|
Dialysis Circuit Peripheral Stent
|
Facility
|
IP
|
$12,657.00
|
|
|
Service Code
|
CPT 36903
|
| Hospital Charge Code |
5218691
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$6,450.01 |
| Max. Negotiated Rate |
$12,110.22 |
| Rate for Payer: Aetna Commercial |
$11,846.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$11,320.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,976.54
|
| Rate for Payer: Cash Price |
$3,797.10
|
| Rate for Payer: Cigna Commercial |
$12,110.22
|
| Rate for Payer: Health EOS Commercial |
$11,715.32
|
| Rate for Payer: HFN Commercial |
$12,110.22
|
| Rate for Payer: Multiplan Commercial |
$10,530.62
|
| 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 |
$7,897.97
|
| Rate for Payer: WEA Trust Commercial |
$7,239.80
|
| Rate for Payer: WPS Commercial |
$9,749.69
|
|
|
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 |
$3,046.39 |
| Max. Negotiated Rate |
$45,194.20 |
| Rate for Payer: Aetna Commercial |
$5,595.41
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,346.72
|
| 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 |
$3,295.07
|
| 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 |
$1,793.40
|
| Rate for Payer: Cash Price |
$1,793.40
|
| Rate for Payer: Cash Price |
$1,793.40
|
| Rate for Payer: Cigna Commercial |
$5,719.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$12,148.98
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12,349.86
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$12,148.98
|
| Rate for Payer: Health EOS Commercial |
$5,533.24
|
| Rate for Payer: HFN Commercial |
$5,719.75
|
| 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 |
$4,973.70
|
| Rate for Payer: NAPHCARE Commercial |
$18,223.47
|
| Rate for Payer: Preferred Network Access Commercial |
$5,719.75
|
| Rate for Payer: Quartz Beloit One Network |
$3,046.39
|
| Rate for Payer: Quartz Commercial |
$4,041.13
|
| 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 |
$3,419.42
|
| Rate for Payer: Wellcare Medicare |
$12,148.98
|
| Rate for Payer: WPS Commercial |
$4,604.85
|
|
|
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 |
$3,046.39 |
| Max. Negotiated Rate |
$5,719.75 |
| Rate for Payer: Aetna Commercial |
$5,595.41
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,346.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,295.07
|
| Rate for Payer: Cash Price |
$1,793.40
|
| Rate for Payer: Cigna Commercial |
$5,719.75
|
| Rate for Payer: Health EOS Commercial |
$5,533.24
|
| Rate for Payer: HFN Commercial |
$5,719.75
|
| Rate for Payer: Multiplan Commercial |
$4,973.70
|
| Rate for Payer: Preferred Network Access Commercial |
$5,719.75
|
| Rate for Payer: Quartz Beloit One Network |
$3,046.39
|
| Rate for Payer: Quartz Commercial |
$3,730.27
|
| Rate for Payer: WEA Trust Commercial |
$3,419.42
|
| Rate for Payer: WPS Commercial |
$4,604.85
|
|
|
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 |
$4,386.95 |
| Max. Negotiated Rate |
$71,766.32 |
| Rate for Payer: Aetna Commercial |
$15,208.13
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$14,532.21
|
| Rate for Payer: Aetna Managed Medicare |
$19,292.02
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$20,607.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$19,113.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$18,158.40
|
| Rate for Payer: Anthem Medicare Advantage |
$19,292.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$8,955.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$19,292.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$19,292.02
|
| 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 |
$15,546.09
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$19,292.02
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$19,292.02
|
| Rate for Payer: Health EOS Commercial |
$15,039.15
|
| Rate for Payer: HFN Commercial |
$15,546.09
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$71,766.32
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$19,292.02
|
| Rate for Payer: Independent Care Health Plan Medicare |
$19,292.02
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$19,292.02
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$19,292.02
