|
Aph Plsm RT 24 ACDA 4
|
Facility
IP
|
$356.00
|
|
|
Service Code
|
HCPCS P9059
|
| Hospital Charge Code |
6224231
|
|
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 4
|
Facility
OP
|
$356.00
|
|
|
Service Code
|
HCPCS P9059
|
| Hospital Charge Code |
6224231
|
|
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 Plt ACDA
|
Facility
OP
|
$3,434.00
|
|
|
Service Code
|
HCPCS P9019
|
| Hospital Charge Code |
1052801
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$64.42 |
| Max. Negotiated Rate |
$3,159.28 |
| Rate for Payer: Aetna Commercial |
$3,090.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,953.24
|
| Rate for Payer: Aetna Managed Medicare |
$67.47
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,232.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,717.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,648.32
|
| Rate for Payer: Anthem Medicaid |
$64.42
|
| Rate for Payer: Anthem Medicare Advantage |
$67.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,820.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$67.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$67.47
|
| Rate for Payer: Cash Price |
$1,030.20
|
| Rate for Payer: Cash Price |
$1,030.20
|
| Rate for Payer: Cigna Commercial |
$3,159.28
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$67.47
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$64.42
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,921.67
|
| Rate for Payer: Dean Health Medicaid |
$64.42
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$67.47
|
| Rate for Payer: Health EOS Commercial |
$3,056.26
|
| Rate for Payer: HFN Commercial |
$3,159.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$250.99
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$67.47
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$64.42
|
| Rate for Payer: Independent Care Health Plan Medicare |
$67.47
|
| Rate for Payer: Managed Health Services Medicaid |
$67.00
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$67.47
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$67.47
|
| Rate for Payer: Multiplan Commercial |
$2,747.20
|
| Rate for Payer: NAPHCARE Commercial |
$101.20
|
| Rate for Payer: Preferred Network Access Commercial |
$3,159.28
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$64.42
|
| Rate for Payer: Quartz Beloit One Network |
$1,682.66
|
| Rate for Payer: Quartz Commercial |
$2,232.10
|
| Rate for Payer: Quartz Medicare Advantage |
$67.47
|
| Rate for Payer: The Alliance Commercial |
$2,042.72
|
| Rate for Payer: United Healthcare Medicaid |
$64.42
|
| Rate for Payer: United Healthcare Medicare Advantage |
$67.47
|
| Rate for Payer: United Healthcare PPO |
$2,575.50
|
| Rate for Payer: WEA Trust Commercial |
$1,888.70
|
| Rate for Payer: Wellcare Medicare |
$67.47
|
| Rate for Payer: WMAP Medicaid |
$64.42
|
| Rate for Payer: WPS Commercial |
$2,543.56
|
|
|
Aph Plt ACDA
|
Facility
IP
|
$3,434.00
|
|
|
Service Code
|
HCPCS P9019
|
| Hospital Charge Code |
1052801
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$1,682.66 |
| Max. Negotiated Rate |
$3,159.28 |
| Rate for Payer: Aetna Commercial |
$3,090.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,820.02
|
| Rate for Payer: Cash Price |
$1,030.20
|
| Rate for Payer: Cigna Commercial |
$3,159.28
|
| Rate for Payer: Health EOS Commercial |
$3,056.26
|
| Rate for Payer: HFN Commercial |
$3,159.28
|
| Rate for Payer: Multiplan Commercial |
$2,747.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,060.40
|
| Rate for Payer: Preferred Network Access Commercial |
$3,159.28
|
| Rate for Payer: Quartz Beloit One Network |
$1,682.66
|
| Rate for Payer: Quartz Commercial |
$2,060.40
|
| Rate for Payer: WEA Trust Commercial |
$1,888.70
|
| Rate for Payer: WPS Commercial |
$2,543.56
|
|
|
Aph Plt ACDA 1
|
Facility
IP
|
$3,434.00
|
|
|
Service Code
|
HCPCS P9019
|
| Hospital Charge Code |
1052811
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$1,682.66 |
| Max. Negotiated Rate |
$3,159.28 |
| Rate for Payer: Aetna Commercial |
$3,090.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,820.02
|
| Rate for Payer: Cash Price |
$1,030.20
|
| Rate for Payer: Cigna Commercial |
$3,159.28
|
| Rate for Payer: Health EOS Commercial |
$3,056.26
|
| Rate for Payer: HFN Commercial |
$3,159.28
|
| Rate for Payer: Multiplan Commercial |
$2,747.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,060.40
|
| Rate for Payer: Preferred Network Access Commercial |
$3,159.28
