|
Diab shoe for density insert A5500
|
Facility
|
OP
|
$98.00
|
|
|
Service Code
|
HCPCS A5500
|
| Hospital Charge Code |
3133657
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$28.54 |
| Max. Negotiated Rate |
$377.02 |
| Rate for Payer: Aetna Commercial |
$91.73
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$87.65
|
| Rate for Payer: Aetna Managed Medicare |
$28.54
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$58.72
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$58.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$58.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$54.02
|
| Rate for Payer: Cash Price |
$29.40
|
| Rate for Payer: Cash Price |
$29.40
|
| Rate for Payer: Cigna Commercial |
$93.77
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$57.04
|
| Rate for Payer: Health EOS Commercial |
$90.71
|
| Rate for Payer: HFN Commercial |
$93.77
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$76.44
|
| Rate for Payer: Multiplan Commercial |
$81.54
|
| Rate for Payer: NAPHCARE Commercial |
$61.15
|
| Rate for Payer: Preferred Network Access Commercial |
$93.77
|
| Rate for Payer: Quartz Beloit One Network |
$49.94
|
| Rate for Payer: Quartz Commercial |
$66.25
|
| Rate for Payer: Quartz Medicare Advantage |
$61.15
|
| Rate for Payer: The Alliance Commercial |
$377.02
|
| Rate for Payer: WEA Trust Commercial |
$56.06
|
| Rate for Payer: WPS Commercial |
$75.49
|
|
|
Diagnostic - Bronchoscopy Charge
|
Facility
|
OP
|
$4,168.00
|
|
|
Service Code
|
CPT 31622
|
| Hospital Charge Code |
2990189
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,873.14 |
| Max. Negotiated Rate |
$6,968.10 |
| Rate for Payer: Aetna Commercial |
$3,901.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,727.86
|
| Rate for Payer: Aetna Managed Medicare |
$1,873.14
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,635.84
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,985.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,835.04
|
| Rate for Payer: Anthem Medicare Advantage |
$1,873.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,297.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$1,873.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$1,873.14
|
| Rate for Payer: Cash Price |
$1,250.40
|
| Rate for Payer: Cash Price |
$1,250.40
|
| Rate for Payer: Cash Price |
$1,250.40
|
| Rate for Payer: Cigna Commercial |
$3,987.94
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$1,873.14
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$1,873.14
|
| Rate for Payer: Health EOS Commercial |
$3,857.90
|
| Rate for Payer: HFN Commercial |
$3,987.94
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,968.10
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,873.14
|
| Rate for Payer: Independent Care Health Plan Medicare |
$1,873.14
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$1,873.14
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$1,873.14
|
| Rate for Payer: Multiplan Commercial |
$3,467.78
|
| Rate for Payer: NAPHCARE Commercial |
$2,809.72
|
| Rate for Payer: Preferred Network Access Commercial |
$3,987.94
|
| Rate for Payer: Quartz Beloit One Network |
$2,124.01
|
| Rate for Payer: Quartz Commercial |
$2,817.57
|
| Rate for Payer: Quartz Medicare Advantage |
$1,873.14
|
| Rate for Payer: The Alliance Commercial |
$3,184.34
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,873.14
|
| Rate for Payer: United Healthcare PPO |
$3,726.32
|
| Rate for Payer: WEA Trust Commercial |
$2,384.10
|
| Rate for Payer: Wellcare Medicare |
$1,873.14
|
| Rate for Payer: WPS Commercial |
$3,210.61
|
|
|
Diagnostic - Bronchoscopy Charge
|
Facility
|
IP
|
$4,168.00
|
|
|
Service Code
|
CPT 31622
|
| Hospital Charge Code |
2990189
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,124.01 |
| Max. Negotiated Rate |
$3,987.94 |
| Rate for Payer: Aetna Commercial |
$3,901.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,727.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,297.40
|
| Rate for Payer: Cash Price |
$1,250.40
|
| Rate for Payer: Cigna Commercial |
$3,987.94
|
| Rate for Payer: Health EOS Commercial |
$3,857.90
|
| Rate for Payer: HFN Commercial |
$3,987.94
|
| Rate for Payer: Multiplan Commercial |
$3,467.78
|
| Rate for Payer: Preferred Network Access Commercial |
$3,987.94
|
| Rate for Payer: Quartz Beloit One Network |
$2,124.01
|
| Rate for Payer: Quartz Commercial |