|
| Rate for Payer: Multiplan Commercial |
$13,518.34
|
| Rate for Payer: NAPHCARE Commercial |
$28,938.03
|
| Rate for Payer: Preferred Network Access Commercial |
$15,546.09
|
| Rate for Payer: Quartz Beloit One Network |
$8,279.98
|
| Rate for Payer: Quartz Commercial |
$10,983.65
|
| Rate for Payer: Quartz Medicare Advantage |
$19,292.02
|
| Rate for Payer: The Alliance Commercial |
$32,796.44
|
| Rate for Payer: United Healthcare Medicare Advantage |
$19,292.02
|
| Rate for Payer: United Healthcare PPO |
$11,521.12
|
| Rate for Payer: WEA Trust Commercial |
$9,293.86
|
| Rate for Payer: Wellcare Medicare |
$19,292.02
|
| Rate for Payer: WPS Commercial |
$12,515.83
|
|
|
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 |
$8,279.98 |
| Max. Negotiated Rate |
$15,546.09 |
| Rate for Payer: Aetna Commercial |
$15,208.13
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$14,532.21
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$8,955.90
|
| Rate for Payer: Cash Price |
$4,874.40
|
| Rate for Payer: Cigna Commercial |
$15,546.09
|
| Rate for Payer: Health EOS Commercial |
$15,039.15
|
| Rate for Payer: HFN Commercial |
$15,546.09
|
| Rate for Payer: Multiplan Commercial |
$13,518.34
|
| Rate for Payer: Preferred Network Access Commercial |
$15,546.09
|
| Rate for Payer: Quartz Beloit One Network |
$8,279.98
|
| Rate for Payer: Quartz Commercial |
$10,138.75
|
| Rate for Payer: WEA Trust Commercial |
$9,293.86
|
| Rate for Payer: WPS Commercial |
$12,515.83
|
|
|
DIALYSIS PROCEDURES
|
Facility
|
OP
|
$179.51
|
|
|
Service Code
|
EAPG 00168
|
| Min. Negotiated Rate |
$172.61 |
| Max. Negotiated Rate |
$179.51 |
| Rate for Payer: Anthem Medicaid |
$172.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$172.61
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$172.61
|
| Rate for Payer: Dean Health Medicaid |
$172.61
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$172.61
|
| Rate for Payer: Managed Health Services Medicaid |
$179.51
|
| Rate for Payer: Molina Healthcare Medicaid |
$172.61
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$172.61
|
| Rate for Payer: United Healthcare Medicaid |
$172.61
|
|
|
Dialysis Water Culture
|
Facility
|
OP
|
$167.00
|
|
|
Service Code
|
CPT 87084
|
| Hospital Charge Code |
979920
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$28.15 |
| Max. Negotiated Rate |
$159.79 |
| Rate for Payer: Aetna Commercial |
$156.31
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$149.36
|
| Rate for Payer: Aetna Managed Medicare |
$28.15
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$105.57
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$49.27
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$46.73
|
| Rate for Payer: Anthem Medicare Advantage |
$28.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$92.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$28.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$28.15
|
| Rate for Payer: Cash Price |
$50.10
|
| Rate for Payer: Cash Price |
$50.10
|
| Rate for Payer: Cigna Commercial |
$159.79
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$28.15
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$97.19
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$28.15
|
| Rate for Payer: Health EOS Commercial |
$154.58
|
| Rate for Payer: HFN Commercial |
$159.79
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$104.73
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$28.15
|
| Rate for Payer: Independent Care Health Plan Medicare |
$28.15
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$28.15
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$28.15
|
| Rate for Payer: Multiplan Commercial |
$138.94
|
| Rate for Payer: NAPHCARE Commercial |
$42.23
|
| Rate for Payer: Preferred Network Access Commercial |
$159.79
|
| Rate for Payer: Quartz Beloit One Network |
$85.10
|
| Rate for Payer: Quartz Commercial |
$112.89
|
| Rate for Payer: Quartz Medicare Advantage |
$28.15
|
| Rate for Payer: The Alliance Commercial |
$112.61
|
| Rate for Payer: United Healthcare Medicare Advantage |
$28.15
|
| Rate for Payer: United Healthcare PPO |
$130.26
|
| Rate for Payer: WEA Trust Commercial |
