|
Apex 4.0mm x 15mm
|
Facility
OP
|
$1,904.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
1159022
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$533.12 |
| Max. Negotiated Rate |
$1,751.68 |
| Rate for Payer: Aetna Commercial |
$1,713.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,637.44
|
| Rate for Payer: Aetna Managed Medicare |
$533.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,237.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$952.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$913.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,009.12
|
| Rate for Payer: Cash Price |
$571.20
|
| Rate for Payer: Cigna Commercial |
$1,751.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,065.48
|
| Rate for Payer: Health EOS Commercial |
$1,694.56
|
| Rate for Payer: HFN Commercial |
$1,751.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,428.00
|
| Rate for Payer: Multiplan Commercial |
$1,523.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,142.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,751.68
|
| Rate for Payer: Quartz Beloit One Network |
$932.96
|
| Rate for Payer: Quartz Commercial |
$1,237.60
|
| Rate for Payer: Quartz Medicare Advantage |
$1,142.40
|
| Rate for Payer: WEA Trust Commercial |
$1,047.20
|
| Rate for Payer: WPS Commercial |
$1,410.29
|
|
|
Apex 4.0mm x 20mm
|
Facility
IP
|
$1,904.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
1159024
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$932.96 |
| Max. Negotiated Rate |
$1,751.68 |
| Rate for Payer: Aetna Commercial |
$1,713.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,009.12
|
| Rate for Payer: Cash Price |
$571.20
|
| Rate for Payer: Cigna Commercial |
$1,751.68
|
| Rate for Payer: Health EOS Commercial |
$1,694.56
|
| Rate for Payer: HFN Commercial |
$1,751.68
|
| Rate for Payer: Multiplan Commercial |
$1,523.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,142.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,751.68
|
| Rate for Payer: Quartz Beloit One Network |
$932.96
|
| Rate for Payer: Quartz Commercial |
$1,142.40
|
| Rate for Payer: WEA Trust Commercial |
$1,047.20
|
| Rate for Payer: WPS Commercial |
$1,410.29
|
|
|
Apex 4.0mm x 20mm
|
Facility
OP
|
$1,904.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
1159024
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$533.12 |
| Max. Negotiated Rate |
$1,751.68 |
| Rate for Payer: Aetna Commercial |
$1,713.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,637.44
|
| Rate for Payer: Aetna Managed Medicare |
$533.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,237.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$952.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$913.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,009.12
|
| Rate for Payer: Cash Price |
$571.20
|
| Rate for Payer: Cigna Commercial |
$1,751.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,065.48
|
| Rate for Payer: Health EOS Commercial |
$1,694.56
|
| Rate for Payer: HFN Commercial |
$1,751.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,428.00
|
| Rate for Payer: Multiplan Commercial |
$1,523.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,142.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,751.68
|
| Rate for Payer: Quartz Beloit One Network |
$932.96
|
| Rate for Payer: Quartz Commercial |
$1,237.60
|
| Rate for Payer: Quartz Medicare Advantage |
$1,142.40
|
| Rate for Payer: WEA Trust Commercial |
$1,047.20
|
| Rate for Payer: WPS Commercial |
$1,410.29
|
|
|
Apex 4.0mm x 20mm
|
Professional
|
$1,904.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
1159024
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$837.76 |
| Max. Negotiated Rate |
$1,808.80 |
| Rate for Payer: Aetna Commercial |
$1,808.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,637.44
|
| Rate for Payer: Cash Price |
$571.20
|
| Rate for Payer: Cigna Commercial |
$1,808.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$952.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,142.40
|
| Rate for Payer: Health EOS Commercial |
$1,732.64
|
| Rate for Payer: Multiplan Commercial |
$1,523.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,808.80
|
| Rate for Payer: Quartz Beloit One Network |
$837.76
|
| Rate for Payer: Quartz Commercial |
$1,085.28
|
| Rate for Payer: The Alliance Commercial |
$952.00
|
| Rate for Payer: WEA Trust Commercial |
$1,047.20
|