$2,600.83
|
| Rate for Payer: WEA Trust Commercial |
$2,384.10
|
| Rate for Payer: WPS Commercial |
$3,210.61
|
|
|
DIAGNOSTIC CARDIAC CATHETERIZATION
|
Facility
|
OP
|
$1,286.71
|
|
|
Service Code
|
EAPG 00084
|
| Min. Negotiated Rate |
$1,237.22 |
| Max. Negotiated Rate |
$1,286.71 |
| Rate for Payer: Anthem Medicaid |
$1,237.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$1,237.22
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,237.22
|
| Rate for Payer: Dean Health Medicaid |
$1,237.22
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$1,237.22
|
| Rate for Payer: Managed Health Services Medicaid |
$1,286.71
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,237.22
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$1,237.22
|
| Rate for Payer: United Healthcare Medicaid |
$1,237.22
|
|
|
DIAGNOSTIC COLONOSCOPY 45378
|
Professional
|
Both
|
$2,188.00
|
|
|
Service Code
|
CPT 45378
|
| Hospital Charge Code |
3014805
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$159.44 |
| Max. Negotiated Rate |
$2,161.74 |
| Rate for Payer: Aetna Commercial |
$2,161.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,956.95
|
| Rate for Payer: Aetna Managed Medicare |
$159.44
|
| Rate for Payer: Anthem Medicare Advantage |
$159.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$159.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$159.44
|
| Rate for Payer: Cash Price |
$656.40
|
| Rate for Payer: Cash Price |
$656.40
|
| Rate for Payer: Cash Price |
$656.40
|
| Rate for Payer: Cigna Commercial |
$2,161.74
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$358.58
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$159.44
|
| Rate for Payer: Health EOS Commercial |
$2,070.72
|
| Rate for Payer: HFN Commercial |
$2,161.74
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$641.91
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$641.91
|
| Rate for Payer: Independent Care Health Plan Medicare |
$159.44
|
| Rate for Payer: Multiplan Commercial |
$1,820.42
|
| Rate for Payer: NAPHCARE Commercial |
$239.16
|
| Rate for Payer: Preferred Network Access Commercial |
$2,161.74
|
| Rate for Payer: Quartz Beloit One Network |
$1,001.23
|
| Rate for Payer: Quartz Commercial |
$1,297.05
|
| Rate for Payer: Quartz Medicare Advantage |
$159.44
|
| Rate for Payer: The Alliance Commercial |
$677.63
|
| Rate for Payer: United Healthcare Medicaid |
$358.58
|
| Rate for Payer: United Healthcare Medicare Advantage |
$159.44
|
| Rate for Payer: WEA Trust Commercial |
$1,251.54
|
| Rate for Payer: WPS Commercial |
$717.49
|
|
|
DIAGNOSTIC COLONOSCOPY, EXTENDED 4537822
|
Professional
|
Both
|
$2,626.00
|
|
|
Service Code
|
CPT 45378 22
|
| Hospital Charge Code |
6178511
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$358.58 |
| Max. Negotiated Rate |
$2,594.49 |
| Rate for Payer: Aetna Commercial |
$2,594.49
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,348.69
|
| Rate for Payer: Cash Price |
$787.80
|
| Rate for Payer: Cash Price |
$787.80
|
| Rate for Payer: Cash Price |
$787.80
|
| Rate for Payer: Cigna Commercial |
$2,594.49
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$358.58
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,638.62
|
| Rate for Payer: Health EOS Commercial |
$2,485.25
|
| Rate for Payer: HFN Commercial |
$2,594.49
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$641.91
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$641.91
|
| Rate for Payer: Multiplan Commercial |
$2,184.83
|
| Rate for Payer: Preferred Network Access Commercial |
$2,594.49
|
| Rate for Payer: Quartz Beloit One Network |
$1,201.66
|
| Rate for Payer: Quartz Commercial |
$1,556.69
|
| Rate for Payer: The Alliance Commercial |
$1,365.52
|
| Rate for Payer: United Healthcare Medicaid |
$358.58
|
| Rate for Payer: WEA Trust Commercial |
$1,502.07
|
| Rate for Payer: WPS Commercial |
$2,022.81
|
|
|
DIAGNOSTIC DENTAL PROCEDURES
|
Facility
|
OP
|
$30.14
|
|
|
Service Code
|
EAPG 00376
|
| Min. Negotiated Rate |
$28.98 |
| Max. Negotiated Rate |
$30.14 |
| Rate for Payer: Anthem Medicaid |
$28.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$28.98
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$28.98
|
| Rate for Payer: Dean Health Medicaid |
$28.98
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$28.98
|
| Rate for Payer: Managed Health Services Medicaid |
$30.14
|
| Rate for Payer: Molina Healthcare Medicaid |