$95.52
|
| Rate for Payer: Wellcare Medicare |
$28.15
|
| Rate for Payer: WPS Commercial |
$128.64
|
|
|
Dialysis Water Culture
|
Professional
|
Both
|
$167.00
|
|
|
Service Code
|
CPT 87084
|
| Hospital Charge Code |
979920
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$28.15 |
| Max. Negotiated Rate |
$165.00 |
| Rate for Payer: Aetna Commercial |
$165.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$149.36
|
| Rate for Payer: Aetna Managed Medicare |
$28.15
|
| Rate for Payer: Anthem Medicare Advantage |
$28.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$28.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$28.15
|
| Rate for Payer: Cash Price |
$50.10
|
| Rate for Payer: Cash Price |
$50.10
|
| Rate for Payer: Cigna Commercial |
$165.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$86.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$28.15
|
| Rate for Payer: Health EOS Commercial |
$158.05
|
| Rate for Payer: HFN Commercial |
$165.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$99.38
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$99.38
|
| Rate for Payer: Independent Care Health Plan Medicare |
$28.15
|
| Rate for Payer: Multiplan Commercial |
$138.94
|
| Rate for Payer: NAPHCARE Commercial |
$42.23
|
| Rate for Payer: Preferred Network Access Commercial |
$165.00
|
| Rate for Payer: Quartz Beloit One Network |
$76.42
|
| Rate for Payer: Quartz Commercial |
$99.00
|
| Rate for Payer: Quartz Medicare Advantage |
$28.15
|
| Rate for Payer: The Alliance Commercial |
$111.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$28.15
|
| Rate for Payer: WEA Trust Commercial |
$95.52
|
| Rate for Payer: WPS Commercial |
$123.87
|
|
|
Dialysis Water Culture
|
Facility
|
IP
|
$167.00
|
|
|
Service Code
|
CPT 87084
|
| Hospital Charge Code |
979920
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$85.10 |
| Max. Negotiated Rate |
$159.79 |
| Rate for Payer: Aetna Commercial |
$156.31
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$149.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$92.05
|
| Rate for Payer: Cash Price |
$50.10
|
| Rate for Payer: Cigna Commercial |
$159.79
|
| Rate for Payer: Health EOS Commercial |
$154.58
|
| Rate for Payer: HFN Commercial |
$159.79
|
| Rate for Payer: Multiplan Commercial |
$138.94
|
| Rate for Payer: Preferred Network Access Commercial |
$159.79
|
| Rate for Payer: Quartz Beloit One Network |
$85.10
|
| Rate for Payer: Quartz Commercial |
$104.21
|
| Rate for Payer: WEA Trust Commercial |
$95.52
|
| Rate for Payer: WPS Commercial |
$128.64
|
|
|
Diamondback Atherectomy Device
|
Facility
|
OP
|
$12,634.00
|
|
|
Service Code
|
HCPCS C1724
|
| Hospital Charge Code |
5184610
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$3,679.02 |
| Max. Negotiated Rate |
$12,088.21 |
| Rate for Payer: Aetna Commercial |
$11,825.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$11,299.85
|
| Rate for Payer: Aetna Managed Medicare |
$3,679.02
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$8,540.58
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$6,569.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$6,306.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,963.86
|
| Rate for Payer: Cash Price |
$3,790.20
|
| Rate for Payer: Cigna Commercial |
$12,088.21
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$7,352.99
|
| Rate for Payer: Health EOS Commercial |
$11,694.03
|
| Rate for Payer: HFN Commercial |
$12,088.21
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$9,854.52
|
| Rate for Payer: Multiplan Commercial |
$10,511.49
|
| Rate for Payer: NAPHCARE Commercial |
$7,883.62
|
| Rate for Payer: Preferred Network Access Commercial |
$12,088.21
|
| Rate for Payer: Quartz Beloit One Network |
$6,438.29
|
| Rate for Payer: Quartz Commercial |
$8,540.58
|
| Rate for Payer: Quartz Medicare Advantage |
$7,883.62
|
| Rate for Payer: The Alliance Commercial |
$6,569.68
|
| Rate for Payer: WEA Trust Commercial |
$7,226.65
|
| Rate for Payer: WPS Commercial |
$9,731.97
|
|
|
Diamondback Atherectomy Device
|
Facility
|
IP
|
$12,634.00
|
|
|
Service Code
|
HCPCS C1724
|
| Hospital Charge Code |
5184610