| Rate for Payer: WPS Commercial |
$1,410.29
|
|
|
Apex 4.0mm x 8mm
|
Facility
OP
|
$1,904.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
1159020
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$533.12 |
| Max. Negotiated Rate |
$1,751.68 |
| Rate for Payer: Aetna Commercial |
$1,713.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,637.44
|
| Rate for Payer: Aetna Managed Medicare |
$533.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,237.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$952.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$913.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,009.12
|
| Rate for Payer: Cash Price |
$571.20
|
| Rate for Payer: Cigna Commercial |
$1,751.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,065.48
|
| Rate for Payer: Health EOS Commercial |
$1,694.56
|
| Rate for Payer: HFN Commercial |
$1,751.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,428.00
|
| Rate for Payer: Multiplan Commercial |
$1,523.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,142.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,751.68
|
| Rate for Payer: Quartz Beloit One Network |
$932.96
|
| Rate for Payer: Quartz Commercial |
$1,237.60
|
| Rate for Payer: Quartz Medicare Advantage |
$1,142.40
|
| Rate for Payer: WEA Trust Commercial |
$1,047.20
|
| Rate for Payer: WPS Commercial |
$1,410.29
|
|
|
Apex 4.0mm x 8mm
|
Facility
IP
|
$1,904.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
1159020
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$932.96 |
| Max. Negotiated Rate |
$1,751.68 |
| Rate for Payer: Aetna Commercial |
$1,713.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,009.12
|
| Rate for Payer: Cash Price |
$571.20
|
| Rate for Payer: Cigna Commercial |
$1,751.68
|
| Rate for Payer: Health EOS Commercial |
$1,694.56
|
| Rate for Payer: HFN Commercial |
$1,751.68
|
| Rate for Payer: Multiplan Commercial |
$1,523.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,142.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,751.68
|
| Rate for Payer: Quartz Beloit One Network |
$932.96
|
| Rate for Payer: Quartz Commercial |
$1,142.40
|
| Rate for Payer: WEA Trust Commercial |
$1,047.20
|
| Rate for Payer: WPS Commercial |
$1,410.29
|
|
|
Apex 4.0mm x 8mm
|
Professional
|
$1,904.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
1159020
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$837.76 |
| Max. Negotiated Rate |
$1,808.80 |
| Rate for Payer: Aetna Commercial |
$1,808.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,637.44
|
| Rate for Payer: Cash Price |
$571.20
|
| Rate for Payer: Cigna Commercial |
$1,808.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$952.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,142.40
|
| Rate for Payer: Health EOS Commercial |
$1,732.64
|
| Rate for Payer: Multiplan Commercial |
$1,523.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,808.80
|
| Rate for Payer: Quartz Beloit One Network |
$837.76
|
| Rate for Payer: Quartz Commercial |
$1,085.28
|
| Rate for Payer: The Alliance Commercial |
$952.00
|
| Rate for Payer: WEA Trust Commercial |
$1,047.20
|
| Rate for Payer: WPS Commercial |
$1,410.29
|
|
|
Aphasia Assessment Charges ST
|
Facility
IP
|
$1,120.00
|
|
|
Service Code
|
CPT 96105 GN
|
| Hospital Charge Code |
753733
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$548.80 |
| Max. Negotiated Rate |
$1,030.40 |
| Rate for Payer: Aetna Commercial |
$1,008.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$593.60
|
| Rate for Payer: Cash Price |
$336.00
|
| Rate for Payer: Cigna Commercial |
$1,030.40
|
| Rate for Payer: Health EOS Commercial |
$996.80
|
| Rate for Payer: HFN Commercial |
$1,030.40
|
| Rate for Payer: Multiplan Commercial |
$896.00
|
| Rate for Payer: NAPHCARE Commercial |
$672.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,030.40
|
| Rate for Payer: Quartz Beloit One Network |
$548.80
|
| Rate for Payer: Quartz Commercial |
$672.00
|
| Rate for Payer: WEA Trust Commercial |
$616.00
|
| Rate for Payer: WPS Commercial |
$829.58
|
|
|
Aphasia Assessment Charges ST
|
Facility
OP
|
$1,120.00
|
|
|
Service Code
|
CPT 96105 GN
|
| Hospital Charge Code |
753733
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$202.00 |
| Max. Negotiated Rate |
$4,480.00 |
| Rate for Payer: Aetna Commercial |
$1,008.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$963.20
|
| Rate for Payer: Aetna Managed Medicare |