$28.98
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$28.98
|
| Rate for Payer: United Healthcare Medicaid |
$28.98
|
|
|
Diagnostic Evaluation (No Medical) 90791
|
Professional
|
Both
|
$560.00
|
|
|
Service Code
|
CPT 90791
|
| Hospital Charge Code |
2990616
|
|
Hospital Revenue Code
|
513
|
| Min. Negotiated Rate |
$141.92 |
| Max. Negotiated Rate |
$567.67 |
| Rate for Payer: Aetna Commercial |
$553.28
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$500.86
|
| Rate for Payer: Aetna Managed Medicare |
$141.92
|
| Rate for Payer: Anthem Medicare Advantage |
$141.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$141.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$141.92
|
| Rate for Payer: Cash Price |
$168.00
|
| Rate for Payer: Cash Price |
$168.00
|
| Rate for Payer: Cigna Commercial |
$553.28
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$291.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$141.92
|
| Rate for Payer: Health EOS Commercial |
$529.98
|
| Rate for Payer: HFN Commercial |
$553.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$557.54
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$557.54
|
| Rate for Payer: Independent Care Health Plan Medicare |
$141.92
|
| Rate for Payer: Multiplan Commercial |
$465.92
|
| Rate for Payer: NAPHCARE Commercial |
$212.88
|
| Rate for Payer: Preferred Network Access Commercial |
$553.28
|
| Rate for Payer: Quartz Beloit One Network |
$256.26
|
| Rate for Payer: Quartz Commercial |
$331.97
|
| Rate for Payer: Quartz Medicare Advantage |
$141.92
|
| Rate for Payer: The Alliance Commercial |
$354.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$141.92
|
| Rate for Payer: WEA Trust Commercial |
$320.32
|
| Rate for Payer: WPS Commercial |
$567.67
|
|
|
Diagnostic OAE
|
Professional
|
Both
|
$532.00
|
|
|
Service Code
|
CPT 92588
|
| Hospital Charge Code |
3203489
|
|
Hospital Revenue Code
|
470
|
| Min. Negotiated Rate |
$33.97 |
| Max. Negotiated Rate |
$525.62 |
| Rate for Payer: Aetna Commercial |
$525.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$475.82
|
| Rate for Payer: Aetna Managed Medicare |
$33.97
|
| Rate for Payer: Anthem Medicare Advantage |
$33.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$33.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$33.97
|
| Rate for Payer: Cash Price |
$159.60
|
| Rate for Payer: Cash Price |
$159.60
|
| Rate for Payer: Cigna Commercial |
$525.62
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$81.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$33.97
|
| Rate for Payer: Health EOS Commercial |
$503.48
|
| Rate for Payer: HFN Commercial |
$525.62
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$121.89
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$121.89
|
| Rate for Payer: Independent Care Health Plan Medicare |
$33.97
|
| Rate for Payer: Multiplan Commercial |
$442.62
|
| Rate for Payer: NAPHCARE Commercial |
$50.95
|
| Rate for Payer: Preferred Network Access Commercial |
$525.62
|
| Rate for Payer: Quartz Beloit One Network |
$243.44
|
| Rate for Payer: Quartz Commercial |
$315.37
|
| Rate for Payer: Quartz Medicare Advantage |
$33.97
|
| Rate for Payer: The Alliance Commercial |
$84.92
|
| Rate for Payer: United Healthcare Medicaid |
$81.08
|
| Rate for Payer: United Healthcare Medicare Advantage |
$33.97
|
| Rate for Payer: WEA Trust Commercial |
$304.30
|
| Rate for Payer: WPS Commercial |
$135.87
|
|
|
Diagnostic OAE
|
Facility
|
OP
|
$532.00
|
|
|
Service Code
|
CPT 92588
|
| Hospital Charge Code |
3203489
|
|
Hospital Revenue Code
|
470
|
| Min. Negotiated Rate |
$265.57 |
| Max. Negotiated Rate |
$1,570.82 |
| Rate for Payer: Aetna Commercial |
$497.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$475.82
|
| Rate for Payer: Aetna Managed Medicare |
$392.70
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$359.63
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$276.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$265.57
|
| Rate for Payer: Anthem Medicare Advantage |
$392.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$293.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$392.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$392.70
|
| Rate for Payer: Cash Price |
$159.60
|
| Rate for Payer: Cash Price |
$159.60
|
| Rate for Payer: Cigna Commercial |
$509.02
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$392.70