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$6,438.29 |
| Max. Negotiated Rate |
$12,088.21 |
| Rate for Payer: Aetna Commercial |
$11,825.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$11,299.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,963.86
|
| Rate for Payer: Cash Price |
$3,790.20
|
| Rate for Payer: Cigna Commercial |
$12,088.21
|
| Rate for Payer: Health EOS Commercial |
$11,694.03
|
| Rate for Payer: HFN Commercial |
$12,088.21
|
| Rate for Payer: Multiplan Commercial |
$10,511.49
|
| Rate for Payer: Preferred Network Access Commercial |
$12,088.21
|
| Rate for Payer: Quartz Beloit One Network |
$6,438.29
|
| Rate for Payer: Quartz Commercial |
$7,883.62
|
| Rate for Payer: WEA Trust Commercial |
$7,226.65
|
| Rate for Payer: WPS Commercial |
$9,731.97
|
|
|
DIAMOND BUR 5MM
|
Facility
|
OP
|
$1,738.00
|
|
| Hospital Charge Code |
2964910
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$506.11 |
| Max. Negotiated Rate |
$1,662.92 |
| Rate for Payer: Aetna Commercial |
$1,626.77
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,554.47
|
| Rate for Payer: Aetna Managed Medicare |
$506.11
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,174.89
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$903.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$867.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$957.99
|
| Rate for Payer: Cash Price |
$521.40
|
| Rate for Payer: Cigna Commercial |
$1,662.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,011.52
|
| Rate for Payer: Health EOS Commercial |
$1,608.69
|
| Rate for Payer: HFN Commercial |
$1,662.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,355.64
|
| Rate for Payer: Multiplan Commercial |
$1,446.02
|
| Rate for Payer: NAPHCARE Commercial |
$1,084.51
|
| Rate for Payer: Preferred Network Access Commercial |
$1,662.92
|
| Rate for Payer: Quartz Beloit One Network |
$885.68
|
| Rate for Payer: Quartz Commercial |
$1,174.89
|
| Rate for Payer: Quartz Medicare Advantage |
$1,084.51
|
| Rate for Payer: The Alliance Commercial |
$903.76
|
| Rate for Payer: WEA Trust Commercial |
$994.14
|
| Rate for Payer: WPS Commercial |
$1,338.78
|
|
|
DIAMOND BUR 5MM
|
Facility
|
IP
|
$1,738.00
|
|
| Hospital Charge Code |
2964910
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$885.68 |
| Max. Negotiated Rate |
$1,662.92 |
| Rate for Payer: Aetna Commercial |
$1,626.77
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,554.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$957.99
|
| Rate for Payer: Cash Price |
$521.40
|
| Rate for Payer: Cigna Commercial |
$1,662.92
|
| Rate for Payer: Health EOS Commercial |
$1,608.69
|
| Rate for Payer: HFN Commercial |
$1,662.92
|
| Rate for Payer: Multiplan Commercial |
$1,446.02
|
| Rate for Payer: Preferred Network Access Commercial |
$1,662.92
|
| Rate for Payer: Quartz Beloit One Network |
$885.68
|
| Rate for Payer: Quartz Commercial |
$1,084.51
|
| Rate for Payer: WEA Trust Commercial |
$994.14
|
| Rate for Payer: WPS Commercial |
$1,338.78
|
|
|
DIAMOND BUR 6MM
|
Facility
|
IP
|
$1,738.00
|
|
| Hospital Charge Code |
2974041
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$885.68 |
| Max. Negotiated Rate |
$1,662.92 |
| Rate for Payer: Aetna Commercial |
$1,626.77
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,554.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$957.99
|
| Rate for Payer: Cash Price |
$521.40
|
| Rate for Payer: Cigna Commercial |
$1,662.92
|
| Rate for Payer: Health EOS Commercial |
$1,608.69
|
| Rate for Payer: HFN Commercial |
$1,662.92
|
| Rate for Payer: Multiplan Commercial |
$1,446.02
|
| Rate for Payer: Preferred Network Access Commercial |
$1,662.92
|
| Rate for Payer: Quartz Beloit One Network |
$885.68
|
| Rate for Payer: Quartz Commercial |
$1,084.51
|
| Rate for Payer: WEA Trust Commercial |
$994.14
|
| Rate for Payer: WPS Commercial |
$1,338.78
|
|
|
DIAMOND BUR 6MM
|
Facility
|
OP
|
$1,738.00
|
|
| Hospital Charge Code |
2974041
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$506.11 |
| Max. Negotiated Rate |
$1,662.92 |
| Rate for Payer: Aetna Commercial |
$1,626.77
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,554.47
|