$313.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$349.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$287.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$272.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$593.60
|
| Rate for Payer: Cash Price |
$336.00
|
| Rate for Payer: Cash Price |
$336.00
|
| Rate for Payer: Cigna Commercial |
$1,030.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$626.75
|
| Rate for Payer: Health EOS Commercial |
$996.80
|
| Rate for Payer: HFN Commercial |
$1,030.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$202.00
|
| Rate for Payer: Multiplan Commercial |
$896.00
|
| Rate for Payer: NAPHCARE Commercial |
$672.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,030.40
|
| Rate for Payer: Quartz Beloit One Network |
$548.80
|
| Rate for Payer: Quartz Commercial |
$728.00
|
| Rate for Payer: Quartz Medicare Advantage |
$672.00
|
| Rate for Payer: The Alliance Commercial |
$4,480.00
|
| Rate for Payer: United Healthcare PPO |
$840.00
|
| Rate for Payer: WEA Trust Commercial |
$616.00
|
| Rate for Payer: WPS Commercial |
$829.58
|
|
|
Aph FFP 3
|
Facility
IP
|
$356.00
|
|
|
Service Code
|
HCPCS P9017
|
| Hospital Charge Code |
1052844
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$174.44 |
| Max. Negotiated Rate |
$327.52 |
| Rate for Payer: Aetna Commercial |
$320.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$188.68
|
| Rate for Payer: Cash Price |
$106.80
|
| Rate for Payer: Cigna Commercial |
$327.52
|
| Rate for Payer: Health EOS Commercial |
$316.84
|
| Rate for Payer: HFN Commercial |
$327.52
|
| Rate for Payer: Multiplan Commercial |
$284.80
|
| Rate for Payer: NAPHCARE Commercial |
$213.60
|
| Rate for Payer: Preferred Network Access Commercial |
$327.52
|
| Rate for Payer: Quartz Beloit One Network |
$174.44
|
| Rate for Payer: Quartz Commercial |
$213.60
|
| Rate for Payer: WEA Trust Commercial |
$195.80
|
| Rate for Payer: WPS Commercial |
$263.69
|
|
|
Aph FFP 3
|
Facility
OP
|
$356.00
|
|
|
Service Code
|
HCPCS P9017
|
| Hospital Charge Code |
1052844
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$38.65 |
| Max. Negotiated Rate |
$595.32 |
| Rate for Payer: Aetna Commercial |
$320.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$306.16
|
| Rate for Payer: Aetna Managed Medicare |
$82.95
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$231.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$178.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$170.88
|
| Rate for Payer: Anthem Medicaid |
$38.65
|
| Rate for Payer: Anthem Medicare Advantage |
$82.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$188.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$82.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$82.95
|
| Rate for Payer: Cash Price |
$106.80
|
| Rate for Payer: Cash Price |
$106.80
|
| Rate for Payer: Cigna Commercial |
$327.52
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$82.95
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$38.65
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$199.22
|
| Rate for Payer: Dean Health Medicaid |
$38.65
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$82.95
|
| Rate for Payer: Health EOS Commercial |
$316.84
|
| Rate for Payer: HFN Commercial |
$327.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$308.57
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$82.95
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$38.65
|
| Rate for Payer: Independent Care Health Plan Medicare |
$82.95
|
| Rate for Payer: Managed Health Services Medicaid |
$40.20
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$82.95
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$82.95
|
| Rate for Payer: Multiplan Commercial |
$284.80
|
| Rate for Payer: NAPHCARE Commercial |
$124.42
|
| Rate for Payer: Preferred Network Access Commercial |
$327.52
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$38.65
|
| Rate for Payer: Quartz Beloit One Network |
$174.44
|
| Rate for Payer: Quartz Commercial |
$231.40
|
| Rate for Payer: Quartz Medicare Advantage |
$82.95
|
| Rate for Payer: The Alliance Commercial |
$595.32
|
| Rate for Payer: United Healthcare Medicaid |
$38.65
|
| Rate for Payer: United Healthcare Medicare Advantage |
$82.95
|
| Rate for Payer: United Healthcare PPO |
$267.00
|
| Rate for Payer: WEA Trust Commercial |
$195.80
|
| Rate for Payer: Wellcare Medicare |
$82.95
|
| Rate for Payer: WMAP Medicaid |