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$309.62
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$392.70
|
| Rate for Payer: Health EOS Commercial |
$492.42
|
| Rate for Payer: HFN Commercial |
$509.02
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,460.86
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$392.70
|
| Rate for Payer: Independent Care Health Plan Medicare |
$392.70
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$392.70
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$392.70
|
| Rate for Payer: Multiplan Commercial |
$442.62
|
| Rate for Payer: NAPHCARE Commercial |
$589.06
|
| Rate for Payer: Preferred Network Access Commercial |
$509.02
|
| Rate for Payer: Quartz Beloit One Network |
$271.11
|
| Rate for Payer: Quartz Commercial |
$359.63
|
| Rate for Payer: Quartz Medicare Advantage |
$392.70
|
| Rate for Payer: The Alliance Commercial |
$1,570.82
|
| Rate for Payer: United Healthcare Medicare Advantage |
$392.70
|
| Rate for Payer: United Healthcare PPO |
$414.96
|
| Rate for Payer: WEA Trust Commercial |
$304.30
|
| Rate for Payer: Wellcare Medicare |
$392.70
|
| Rate for Payer: WPS Commercial |
$409.80
|
|
|
Diagnostic OAE
|
Facility
|
IP
|
$532.00
|
|
|
Service Code
|
CPT 92588
|
| Hospital Charge Code |
3203489
|
|
Hospital Revenue Code
|
470
|
| Min. Negotiated Rate |
$271.11 |
| Max. Negotiated Rate |
$509.02 |
| Rate for Payer: Aetna Commercial |
$497.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$475.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$293.24
|
| Rate for Payer: Cash Price |
$159.60
|
| Rate for Payer: Cigna Commercial |
$509.02
|
| Rate for Payer: Health EOS Commercial |
$492.42
|
| Rate for Payer: HFN Commercial |
$509.02
|
| Rate for Payer: Multiplan Commercial |
$442.62
|
| Rate for Payer: Preferred Network Access Commercial |
$509.02
|
| Rate for Payer: Quartz Beloit One Network |
$271.11
|
| Rate for Payer: Quartz Commercial |
$331.97
|
| Rate for Payer: WEA Trust Commercial |
$304.30
|
| Rate for Payer: WPS Commercial |
$409.80
|
|
|
Diagnostic Sigmoidoscopy 45330
|
Professional
|
Both
|
$461.00
|
|
|
Service Code
|
CPT 45330
|
| Hospital Charge Code |
3983432
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$52.06 |
| Max. Negotiated Rate |
$455.47 |
| Rate for Payer: Aetna Commercial |
$455.47
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$412.32
|
| Rate for Payer: Aetna Managed Medicare |
$52.06
|
| Rate for Payer: Anthem Medicare Advantage |
$52.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$52.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$52.06
|
| Rate for Payer: Cash Price |
$138.30
|
| Rate for Payer: Cash Price |
$138.30
|
| Rate for Payer: Cash Price |
$138.30
|
| Rate for Payer: Cigna Commercial |
$455.47
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$69.90
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$52.06
|
| Rate for Payer: Health EOS Commercial |
$436.29
|
| Rate for Payer: HFN Commercial |
$455.47
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$192.63
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$192.63
|
| Rate for Payer: Independent Care Health Plan Medicare |
$52.06
|
| Rate for Payer: Multiplan Commercial |
$383.55
|
| Rate for Payer: NAPHCARE Commercial |
$78.09
|
| Rate for Payer: Preferred Network Access Commercial |
$455.47
|
| Rate for Payer: Quartz Beloit One Network |
$210.95
|
| Rate for Payer: Quartz Commercial |
$273.28
|
| Rate for Payer: Quartz Medicare Advantage |
$52.06
|
| Rate for Payer: The Alliance Commercial |
$221.27
|
| Rate for Payer: United Healthcare Medicaid |
$69.90
|
| Rate for Payer: United Healthcare Medicare Advantage |
$52.06
|
| Rate for Payer: WEA Trust Commercial |
$263.69
|
| Rate for Payer: WPS Commercial |
$234.28
|
|
|
Dialysis Circuit Angio
|
Facility
|
OP
|
$2,380.00
|
|
|
Service Code
|
CPT 36901
|
| Hospital Charge Code |
5218689
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,212.85 |
| Max. Negotiated Rate |
$6,626.51 |
| Rate for Payer: Aetna Commercial |
$2,227.68
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,128.67
|
| Rate for Payer: Aetna Managed Medicare |
$1,656.63
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,635.84
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,985.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,835.04
|
| Rate for Payer: Anthem Medicare Advantage |