| Rate for Payer: Aetna Managed Medicare |
$506.11
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,174.89
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$903.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$867.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$957.99
|
| Rate for Payer: Cash Price |
$521.40
|
| Rate for Payer: Cigna Commercial |
$1,662.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,011.52
|
| Rate for Payer: Health EOS Commercial |
$1,608.69
|
| Rate for Payer: HFN Commercial |
$1,662.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,355.64
|
| Rate for Payer: Multiplan Commercial |
$1,446.02
|
| Rate for Payer: NAPHCARE Commercial |
$1,084.51
|
| Rate for Payer: Preferred Network Access Commercial |
$1,662.92
|
| Rate for Payer: Quartz Beloit One Network |
$885.68
|
| Rate for Payer: Quartz Commercial |
$1,174.89
|
| Rate for Payer: Quartz Medicare Advantage |
$1,084.51
|
| Rate for Payer: The Alliance Commercial |
$903.76
|
| Rate for Payer: WEA Trust Commercial |
$994.14
|
| Rate for Payer: WPS Commercial |
$1,338.78
|
|
|
DIAMOND TOOL MIDAS REX 2MM BALL 75BA20D
|
Facility
|
IP
|
$2,024.00
|
|
| Hospital Charge Code |
3613497
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,031.43 |
| Max. Negotiated Rate |
$1,936.56 |
| Rate for Payer: Aetna Commercial |
$1,894.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,810.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,115.63
|
| Rate for Payer: Cash Price |
$607.20
|
| Rate for Payer: Cigna Commercial |
$1,936.56
|
| Rate for Payer: Health EOS Commercial |
$1,873.41
|
| Rate for Payer: HFN Commercial |
$1,936.56
|
| Rate for Payer: Multiplan Commercial |
$1,683.97
|
| Rate for Payer: Preferred Network Access Commercial |
$1,936.56
|
| Rate for Payer: Quartz Beloit One Network |
$1,031.43
|
| Rate for Payer: Quartz Commercial |
$1,262.98
|
| Rate for Payer: WEA Trust Commercial |
$1,157.73
|
| Rate for Payer: WPS Commercial |
$1,559.09
|
|
|
DIAMOND TOOL MIDAS REX 2MM BALL 75BA20D
|
Facility
|
OP
|
$2,024.00
|
|
| Hospital Charge Code |
3613497
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$589.39 |
| Max. Negotiated Rate |
$1,936.56 |
| Rate for Payer: Aetna Commercial |
$1,894.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,810.27
|
| Rate for Payer: Aetna Managed Medicare |
$589.39
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,368.22
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,052.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,010.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,115.63
|
| Rate for Payer: Cash Price |
$607.20
|
| Rate for Payer: Cigna Commercial |
$1,936.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,177.97
|
| Rate for Payer: Health EOS Commercial |
$1,873.41
|
| Rate for Payer: HFN Commercial |
$1,936.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,578.72
|
| Rate for Payer: Multiplan Commercial |
$1,683.97
|
| Rate for Payer: NAPHCARE Commercial |
$1,262.98
|
| Rate for Payer: Preferred Network Access Commercial |
$1,936.56
|
| Rate for Payer: Quartz Beloit One Network |
$1,031.43
|
| Rate for Payer: Quartz Commercial |
$1,368.22
|
| Rate for Payer: Quartz Medicare Advantage |
$1,262.98
|
| Rate for Payer: The Alliance Commercial |
$1,052.48
|
| Rate for Payer: WEA Trust Commercial |
$1,157.73
|
| Rate for Payer: WPS Commercial |
$1,559.09
|
|
|
DIAMOND TOOL MIDAS REX 2MM BALL 75BA20DL
|
Facility
|
OP
|
$2,024.00
|
|
| Hospital Charge Code |
3495516
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$589.39 |
| Max. Negotiated Rate |
$1,936.56 |
| Rate for Payer: Aetna Commercial |
$1,894.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,810.27
|
| Rate for Payer: Aetna Managed Medicare |
$589.39
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,368.22
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,052.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,010.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,115.63
|
| Rate for Payer: Cash Price |
$607.20
|
| Rate for Payer: Cigna Commercial |
$1,936.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,177.97
|
| Rate for Payer: Health EOS Commercial |
$1,873.41
|