$38.65
|
| Rate for Payer: WPS Commercial |
$263.69
|
|
|
Aph FFP ACDA
|
Facility
OP
|
$356.00
|
|
|
Service Code
|
HCPCS P9017
|
| Hospital Charge Code |
1052860
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$38.65 |
| Max. Negotiated Rate |
$595.32 |
| Rate for Payer: Aetna Commercial |
$320.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$306.16
|
| Rate for Payer: Aetna Managed Medicare |
$82.95
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$231.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$178.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$170.88
|
| Rate for Payer: Anthem Medicaid |
$38.65
|
| Rate for Payer: Anthem Medicare Advantage |
$82.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$188.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$82.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$82.95
|
| Rate for Payer: Cash Price |
$106.80
|
| Rate for Payer: Cash Price |
$106.80
|
| Rate for Payer: Cigna Commercial |
$327.52
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$82.95
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$38.65
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$199.22
|
| Rate for Payer: Dean Health Medicaid |
$38.65
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$82.95
|
| Rate for Payer: Health EOS Commercial |
$316.84
|
| Rate for Payer: HFN Commercial |
$327.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$308.57
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$82.95
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$38.65
|
| Rate for Payer: Independent Care Health Plan Medicare |
$82.95
|
| Rate for Payer: Managed Health Services Medicaid |
$40.20
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$82.95
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$82.95
|
| Rate for Payer: Multiplan Commercial |
$284.80
|
| Rate for Payer: NAPHCARE Commercial |
$124.42
|
| Rate for Payer: Preferred Network Access Commercial |
$327.52
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$38.65
|
| Rate for Payer: Quartz Beloit One Network |
$174.44
|
| Rate for Payer: Quartz Commercial |
$231.40
|
| Rate for Payer: Quartz Medicare Advantage |
$82.95
|
| Rate for Payer: The Alliance Commercial |
$595.32
|
| Rate for Payer: United Healthcare Medicaid |
$38.65
|
| Rate for Payer: United Healthcare Medicare Advantage |
$82.95
|
| Rate for Payer: United Healthcare PPO |
$267.00
|
| Rate for Payer: WEA Trust Commercial |
$195.80
|
| Rate for Payer: Wellcare Medicare |
$82.95
|
| Rate for Payer: WMAP Medicaid |
$38.65
|
| Rate for Payer: WPS Commercial |
$263.69
|
|
|
Aph FFP ACDA
|
Facility
IP
|
$356.00
|
|
|
Service Code
|
HCPCS P9017
|
| Hospital Charge Code |
1052860
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$174.44 |
| Max. Negotiated Rate |
$327.52 |
| Rate for Payer: Aetna Commercial |
$320.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$188.68
|
| Rate for Payer: Cash Price |
$106.80
|
| Rate for Payer: Cigna Commercial |
$327.52
|
| Rate for Payer: Health EOS Commercial |
$316.84
|
| Rate for Payer: HFN Commercial |
$327.52
|
| Rate for Payer: Multiplan Commercial |
$284.80
|
| Rate for Payer: NAPHCARE Commercial |
$213.60
|
| Rate for Payer: Preferred Network Access Commercial |
$327.52
|
| Rate for Payer: Quartz Beloit One Network |
$174.44
|
| Rate for Payer: Quartz Commercial |
$213.60
|
| Rate for Payer: WEA Trust Commercial |
$195.80
|
| Rate for Payer: WPS Commercial |
$263.69
|
|
|
Aph FFP ACDA 1
|
Facility
IP
|
$356.00
|
|
|
Service Code
|
HCPCS P9017
|
| Hospital Charge Code |
1052867
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$174.44 |
| Max. Negotiated Rate |
$327.52 |
| Rate for Payer: Aetna Commercial |
$320.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$188.68
|
| Rate for Payer: Cash Price |
$106.80
|
| Rate for Payer: Cigna Commercial |
$327.52
|
| Rate for Payer: Health EOS Commercial |
$316.84
|
| Rate for Payer: HFN Commercial |
$327.52
|
| Rate for Payer: Multiplan Commercial |
$284.80
|
| Rate for Payer: NAPHCARE Commercial |
$213.60
|
| Rate for Payer: Preferred Network Access Commercial |
$327.52
|
| Rate for Payer: Quartz Beloit One Network |
$174.44
|
| Rate for Payer: Quartz Commercial |
$213.60
|
| Rate for Payer: WEA Trust Commercial |
$195.80
|
| Rate for Payer: WPS Commercial |
$263.69
|
|
|
Aph FFP ACDA 1
|
Facility
OP
|
$356.00
|
|
|
Service Code
|
HCPCS P9017
|
| Hospital Charge Code |
1052867