$1,656.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,311.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$1,656.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$1,656.63
|
| 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 |
$2,277.18
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$1,656.63
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$1,656.63
|
| Rate for Payer: Health EOS Commercial |
$2,202.93
|
| Rate for Payer: HFN Commercial |
$2,277.18
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,162.65
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,656.63
|
| Rate for Payer: Independent Care Health Plan Medicare |
$1,656.63
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$1,656.63
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$1,656.63
|
| Rate for Payer: Multiplan Commercial |
$1,980.16
|
| Rate for Payer: NAPHCARE Commercial |
$2,484.94
|
| Rate for Payer: Preferred Network Access Commercial |
$2,277.18
|
| Rate for Payer: Quartz Beloit One Network |
$1,212.85
|
| Rate for Payer: Quartz Commercial |
$1,608.88
|
| Rate for Payer: Quartz Medicare Advantage |
$1,656.63
|
| Rate for Payer: The Alliance Commercial |
$6,626.51
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,656.63
|
| Rate for Payer: United Healthcare PPO |
$3,726.32
|
| Rate for Payer: WEA Trust Commercial |
$1,361.36
|
| Rate for Payer: Wellcare Medicare |
$1,656.63
|
| Rate for Payer: WPS Commercial |
$1,833.31
|
|
|
Dialysis Circuit Angio
|
Facility
|
IP
|
$2,380.00
|
|
|
Service Code
|
CPT 36901
|
| Hospital Charge Code |
5218689
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,212.85 |
| Max. Negotiated Rate |
$2,277.18 |
| Rate for Payer: Aetna Commercial |
$2,227.68
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,128.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,311.86
|
| Rate for Payer: Cash Price |
$714.00
|
| Rate for Payer: Cigna Commercial |
$2,277.18
|
| Rate for Payer: Health EOS Commercial |
$2,202.93
|
| Rate for Payer: HFN Commercial |
$2,277.18
|
| Rate for Payer: Multiplan Commercial |
$1,980.16
|
| Rate for Payer: Preferred Network Access Commercial |
$2,277.18
|
| Rate for Payer: Quartz Beloit One Network |
$1,212.85
|
| Rate for Payer: Quartz Commercial |
$1,485.12
|
| Rate for Payer: WEA Trust Commercial |
$1,361.36
|
| Rate for Payer: WPS Commercial |
$1,833.31
|
|
|
Dialysis Circuit Central PTA
|
Facility
|
IP
|
$1,370.00
|
|
|
Service Code
|
CPT 36907
|
| Hospital Charge Code |
5218695
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$698.15 |
| Max. Negotiated Rate |
$1,310.82 |
| Rate for Payer: Aetna Commercial |
$1,282.32
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,225.33
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$755.14
|
| Rate for Payer: Cash Price |
$411.00
|
| Rate for Payer: Cigna Commercial |
$1,310.82
|
| Rate for Payer: Health EOS Commercial |
$1,268.07
|
| Rate for Payer: HFN Commercial |
$1,310.82
|
| Rate for Payer: Multiplan Commercial |
$1,139.84
|
| Rate for Payer: Preferred Network Access Commercial |
$1,310.82
|
| Rate for Payer: Quartz Beloit One Network |
$698.15
|
| Rate for Payer: Quartz Commercial |
$854.88
|
| Rate for Payer: WEA Trust Commercial |
$783.64
|
| Rate for Payer: WPS Commercial |
$1,055.31
|
|
|
Dialysis Circuit Central PTA
|
Facility
|
OP
|
$1,370.00
|
|
|
Service Code
|
CPT 36907
|
| Hospital Charge Code |
5218695
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$398.94 |
| Max. Negotiated Rate |
$12,349.86 |
| Rate for Payer: Aetna Commercial |
$1,282.32
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,225.33
|
| Rate for Payer: Aetna Managed Medicare |
$398.94
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$926.12
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$712.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$683.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$755.14
|
| Rate for Payer: Cash Price |
$411.00
|
| Rate for Payer: Cash Price |
$411.00
|
| Rate for Payer: Cigna Commercial |
$1,310.82
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12,349.86
|
| Rate for Payer: Health EOS Commercial |
$1,268.07
|
| Rate for Payer: HFN Commercial |
$1,310.82
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,068.60
|
| Rate for Payer: Multiplan Commercial |
$1,139.84
|
| Rate for Payer: NAPHCARE Commercial |
$854.88
|
| Rate for Payer: Preferred Network Access Commercial |