| Rate for Payer: HFN Commercial |
$1,936.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,578.72
|
| Rate for Payer: Multiplan Commercial |
$1,683.97
|
| Rate for Payer: NAPHCARE Commercial |
$1,262.98
|
| Rate for Payer: Preferred Network Access Commercial |
$1,936.56
|
| Rate for Payer: Quartz Beloit One Network |
$1,031.43
|
| Rate for Payer: Quartz Commercial |
$1,368.22
|
| Rate for Payer: Quartz Medicare Advantage |
$1,262.98
|
| Rate for Payer: The Alliance Commercial |
$1,052.48
|
| Rate for Payer: WEA Trust Commercial |
$1,157.73
|
| Rate for Payer: WPS Commercial |
$1,559.09
|
|
|
DIAMOND TOOL MIDAS REX 2MM BALL 75BA20DL
|
Facility
|
IP
|
$2,024.00
|
|
| Hospital Charge Code |
3495516
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,031.43 |
| Max. Negotiated Rate |
$1,936.56 |
| Rate for Payer: Aetna Commercial |
$1,894.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,810.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,115.63
|
| Rate for Payer: Cash Price |
$607.20
|
| Rate for Payer: Cigna Commercial |
$1,936.56
|
| Rate for Payer: Health EOS Commercial |
$1,873.41
|
| Rate for Payer: HFN Commercial |
$1,936.56
|
| Rate for Payer: Multiplan Commercial |
$1,683.97
|
| Rate for Payer: Preferred Network Access Commercial |
$1,936.56
|
| Rate for Payer: Quartz Beloit One Network |
$1,031.43
|
| Rate for Payer: Quartz Commercial |
$1,262.98
|
| Rate for Payer: WEA Trust Commercial |
$1,157.73
|
| Rate for Payer: WPS Commercial |
$1,559.09
|
|
|
DIAMOND TOOL MIDAS REX 3MM BALL D 75BA30DL
|
Facility
|
IP
|
$2,024.00
|
|
| Hospital Charge Code |
4519596
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,031.43 |
| Max. Negotiated Rate |
$1,936.56 |
| Rate for Payer: Aetna Commercial |
$1,894.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,810.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,115.63
|
| Rate for Payer: Cash Price |
$607.20
|
| Rate for Payer: Cigna Commercial |
$1,936.56
|
| Rate for Payer: Health EOS Commercial |
$1,873.41
|
| Rate for Payer: HFN Commercial |
$1,936.56
|
| Rate for Payer: Multiplan Commercial |
$1,683.97
|
| Rate for Payer: Preferred Network Access Commercial |
$1,936.56
|
| Rate for Payer: Quartz Beloit One Network |
$1,031.43
|
| Rate for Payer: Quartz Commercial |
$1,262.98
|
| Rate for Payer: WEA Trust Commercial |
$1,157.73
|
| Rate for Payer: WPS Commercial |
$1,559.09
|
|
|
DIAMOND TOOL MIDAS REX 3MM BALL D 75BA30DL
|
Facility
|
OP
|
$2,024.00
|
|
| Hospital Charge Code |
4519596
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$589.39 |
| Max. Negotiated Rate |
$1,936.56 |
| Rate for Payer: Aetna Commercial |
$1,894.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,810.27
|
| Rate for Payer: Aetna Managed Medicare |
$589.39
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,368.22
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,052.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,010.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,115.63
|
| Rate for Payer: Cash Price |
$607.20
|
| Rate for Payer: Cigna Commercial |
$1,936.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,177.97
|
| Rate for Payer: Health EOS Commercial |
$1,873.41
|
| Rate for Payer: HFN Commercial |
$1,936.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,578.72
|
| Rate for Payer: Multiplan Commercial |
$1,683.97
|
| Rate for Payer: NAPHCARE Commercial |
$1,262.98
|
| Rate for Payer: Preferred Network Access Commercial |
$1,936.56
|
| Rate for Payer: Quartz Beloit One Network |
$1,031.43
|
| Rate for Payer: Quartz Commercial |
$1,368.22
|
| Rate for Payer: Quartz Medicare Advantage |
$1,262.98
|
| Rate for Payer: The Alliance Commercial |
$1,052.48
|
| Rate for Payer: WEA Trust Commercial |
$1,157.73
|
| Rate for Payer: WPS Commercial |
$1,559.09
|
|
|
DIAMOND TOOL MIDAS REX 4MM BALL 75BA40D
|
Facility
|
IP
|
$2,024.00
|
|
| Hospital Charge Code |
3495514
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,031.43 |
| Max. Negotiated Rate |
$1,936.56 |
| Rate for Payer: Aetna Commercial |
$1,894.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,810.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,115.63
|
| Rate for Payer: Cash Price |
$607.20