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$38.65 |
| Max. Negotiated Rate |
$595.32 |
| Rate for Payer: Aetna Commercial |
$320.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$306.16
|
| Rate for Payer: Aetna Managed Medicare |
$82.95
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$231.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$178.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$170.88
|
| Rate for Payer: Anthem Medicaid |
$38.65
|
| Rate for Payer: Anthem Medicare Advantage |
$82.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$188.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$82.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$82.95
|
| Rate for Payer: Cash Price |
$106.80
|
| Rate for Payer: Cash Price |
$106.80
|
| Rate for Payer: Cigna Commercial |
$327.52
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$82.95
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$38.65
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$199.22
|
| Rate for Payer: Dean Health Medicaid |
$38.65
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$82.95
|
| Rate for Payer: Health EOS Commercial |
$316.84
|
| Rate for Payer: HFN Commercial |
$327.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$308.57
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$82.95
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$38.65
|
| Rate for Payer: Independent Care Health Plan Medicare |
$82.95
|
| Rate for Payer: Managed Health Services Medicaid |
$40.20
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$82.95
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$82.95
|
| Rate for Payer: Multiplan Commercial |
$284.80
|
| Rate for Payer: NAPHCARE Commercial |
$124.42
|
| Rate for Payer: Preferred Network Access Commercial |
$327.52
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$38.65
|
| Rate for Payer: Quartz Beloit One Network |
$174.44
|
| Rate for Payer: Quartz Commercial |
$231.40
|
| Rate for Payer: Quartz Medicare Advantage |
$82.95
|
| Rate for Payer: The Alliance Commercial |
$595.32
|
| Rate for Payer: United Healthcare Medicaid |
$38.65
|
| Rate for Payer: United Healthcare Medicare Advantage |
$82.95
|
| Rate for Payer: United Healthcare PPO |
$267.00
|
| Rate for Payer: WEA Trust Commercial |
$195.80
|
| Rate for Payer: Wellcare Medicare |
$82.95
|
| Rate for Payer: WMAP Medicaid |
$38.65
|
| Rate for Payer: WPS Commercial |
$263.69
|
|
|
Aph FFP ACDA 2
|
Facility
OP
|
$356.00
|
|
|
Service Code
|
HCPCS P9017
|
| Hospital Charge Code |
1052861
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$38.65 |
| Max. Negotiated Rate |
$595.32 |
| Rate for Payer: Aetna Commercial |
$320.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$306.16
|
| Rate for Payer: Aetna Managed Medicare |
$82.95
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$231.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$178.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$170.88
|
| Rate for Payer: Anthem Medicaid |
$38.65
|
| Rate for Payer: Anthem Medicare Advantage |
$82.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$188.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$82.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$82.95
|
| Rate for Payer: Cash Price |
$106.80
|
| Rate for Payer: Cash Price |
$106.80
|
| Rate for Payer: Cigna Commercial |
$327.52
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$82.95
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$38.65
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$199.22
|
| Rate for Payer: Dean Health Medicaid |
$38.65
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$82.95
|
| Rate for Payer: Health EOS Commercial |
$316.84
|
| Rate for Payer: HFN Commercial |
$327.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$308.57
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$82.95
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$38.65
|
| Rate for Payer: Independent Care Health Plan Medicare |
$82.95
|
| Rate for Payer: Managed Health Services Medicaid |
$40.20
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$82.95
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$82.95
|
| Rate for Payer: Multiplan Commercial |
$284.80
|
| Rate for Payer: NAPHCARE Commercial |
$124.42
|
| Rate for Payer: Preferred Network Access Commercial |
$327.52
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$38.65
|
| Rate for Payer: Quartz Beloit One Network |