$1,310.82
|
| Rate for Payer: Quartz Beloit One Network |
$698.15
|
| Rate for Payer: Quartz Commercial |
$926.12
|
| Rate for Payer: Quartz Medicare Advantage |
$854.88
|
| Rate for Payer: The Alliance Commercial |
$484.93
|
| Rate for Payer: WEA Trust Commercial |
$783.64
|
| Rate for Payer: WPS Commercial |
$1,055.31
|
|
|
Dialysis Circuit Central Stent
|
Facility
|
OP
|
$6,182.00
|
|
|
Service Code
|
CPT 36908
|
| Hospital Charge Code |
5218696
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$685.98 |
| Max. Negotiated Rate |
$12,349.86 |
| Rate for Payer: Aetna Commercial |
$5,786.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,529.18
|
| Rate for Payer: Aetna Managed Medicare |
$1,800.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,179.03
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,214.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,086.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,407.52
|
| Rate for Payer: Cash Price |
$1,854.60
|
| Rate for Payer: Cash Price |
$1,854.60
|
| Rate for Payer: Cigna Commercial |
$5,914.94
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12,349.86
|
| Rate for Payer: Health EOS Commercial |
$5,722.06
|
| Rate for Payer: HFN Commercial |
$5,914.94
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,821.96
|
| Rate for Payer: Multiplan Commercial |
$5,143.42
|
| Rate for Payer: NAPHCARE Commercial |
$3,857.57
|
| Rate for Payer: Preferred Network Access Commercial |
$5,914.94
|
| Rate for Payer: Quartz Beloit One Network |
$3,150.35
|
| Rate for Payer: Quartz Commercial |
$4,179.03
|
| Rate for Payer: Quartz Medicare Advantage |
$3,857.57
|
| Rate for Payer: The Alliance Commercial |
$685.98
|
| Rate for Payer: WEA Trust Commercial |
$3,536.10
|
| Rate for Payer: WPS Commercial |
$4,761.99
|
|
|
Dialysis Circuit Central Stent
|
Facility
|
IP
|
$6,182.00
|
|
|
Service Code
|
CPT 36908
|
| Hospital Charge Code |
5218696
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$3,150.35 |
| Max. Negotiated Rate |
$5,914.94 |
| Rate for Payer: Aetna Commercial |
$5,786.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,529.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,407.52
|
| Rate for Payer: Cash Price |
$1,854.60
|
| Rate for Payer: Cigna Commercial |
$5,914.94
|
| Rate for Payer: Health EOS Commercial |
$5,722.06
|
| Rate for Payer: HFN Commercial |
$5,914.94
|
| Rate for Payer: Multiplan Commercial |
$5,143.42
|
| Rate for Payer: Preferred Network Access Commercial |
$5,914.94
|
| Rate for Payer: Quartz Beloit One Network |
$3,150.35
|
| Rate for Payer: Quartz Commercial |
$3,857.57
|
| Rate for Payer: WEA Trust Commercial |
$3,536.10
|
| Rate for Payer: WPS Commercial |
$4,761.99
|
|
|
Dialysis Circuit Embolization
|
Facility
|
IP
|
$4,600.00
|
|
|
Service Code
|
CPT 36909
|
| Hospital Charge Code |
5218697
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,344.16 |
| Max. Negotiated Rate |
$4,401.28 |
| Rate for Payer: Aetna Commercial |
$4,305.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,114.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,535.52
|
| Rate for Payer: Cash Price |
$1,380.00
|
| Rate for Payer: Cigna Commercial |
$4,401.28
|
| Rate for Payer: Health EOS Commercial |
$4,257.76
|
| Rate for Payer: HFN Commercial |
$4,401.28
|
| Rate for Payer: Multiplan Commercial |
$3,827.20
|
| Rate for Payer: Preferred Network Access Commercial |
$4,401.28
|
| Rate for Payer: Quartz Beloit One Network |
$2,344.16
|
| Rate for Payer: Quartz Commercial |
$2,870.40
|
| Rate for Payer: WEA Trust Commercial |
$2,631.20
|
| Rate for Payer: WPS Commercial |
$3,543.38
|
|
|
Dialysis Circuit Embolization
|
Facility
|
OP
|
$4,600.00
|
|
|
Service Code
|
CPT 36909
|
| Hospital Charge Code |
5218697
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$663.10 |
| Max. Negotiated Rate |
$12,349.86 |
| Rate for Payer: Aetna Commercial |
$4,305.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,114.24
|
| Rate for Payer: Aetna Managed Medicare |
$1,339.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,109.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,392.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,296.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,535.52
|
| Rate for Payer: Cash Price |
$1,380.00
|
| Rate for Payer: Cash Price |
$1,380.00
|
| Rate for Payer: Cigna Commercial |
