18,649.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$17,230.00
|
| Rate for Payer: Anthem Medicare Advantage |
$10,873.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,708.21
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$10,873.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$10,873.62
|
| Rate for Payer: Cash Price |
$3,797.10
|
| Rate for Payer: Cash Price |
$3,797.10
|
| Rate for Payer: Cash Price |
$3,797.10
|
| Rate for Payer: Cigna Commercial |
$11,644.44
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$10,873.62
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$10,873.62
|
| Rate for Payer: Health EOS Commercial |
$11,264.73
|
| Rate for Payer: HFN Commercial |
$11,644.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$40,449.87
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$10,873.62
|
| Rate for Payer: Independent Care Health Plan Medicare |
$10,873.62
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$10,873.62
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$10,873.62
|
| Rate for Payer: Multiplan Commercial |
$10,125.60
|
| Rate for Payer: NAPHCARE Commercial |
$16,310.43
|
| Rate for Payer: Preferred Network Access Commercial |
$11,644.44
|
| Rate for Payer: Quartz Beloit One Network |
$6,201.93
|
| Rate for Payer: Quartz Commercial |
$8,227.05
|
| Rate for Payer: Quartz Medicare Advantage |
$10,873.62
|
| Rate for Payer: The Alliance Commercial |
$5,162.92
|
| Rate for Payer: United Healthcare Medicare Advantage |
$10,873.62
|
| Rate for Payer: United Healthcare PPO |
$9,596.00
|
| Rate for Payer: WEA Trust Commercial |
$6,961.35
|
| Rate for Payer: Wellcare Medicare |
$10,873.62
|
| Rate for Payer: WPS Commercial |
$9,375.04
|
|
|
Dialysis Circuit Thromb W/PTA
|
Facility
IP
|
$5,978.00
|
|
|
Service Code
|
CPT 36905
|
| Hospital Charge Code |
5218693
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,929.22 |
| Max. Negotiated Rate |
$5,499.76 |
| Rate for Payer: Aetna Commercial |
$5,380.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,168.34
|
| Rate for Payer: Cash Price |
$1,793.40
|
| Rate for Payer: Cigna Commercial |
$5,499.76
|
| Rate for Payer: Health EOS Commercial |
$5,320.42
|
| Rate for Payer: HFN Commercial |
$5,499.76
|
| Rate for Payer: Multiplan Commercial |
$4,782.40
|
| Rate for Payer: NAPHCARE Commercial |
$3,586.80
|
| Rate for Payer: Preferred Network Access Commercial |
$5,499.76
|
| Rate for Payer: Quartz Beloit One Network |
$2,929.22
|
| Rate for Payer: Quartz Commercial |
$3,586.80
|
| Rate for Payer: WEA Trust Commercial |
$3,287.90
|
| Rate for Payer: WPS Commercial |
$4,427.90
|
|
|
Dialysis Circuit Thromb W/PTA
|
Facility
OP
|
$5,978.00
|
|
|
Service Code
|
CPT 36905
|
| Hospital Charge Code |
5218693
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,929.22 |
| Max. Negotiated Rate |
$40,449.87 |
| Rate for Payer: Aetna Commercial |
$5,380.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,141.08
|
| Rate for Payer: Aetna Managed Medicare |
$10,873.62
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$18,649.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$18,649.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$17,230.00
|
| Rate for Payer: Anthem Medicare Advantage |
$10,873.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,168.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$10,873.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$10,873.62
|
| Rate for Payer: Cash Price |
$1,793.40
|
| Rate for Payer: Cash Price |
$1,793.40
|
| Rate for Payer: Cash Price |
$1,793.40
|
| Rate for Payer: Cigna Commercial |
$5,499.76
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$10,873.62
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$11,874.87
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$10,873.62
|
| Rate for Payer: Health EOS Commercial |
$5,320.42
|
| Rate for Payer: HFN Commercial |
$5,499.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$40,449.87
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$10,873.62
|
| Rate for Payer: Independent Care Health Plan Medicare |