$174.44
|
| Rate for Payer: Quartz Commercial |
$231.40
|
| Rate for Payer: Quartz Medicare Advantage |
$82.95
|
| Rate for Payer: The Alliance Commercial |
$595.32
|
| Rate for Payer: United Healthcare Medicaid |
$38.65
|
| Rate for Payer: United Healthcare Medicare Advantage |
$82.95
|
| Rate for Payer: United Healthcare PPO |
$267.00
|
| Rate for Payer: WEA Trust Commercial |
$195.80
|
| Rate for Payer: Wellcare Medicare |
$82.95
|
| Rate for Payer: WMAP Medicaid |
$38.65
|
| Rate for Payer: WPS Commercial |
$263.69
|
|
|
Aph FFP ACDA 2
|
Facility
IP
|
$356.00
|
|
|
Service Code
|
HCPCS P9017
|
| Hospital Charge Code |
1052861
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$174.44 |
| Max. Negotiated Rate |
$327.52 |
| Rate for Payer: Aetna Commercial |
$320.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$188.68
|
| Rate for Payer: Cash Price |
$106.80
|
| Rate for Payer: Cigna Commercial |
$327.52
|
| Rate for Payer: Health EOS Commercial |
$316.84
|
| Rate for Payer: HFN Commercial |
$327.52
|
| Rate for Payer: Multiplan Commercial |
$284.80
|
| Rate for Payer: NAPHCARE Commercial |
$213.60
|
| Rate for Payer: Preferred Network Access Commercial |
$327.52
|
| Rate for Payer: Quartz Beloit One Network |
$174.44
|
| Rate for Payer: Quartz Commercial |
$213.60
|
| Rate for Payer: WEA Trust Commercial |
$195.80
|
| Rate for Payer: WPS Commercial |
$263.69
|
|
|
Aph Plsm RT 24 ACDA
|
Facility
IP
|
$356.00
|
|
|
Service Code
|
HCPCS P9059
|
| Hospital Charge Code |
6224232
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$174.44 |
| Max. Negotiated Rate |
$327.52 |
| Rate for Payer: Aetna Commercial |
$320.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$188.68
|
| Rate for Payer: Cash Price |
$106.80
|
| Rate for Payer: Cigna Commercial |
$327.52
|
| Rate for Payer: Health EOS Commercial |
$316.84
|
| Rate for Payer: HFN Commercial |
$327.52
|
| Rate for Payer: Multiplan Commercial |
$284.80
|
| Rate for Payer: NAPHCARE Commercial |
$213.60
|
| Rate for Payer: Preferred Network Access Commercial |
$327.52
|
| Rate for Payer: Quartz Beloit One Network |
$174.44
|
| Rate for Payer: Quartz Commercial |
$213.60
|
| Rate for Payer: WEA Trust Commercial |
$195.80
|
| Rate for Payer: WPS Commercial |
$263.69
|
|
|
Aph Plsm RT 24 ACDA
|
Facility
OP
|
$356.00
|
|
|
Service Code
|
HCPCS P9059
|
| Hospital Charge Code |
6224232
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$75.28 |
| Max. Negotiated Rate |
$2,042.72 |
| Rate for Payer: Aetna Commercial |
$320.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$306.16
|
| Rate for Payer: Aetna Managed Medicare |
$75.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$231.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$178.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$170.88
|
| Rate for Payer: Anthem Medicare Advantage |
$75.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$188.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$75.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$75.28
|
| Rate for Payer: Cash Price |
$106.80
|
| Rate for Payer: Cash Price |
$106.80
|
| Rate for Payer: Cigna Commercial |
$327.52
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$75.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$199.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$75.28
|
| Rate for Payer: Health EOS Commercial |
$316.84
|
| Rate for Payer: HFN Commercial |
$327.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$280.04
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$75.28
|
| Rate for Payer: Independent Care Health Plan Medicare |
$75.28
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$75.28
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$75.28
|
| Rate for Payer: Multiplan Commercial |
$284.80
|
| Rate for Payer: NAPHCARE Commercial |
$112.92
|
| Rate for Payer: Preferred Network Access Commercial |
$327.52
|
| Rate for Payer: Quartz Beloit One Network |
$174.44
|
| Rate for Payer: Quartz Commercial |
$231.40
|
| Rate for Payer: Quartz Medicare Advantage |
$75.28
|
| Rate for Payer: The Alliance Commercial |
$2,042.72
|
| Rate for Payer: United Healthcare Medicare Advantage |
$75.28
|
| Rate for Payer: United Healthcare PPO |
$267.00
|
| Rate for Payer: WEA Trust Commercial |
$195.80
|
| Rate for Payer: Wellcare Medicare |
$75.28
|
| Rate for Payer: WPS Commercial |
$263.69
|
|
|
Aph Plsm RT 24 ACDA 1
|
Facility
IP
|
$356.00
|
|
|
Service Code
