|
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
|
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 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 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 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 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
|
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 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 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 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 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
|
|
|
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
|
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/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/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 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 PROCEDURES
|
Facility
|
OP
|
$191.28
|
|
|
Service Code
|
EAPG 00168
|
| Min. Negotiated Rate |
$183.92 |
| Max. Negotiated Rate |
$191.28 |
| Rate for Payer: Anthem Medicaid |
$183.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$183.92
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$183.92
|
| Rate for Payer: Dean Health Medicaid |
$183.92
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$183.92
|
| Rate for Payer: Managed Health Services Medicaid |
$191.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$183.92
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$183.92
|
| Rate for Payer: United Healthcare Medicaid |
$183.92
|
|
|
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
|
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
|
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
|
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
|
|
|
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: Quartz Medicare Advantage |
$7,883.62
|
| 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: The Alliance Commercial |
$6,569.68
|
| Rate for Payer: WEA Trust Commercial |
$7,226.65
|
| Rate for Payer: WPS Commercial |
$9,731.97
|
|