$10,873.62
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$10,873.62
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$10,873.62
|
| Rate for Payer: Multiplan Commercial |
$4,782.40
|
| Rate for Payer: NAPHCARE Commercial |
$16,310.43
|
| Rate for Payer: Preferred Network Access Commercial |
$5,499.76
|
| Rate for Payer: Quartz Beloit One Network |
$2,929.22
|
| Rate for Payer: Quartz Commercial |
$3,885.70
|
| Rate for Payer: Quartz Medicare Advantage |
$10,873.62
|
| Rate for Payer: The Alliance Commercial |
$5,162.92
|
| Rate for Payer: United Healthcare Medicare Advantage |
$10,873.62
|
| Rate for Payer: United Healthcare PPO |
$9,596.00
|
| Rate for Payer: WEA Trust Commercial |
$3,287.90
|
| Rate for Payer: Wellcare Medicare |
$10,873.62
|
| Rate for Payer: WPS Commercial |
$4,427.90
|
|
|
Dialysis Circuit Thromb W/Stent
|
Facility
IP
|
$16,248.00
|
|
|
Service Code
|
CPT 36906
|
| Hospital Charge Code |
5218694
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$7,961.52 |
| Max. Negotiated Rate |
$14,948.16 |
| Rate for Payer: Aetna Commercial |
$14,623.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$8,611.44
|
| Rate for Payer: Cash Price |
$4,874.40
|
| Rate for Payer: Cigna Commercial |
$14,948.16
|
| Rate for Payer: Health EOS Commercial |
$14,460.72
|
| Rate for Payer: HFN Commercial |
$14,948.16
|
| Rate for Payer: Multiplan Commercial |
$12,998.40
|
| Rate for Payer: NAPHCARE Commercial |
$9,748.80
|
| Rate for Payer: Preferred Network Access Commercial |
$14,948.16
|
| Rate for Payer: Quartz Beloit One Network |
$7,961.52
|
| Rate for Payer: Quartz Commercial |
$9,748.80
|
| Rate for Payer: WEA Trust Commercial |
$8,936.40
|
| Rate for Payer: WPS Commercial |
$12,034.89
|
|
|
Dialysis Circuit Thromb W/Stent
|
Facility
OP
|
$16,248.00
|
|
|
Service Code
|
CPT 36906
|
| Hospital Charge Code |
5218694
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$4,218.22 |
| Max. Negotiated Rate |
$64,474.41 |
| Rate for Payer: Aetna Commercial |
$14,623.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$13,973.28
|
| Rate for Payer: Aetna Managed Medicare |
$17,331.83
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$19,815.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$18,378.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$17,460.00
|
| Rate for Payer: Anthem Medicare Advantage |
$17,331.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$8,611.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$17,331.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$17,331.83
|
| Rate for Payer: Cash Price |
$4,874.40
|
| Rate for Payer: Cash Price |
$4,874.40
|
| Rate for Payer: Cash Price |
$4,874.40
|
| Rate for Payer: Cigna Commercial |
$14,948.16
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$17,331.83
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$17,331.83
|
| Rate for Payer: Health EOS Commercial |
$14,460.72
|
| Rate for Payer: HFN Commercial |
$14,948.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$64,474.41
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$17,331.83
|
| Rate for Payer: Independent Care Health Plan Medicare |
$17,331.83
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$17,331.83
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$17,331.83
|
| Rate for Payer: Multiplan Commercial |
$12,998.40
|
| Rate for Payer: NAPHCARE Commercial |
$25,997.74
|
| Rate for Payer: Preferred Network Access Commercial |
$14,948.16
|
| Rate for Payer: Quartz Beloit One Network |
$7,961.52
|
| Rate for Payer: Quartz Commercial |
$10,561.20
|
| Rate for Payer: Quartz Medicare Advantage |
$17,331.83
|
| Rate for Payer: The Alliance Commercial |
$5,162.92
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17,331.83
|
| Rate for Payer: United Healthcare PPO |
$11,078.00
|
| Rate for Payer: WEA Trust Commercial |
$8,936.40
|
| Rate for Payer: Wellcare Medicare |
$17,331.83
|
| Rate for Payer: WPS Commercial |
$12,034.89
|
|
|
Dialysis Water Culture
|
Facility
OP
|
$167.00
|
|
|
Service Code
|
CPT 87084
|
| Hospital Charge Code |
979920