$4,401.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12,349.86
|
| Rate for Payer: Health EOS Commercial |
$4,257.76
|
| Rate for Payer: HFN Commercial |
$4,401.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,588.00
|
| Rate for Payer: Multiplan Commercial |
$3,827.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,870.40
|
| Rate for Payer: Preferred Network Access Commercial |
$4,401.28
|
| Rate for Payer: Quartz Beloit One Network |
$2,344.16
|
| Rate for Payer: Quartz Commercial |
$3,109.60
|
| Rate for Payer: Quartz Medicare Advantage |
$2,870.40
|
| Rate for Payer: The Alliance Commercial |
$663.10
|
| Rate for Payer: WEA Trust Commercial |
$2,631.20
|
| Rate for Payer: WPS Commercial |
$3,543.38
|
|
|
Dialysis Circuit Mech Thrombectomy
|
Facility
|
OP
|
$4,568.00
|
|
|
Service Code
|
CPT 36904
|
| Hospital Charge Code |
5218692
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,327.85 |
| Max. Negotiated Rate |
$23,958.98 |
| Rate for Payer: Aetna Commercial |
$4,275.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,085.62
|
| Rate for Payer: Aetna Managed Medicare |
$5,989.74
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$16,970.72
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$14,336.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$13,619.84
|
| Rate for Payer: Anthem Medicare Advantage |
$5,989.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,517.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5,989.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5,989.74
|
| 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 |
$4,370.66
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$5,989.74
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$5,989.74
|
| Rate for Payer: Health EOS Commercial |
$4,228.14
|
| Rate for Payer: HFN Commercial |
$4,370.66
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$22,281.85
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$5,989.74
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5,989.74
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$5,989.74
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$5,989.74
|
| Rate for Payer: Multiplan Commercial |
$3,800.58
|
| Rate for Payer: NAPHCARE Commercial |
$8,984.62
|
| Rate for Payer: Preferred Network Access Commercial |
$4,370.66
|
| Rate for Payer: Quartz Beloit One Network |
$2,327.85
|
| Rate for Payer: Quartz Commercial |
$3,087.97
|
| Rate for Payer: Quartz Medicare Advantage |
$5,989.74
|
| Rate for Payer: The Alliance Commercial |
$23,958.98
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5,989.74
|
| Rate for Payer: United Healthcare PPO |
$6,400.16
|
| Rate for Payer: WEA Trust Commercial |
$2,612.90
|
| Rate for Payer: Wellcare Medicare |
$5,989.74
|
| Rate for Payer: WPS Commercial |
$3,518.73
|
|
|
Dialysis Circuit Mech Thrombectomy
|
Facility
|
IP
|
$4,568.00
|
|
|
Service Code
|
CPT 36904
|
| Hospital Charge Code |
5218692
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,327.85 |
| Max. Negotiated Rate |
$4,370.66 |
| Rate for Payer: Aetna Commercial |
$4,275.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,085.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,517.88
|
| Rate for Payer: Cash Price |
$1,370.40
|
| Rate for Payer: Cigna Commercial |
$4,370.66
|
| Rate for Payer: Health EOS Commercial |
$4,228.14
|
| Rate for Payer: HFN Commercial |
$4,370.66
|
| Rate for Payer: Multiplan Commercial |
$3,800.58
|
| Rate for Payer: Preferred Network Access Commercial |
$4,370.66
|
| Rate for Payer: Quartz Beloit One Network |
$2,327.85
|
| Rate for Payer: Quartz Commercial |
$2,850.43
|
| Rate for Payer: WEA Trust Commercial |
$2,612.90
|
| Rate for Payer: WPS Commercial |
$3,518.73
|
|
|
Dialysis Circuit Peripheral PTA
|
Facility
|
IP
|
$5,559.00
|
|
|
Service Code
|
CPT 36902
|
| Hospital Charge Code |
5218690
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,832.87 |
| Max. Negotiated Rate |
$5,318.85 |
| Rate for Payer: Aetna Commercial |
$5,203.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,971.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,064.12
|
| Rate for Payer: Cash Price |
$1,667.70
|
| Rate for Payer: Cigna Commercial |
$5,318.85
|
| Rate for Payer: Health EOS Commercial |
$5,145.41
|
| Rate for Payer: HFN Commercial |
$5,318.85
|
| Rate for Payer: Multiplan Commercial |
$4,625.09
|
| Rate for Payer: Preferred Network Access Commercial |
$5,318.85