|
HCPCS P9059
|
| Hospital Charge Code |
6224233
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$174.44 |
| Max. Negotiated Rate |
$327.52 |
| Rate for Payer: Aetna Commercial |
$320.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$188.68
|
| Rate for Payer: Cash Price |
$106.80
|
| Rate for Payer: Cigna Commercial |
$327.52
|
| Rate for Payer: Health EOS Commercial |
$316.84
|
| Rate for Payer: HFN Commercial |
$327.52
|
| Rate for Payer: Multiplan Commercial |
$284.80
|
| Rate for Payer: NAPHCARE Commercial |
$213.60
|
| Rate for Payer: Preferred Network Access Commercial |
$327.52
|
| Rate for Payer: Quartz Beloit One Network |
$174.44
|
| Rate for Payer: Quartz Commercial |
$213.60
|
| Rate for Payer: WEA Trust Commercial |
$195.80
|
| Rate for Payer: WPS Commercial |
$263.69
|
|
|
Aph Plsm RT 24 ACDA 1
|
Facility
OP
|
$356.00
|
|
|
Service Code
|
HCPCS P9059
|
| Hospital Charge Code |
6224233
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$75.28 |
| Max. Negotiated Rate |
$2,042.72 |
| Rate for Payer: Aetna Commercial |
$320.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$306.16
|
| Rate for Payer: Aetna Managed Medicare |
$75.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$231.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$178.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$170.88
|
| Rate for Payer: Anthem Medicare Advantage |
$75.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$188.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$75.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$75.28
|
| Rate for Payer: Cash Price |
$106.80
|
| Rate for Payer: Cash Price |
$106.80
|
| Rate for Payer: Cigna Commercial |
$327.52
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$75.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$199.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$75.28
|
| Rate for Payer: Health EOS Commercial |
$316.84
|
| Rate for Payer: HFN Commercial |
$327.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$280.04
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$75.28
|
| Rate for Payer: Independent Care Health Plan Medicare |
$75.28
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$75.28
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$75.28
|
| Rate for Payer: Multiplan Commercial |
$284.80
|
| Rate for Payer: NAPHCARE Commercial |
$112.92
|
| Rate for Payer: Preferred Network Access Commercial |
$327.52
|
| Rate for Payer: Quartz Beloit One Network |
$174.44
|
| Rate for Payer: Quartz Commercial |
$231.40
|
| Rate for Payer: Quartz Medicare Advantage |
$75.28
|
| Rate for Payer: The Alliance Commercial |
$2,042.72
|
| Rate for Payer: United Healthcare Medicare Advantage |
$75.28
|
| Rate for Payer: United Healthcare PPO |
$267.00
|
| Rate for Payer: WEA Trust Commercial |
$195.80
|
| Rate for Payer: Wellcare Medicare |
$75.28
|
| Rate for Payer: WPS Commercial |
$263.69
|
|
|
Aph Plsm RT 24 ACDA 2
|
Facility
IP
|
$356.00
|
|
|
Service Code
|
HCPCS P9059
|
| Hospital Charge Code |
6224234
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$174.44 |
| Max. Negotiated Rate |
$327.52 |
| Rate for Payer: Aetna Commercial |
$320.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$188.68
|
| Rate for Payer: Cash Price |
$106.80
|
| Rate for Payer: Cigna Commercial |
$327.52
|
| Rate for Payer: Health EOS Commercial |
$316.84
|
| Rate for Payer: HFN Commercial |
$327.52
|
| Rate for Payer: Multiplan Commercial |
$284.80
|
| Rate for Payer: NAPHCARE Commercial |
$213.60
|
| Rate for Payer: Preferred Network Access Commercial |
$327.52
|
| Rate for Payer: Quartz Beloit One Network |
$174.44
|
| Rate for Payer: Quartz Commercial |
$213.60
|
| Rate for Payer: WEA Trust Commercial |
$195.80
|
| Rate for Payer: WPS Commercial |
$263.69
|
|
|
Aph Plsm RT 24 ACDA 2
|
Facility
OP
|
$356.00
|
|
|
Service Code
|
HCPCS P9059
|
| Hospital Charge Code |
6224234
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$75.28 |
| Max. Negotiated Rate |
$2,042.72 |
| Rate for Payer: Aetna Commercial |
$320.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$306.16
|
| Rate for Payer: Aetna Managed Medicare |
$75.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$231.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$178.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$170.88
|
| Rate for Payer: Anthem Medicare Advantage |