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.59 |
| 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 |
$27.07
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$101.51
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$47.37
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$44.94
|
| Rate for Payer: Anthem Medicaid |
$10.59
|
| Rate for Payer: Anthem Medicare Advantage |
$27.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$88.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$27.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$27.07
|
| Rate for Payer: Cash Price |
$50.10
|
| Rate for Payer: Cash Price |
$50.10
|
| Rate for Payer: Cigna Commercial |
$153.64
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$27.07
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$10.59
|
| Rate for Payer: Dean Health Medicaid |
$10.59
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$27.07
|
| Rate for Payer: Health EOS Commercial |
$148.63
|
| Rate for Payer: HFN Commercial |
$153.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$100.70
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$27.07
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$10.59
|
| Rate for Payer: Independent Care Health Plan Medicare |
$27.07
|
| Rate for Payer: Managed Health Services Medicaid |
$11.01
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$27.07
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$27.07
|
| Rate for Payer: Multiplan Commercial |
$133.60
|
| Rate for Payer: NAPHCARE Commercial |
$40.60
|
| Rate for Payer: Preferred Network Access Commercial |
$153.64
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$10.59
|
| Rate for Payer: Quartz Beloit One Network |
$81.83
|
| Rate for Payer: Quartz Commercial |
$108.55
|
| Rate for Payer: Quartz Medicare Advantage |
$27.07
|
| Rate for Payer: The Alliance Commercial |
$668.00
|
| Rate for Payer: United Healthcare Medicaid |
$10.59
|
| Rate for Payer: United Healthcare Medicare Advantage |
$27.07
|
| Rate for Payer: United Healthcare PPO |
$125.25
|
| Rate for Payer: WEA Trust Commercial |
$91.85
|
| Rate for Payer: Wellcare Medicare |
$27.07
|
| Rate for Payer: WMAP Medicaid |
$10.59
|
| Rate for Payer: WPS Commercial |
$123.70
|
|
|
Dialysis Water Culture
|
Professional
|
$167.00
|
|
|
Service Code
|
CPT 87084
|
| Hospital Charge Code |
979920
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$27.07 |
| Max. Negotiated Rate |
$158.65 |
| Rate for Payer: Aetna Commercial |
$158.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$143.62
|
| Rate for Payer: Aetna Managed Medicare |
$27.07
|
| Rate for Payer: Anthem Medicare Advantage |
$27.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$27.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$27.07
|
| Rate for Payer: Cash Price |
$50.10
|
| Rate for Payer: Cash Price |
$50.10
|
| Rate for Payer: Cigna Commercial |
$158.65
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$83.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$27.07
|
| Rate for Payer: Health EOS Commercial |
$151.97
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$95.56
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$95.56
|
| Rate for Payer: Independent Care Health Plan Medicare |
$27.07
|
| Rate for Payer: Multiplan Commercial |
$133.60
|
| Rate for Payer: Preferred Network Access Commercial |
$158.65
|
| Rate for Payer: Quartz Beloit One Network |
$73.48
|
| Rate for Payer: Quartz Commercial |
$95.19
|
| Rate for Payer: Quartz Medicare Advantage |
$27.07
|
| Rate for Payer: The Alliance Commercial |
$106.93
|
| Rate for Payer: United Healthcare Medicare Advantage |
$27.07
|
| Rate for Payer: WEA Trust Commercial |
$91.85
|
| Rate for Payer: WPS Commercial |
$119.11
|
|
|
Dialysis Water Culture
|
Facility
IP
|
$167.00
|
|
|
Service Code
|
CPT 87084
|
| Hospital Charge Code |
979920
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$81.83 |
| Max. Negotiated Rate |
$153.64 |
| Rate for Payer: Aetna Commercial |
$150.30
|
| 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
|
|