|
| Rate for Payer: Quartz Beloit One Network |
$2,832.87
|
| Rate for Payer: Quartz Commercial |
$3,468.82
|
| Rate for Payer: WEA Trust Commercial |
$3,179.75
|
| Rate for Payer: WPS Commercial |
$4,282.10
|
|
|
Dialysis Circuit Peripheral PTA
|
Facility
|
OP
|
$5,559.00
|
|
|
Service Code
|
CPT 36902
|
| Hospital Charge Code |
5218690
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,832.87 |
| Max. Negotiated Rate |
$22,281.85 |
| Rate for Payer: Aetna Commercial |
$5,203.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,971.97
|
| Rate for Payer: Aetna Managed Medicare |
$5,989.74
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$16,970.72
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$14,336.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$13,619.84
|
| Rate for Payer: Anthem Medicare Advantage |
$5,989.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,064.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5,989.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5,989.74
|
| 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 |
$5,318.85
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$5,989.74
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$5,989.74
|
| Rate for Payer: Health EOS Commercial |
$5,145.41
|
| Rate for Payer: HFN Commercial |
$5,318.85
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$22,281.85
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$5,989.74
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5,989.74
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$5,989.74
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$5,989.74
|
| Rate for Payer: Multiplan Commercial |
$4,625.09
|
| Rate for Payer: NAPHCARE Commercial |
$8,984.62
|
| Rate for Payer: Preferred Network Access Commercial |
$5,318.85
|
| Rate for Payer: Quartz Beloit One Network |
$2,832.87
|
| Rate for Payer: Quartz Commercial |
$3,757.88
|
| Rate for Payer: Quartz Medicare Advantage |
$5,989.74
|
| Rate for Payer: The Alliance Commercial |
$10,182.57
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5,989.74
|
| Rate for Payer: United Healthcare PPO |
$6,400.16
|
| Rate for Payer: WEA Trust Commercial |
$3,179.75
|
| Rate for Payer: Wellcare Medicare |
$5,989.74
|
| Rate for Payer: WPS Commercial |
$4,282.10
|
|
|
Dialysis Circuit Peripheral Stent
|
Facility
|
OP
|
$12,657.00
|
|
|
Service Code
|
CPT 36903
|
| Hospital Charge Code |
5218691
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$4,386.95 |
| Max. Negotiated Rate |
$45,194.20 |
| Rate for Payer: Aetna Commercial |
$11,846.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$11,320.42
|
| Rate for Payer: Aetna Managed Medicare |
$12,148.98
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$19,394.96
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$19,394.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$17,919.20
|
| Rate for Payer: Anthem Medicare Advantage |
$12,148.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,976.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12,148.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12,148.98
|
| 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 |
$12,110.22
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$12,148.98
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$12,148.98
|
| Rate for Payer: Health EOS Commercial |
$11,715.32
|
| Rate for Payer: HFN Commercial |
$12,110.22
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$45,194.20
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$12,148.98
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12,148.98
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$12,148.98
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$12,148.98
|
| Rate for Payer: Multiplan Commercial |
$10,530.62
|
| Rate for Payer: NAPHCARE Commercial |
$18,223.47
|
| Rate for Payer: Preferred Network Access Commercial |
$12,110.22
|
| Rate for Payer: Quartz Beloit One Network |
$6,450.01
|
| Rate for Payer: Quartz Commercial |
$8,556.13
|
| Rate for Payer: Quartz Medicare Advantage |
$12,148.98
|
| Rate for Payer: The Alliance Commercial |
$20,653.26
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12,148.98
|
| Rate for Payer: United Healthcare PPO |
$9,979.84
|
| Rate for Payer: WEA Trust Commercial |
$7,239.80
|
| Rate for Payer: Wellcare Medicare |
$12,148.98
|
| Rate for Payer: WPS Commercial |
$9,749.69
|
|