|
| Rate for Payer: Cigna Commercial |
$1,936.56
|
| Rate for Payer: Health EOS Commercial |
$1,873.41
|
| Rate for Payer: HFN Commercial |
$1,936.56
|
| Rate for Payer: Multiplan Commercial |
$1,683.97
|
| Rate for Payer: Preferred Network Access Commercial |
$1,936.56
|
| Rate for Payer: Quartz Beloit One Network |
$1,031.43
|
| Rate for Payer: Quartz Commercial |
$1,262.98
|
| Rate for Payer: WEA Trust Commercial |
$1,157.73
|
| Rate for Payer: WPS Commercial |
$1,559.09
|
|
|
DIAMOND TOOL MIDAS REX 4MM BALL 75BA40D
|
Facility
|
OP
|
$2,024.00
|
|
| Hospital Charge Code |
3495514
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$589.39 |
| Max. Negotiated Rate |
$1,936.56 |
| Rate for Payer: Aetna Commercial |
$1,894.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,810.27
|
| Rate for Payer: Aetna Managed Medicare |
$589.39
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,368.22
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,052.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,010.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,115.63
|
| Rate for Payer: Cash Price |
$607.20
|
| Rate for Payer: Cigna Commercial |
$1,936.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,177.97
|
| Rate for Payer: Health EOS Commercial |
$1,873.41
|
| Rate for Payer: HFN Commercial |
$1,936.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,578.72
|
| Rate for Payer: Multiplan Commercial |
$1,683.97
|
| Rate for Payer: NAPHCARE Commercial |
$1,262.98
|
| Rate for Payer: Preferred Network Access Commercial |
$1,936.56
|
| Rate for Payer: Quartz Beloit One Network |
$1,031.43
|
| Rate for Payer: Quartz Commercial |
$1,368.22
|
| Rate for Payer: Quartz Medicare Advantage |
$1,262.98
|
| Rate for Payer: The Alliance Commercial |
$1,052.48
|
| Rate for Payer: WEA Trust Commercial |
$1,157.73
|
| Rate for Payer: WPS Commercial |
$1,559.09
|
|
|
DIAMOND TOOL MIDAS REX 4MM BALL D 75BA40DL
|
Facility
|
OP
|
$2,024.00
|
|
| Hospital Charge Code |
3495515
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$589.39 |
| Max. Negotiated Rate |
$1,936.56 |
| Rate for Payer: Aetna Commercial |
$1,894.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,810.27
|
| Rate for Payer: Aetna Managed Medicare |
$589.39
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,368.22
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,052.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,010.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,115.63
|
| Rate for Payer: Cash Price |
$607.20
|
| Rate for Payer: Cigna Commercial |
$1,936.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,177.97
|
| Rate for Payer: Health EOS Commercial |
$1,873.41
|
| Rate for Payer: HFN Commercial |
$1,936.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,578.72
|
| Rate for Payer: Multiplan Commercial |
$1,683.97
|
| Rate for Payer: NAPHCARE Commercial |
$1,262.98
|
| Rate for Payer: Preferred Network Access Commercial |
$1,936.56
|
| Rate for Payer: Quartz Beloit One Network |
$1,031.43
|
| Rate for Payer: Quartz Commercial |
$1,368.22
|
| Rate for Payer: Quartz Medicare Advantage |
$1,262.98
|
| Rate for Payer: The Alliance Commercial |
$1,052.48
|
| Rate for Payer: WEA Trust Commercial |
$1,157.73
|
| Rate for Payer: WPS Commercial |
$1,559.09
|
|
|
DIAMOND TOOL MIDAS REX 4MM BALL D 75BA40DL
|
Facility
|
IP
|
$2,024.00
|
|
| Hospital Charge Code |
3495515
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,031.43 |
| Max. Negotiated Rate |
$1,936.56 |
| Rate for Payer: Aetna Commercial |
$1,894.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,810.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,115.63
|
| Rate for Payer: Cash Price |
$607.20
|
| Rate for Payer: Cigna Commercial |
$1,936.56
|
| Rate for Payer: Health EOS Commercial |
$1,873.41
|
| Rate for Payer: HFN Commercial |
$1,936.56
|
| Rate for Payer: Multiplan Commercial |
$1,683.97
|
| Rate for Payer: Preferred Network Access Commercial |
$1,936.56
|
| Rate for Payer: Quartz Beloit One Network |
$1,031.43
|
| Rate for Payer: Quartz Commercial |
$1,262.98
|
| Rate for Payer: WEA Trust Commercial |
$1,157.73
|
| Rate for Payer: WPS Commercial |
$1,559.09
|
|