$75.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$188.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$75.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$75.28
|
| Rate for Payer: Cash Price |
$106.80
|
| Rate for Payer: Cash Price |
$106.80
|
| Rate for Payer: Cigna Commercial |
$327.52
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$75.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$199.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$75.28
|
| Rate for Payer: Health EOS Commercial |
$316.84
|
| Rate for Payer: HFN Commercial |
$327.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$280.04
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$75.28
|
| Rate for Payer: Independent Care Health Plan Medicare |
$75.28
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$75.28
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$75.28
|
| Rate for Payer: Multiplan Commercial |
$284.80
|
| Rate for Payer: NAPHCARE Commercial |
$112.92
|
| Rate for Payer: Preferred Network Access Commercial |
$327.52
|
| Rate for Payer: Quartz Beloit One Network |
$174.44
|
| Rate for Payer: Quartz Commercial |
$231.40
|
| Rate for Payer: Quartz Medicare Advantage |
$75.28
|
| Rate for Payer: The Alliance Commercial |
$2,042.72
|
| Rate for Payer: United Healthcare Medicare Advantage |
$75.28
|
| Rate for Payer: United Healthcare PPO |
$267.00
|
| Rate for Payer: WEA Trust Commercial |
$195.80
|
| Rate for Payer: Wellcare Medicare |
$75.28
|
| Rate for Payer: WPS Commercial |
$263.69
|
|
|
Aph Plsm RT 24 ACDA 3
|
Facility
OP
|
$356.00
|
|
|
Service Code
|
HCPCS P9059
|
| Hospital Charge Code |
6224230
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$75.28 |
| Max. Negotiated Rate |
$2,042.72 |
| Rate for Payer: Aetna Commercial |
$320.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$306.16
|
| Rate for Payer: Aetna Managed Medicare |
$75.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$231.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$178.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$170.88
|
| Rate for Payer: Anthem Medicare Advantage |
$75.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$188.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$75.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$75.28
|
| Rate for Payer: Cash Price |
$106.80
|
| Rate for Payer: Cash Price |
$106.80
|
| Rate for Payer: Cigna Commercial |
$327.52
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$75.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$199.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$75.28
|
| Rate for Payer: Health EOS Commercial |
$316.84
|
| Rate for Payer: HFN Commercial |
$327.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$280.04
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$75.28
|
| Rate for Payer: Independent Care Health Plan Medicare |
$75.28
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$75.28
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$75.28
|
| Rate for Payer: Multiplan Commercial |
$284.80
|
| Rate for Payer: NAPHCARE Commercial |
$112.92
|
| Rate for Payer: Preferred Network Access Commercial |
$327.52
|
| Rate for Payer: Quartz Beloit One Network |
$174.44
|
| Rate for Payer: Quartz Commercial |
$231.40
|
| Rate for Payer: Quartz Medicare Advantage |
$75.28
|
| Rate for Payer: The Alliance Commercial |
$2,042.72
|
| Rate for Payer: United Healthcare Medicare Advantage |
$75.28
|
| Rate for Payer: United Healthcare PPO |
$267.00
|
| Rate for Payer: WEA Trust Commercial |
$195.80
|
| Rate for Payer: Wellcare Medicare |
$75.28
|
| Rate for Payer: WPS Commercial |
$263.69
|
|
|
Aph Plsm RT 24 ACDA 3
|
Facility
IP
|
$356.00
|
|
|
Service Code
|
HCPCS P9059
|
| Hospital Charge Code |
6224230
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$174.44 |
| Max. Negotiated Rate |
$327.52 |
| Rate for Payer: Aetna Commercial |
$320.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$188.68
|
| Rate for Payer: Cash Price |
$106.80
|
| Rate for Payer: Cigna Commercial |
$327.52
|
| Rate for Payer: Health EOS Commercial |
$316.84
|
| Rate for Payer: HFN Commercial |
$327.52
|
| Rate for Payer: Multiplan Commercial |
$284.80
|
| Rate for Payer: NAPHCARE Commercial |
$213.60
|
| Rate for Payer: Preferred Network Access Commercial |
$327.52
|
| Rate for Payer: Quartz Beloit One Network |
$174.44
|
| Rate for Payer: Quartz Commercial |
$213.60
|
| Rate for Payer: WEA Trust Commercial |
$195.80
|
| Rate for Payer: WPS Commercial |
$263.69
|
|