|
| Rate for Payer: Quartz Beloit One Network |
$1,682.66
|
| Rate for Payer: Quartz Commercial |
$2,060.40
|
| Rate for Payer: WEA Trust Commercial |
$1,888.70
|
| Rate for Payer: WPS Commercial |
$2,543.56
|
|
|
Aph Plt ACDA 1
|
Facility
OP
|
$3,434.00
|
|
|
Service Code
|
HCPCS P9019
|
| Hospital Charge Code |
1052811
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$64.42 |
| Max. Negotiated Rate |
$3,159.28 |
| Rate for Payer: Aetna Commercial |
$3,090.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,953.24
|
| Rate for Payer: Aetna Managed Medicare |
$67.47
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,232.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,717.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,648.32
|
| Rate for Payer: Anthem Medicaid |
$64.42
|
| Rate for Payer: Anthem Medicare Advantage |
$67.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,820.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$67.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$67.47
|
| Rate for Payer: Cash Price |
$1,030.20
|
| Rate for Payer: Cash Price |
$1,030.20
|
| Rate for Payer: Cigna Commercial |
$3,159.28
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$67.47
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$64.42
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,921.67
|
| Rate for Payer: Dean Health Medicaid |
$64.42
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$67.47
|
| Rate for Payer: Health EOS Commercial |
$3,056.26
|
| Rate for Payer: HFN Commercial |
$3,159.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$250.99
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$67.47
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$64.42
|
| Rate for Payer: Independent Care Health Plan Medicare |
$67.47
|
| Rate for Payer: Managed Health Services Medicaid |
$67.00
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$67.47
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$67.47
|
| Rate for Payer: Multiplan Commercial |
$2,747.20
|
| Rate for Payer: NAPHCARE Commercial |
$101.20
|
| Rate for Payer: Preferred Network Access Commercial |
$3,159.28
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$64.42
|
| Rate for Payer: Quartz Beloit One Network |
$1,682.66
|
| Rate for Payer: Quartz Commercial |
$2,232.10
|
| Rate for Payer: Quartz Medicare Advantage |
$67.47
|
| Rate for Payer: The Alliance Commercial |
$2,042.72
|
| Rate for Payer: United Healthcare Medicaid |
$64.42
|
| Rate for Payer: United Healthcare Medicare Advantage |
$67.47
|
| Rate for Payer: United Healthcare PPO |
$2,575.50
|
| Rate for Payer: WEA Trust Commercial |
$1,888.70
|
| Rate for Payer: Wellcare Medicare |
$67.47
|
| Rate for Payer: WMAP Medicaid |
$64.42
|
| Rate for Payer: WPS Commercial |
$2,543.56
|
|
|
Aph Plt ACDA 1 Psoralen
|
Facility
IP
|
$3,434.00
|
|
|
Service Code
|
HCPCS P9073
|
| Hospital Charge Code |
5775838
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$1,682.66 |
| Max. Negotiated Rate |
$3,159.28 |
| Rate for Payer: Aetna Commercial |
$3,090.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,820.02
|
| Rate for Payer: Cash Price |
$1,030.20
|
| Rate for Payer: Cigna Commercial |
$3,159.28
|
| Rate for Payer: Health EOS Commercial |
$3,056.26
|
| Rate for Payer: HFN Commercial |
$3,159.28
|
| Rate for Payer: Multiplan Commercial |
$2,747.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,060.40
|
| Rate for Payer: Preferred Network Access Commercial |
$3,159.28
|
| Rate for Payer: Quartz Beloit One Network |
$1,682.66
|
| Rate for Payer: Quartz Commercial |
$2,060.40
|
| Rate for Payer: WEA Trust Commercial |
$1,888.70
|
| Rate for Payer: WPS Commercial |
$2,543.56
|
|
|
Aph Plt ACDA 1 Psoralen
|
Facility
OP
|
$3,434.00
|
|
|
Service Code
|
HCPCS P9073
|
| Hospital Charge Code |
5775838
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$571.89 |
| Max. Negotiated Rate |
$3,984.72 |
| Rate for Payer: Aetna Commercial |
$3,090.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,953.24
|
| Rate for Payer: Aetna Managed Medicare |
$571.89
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,232.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,717.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,648.32
|
| Rate for Payer: Anthem Medicare Advantage |
$571.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,820.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$571.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$571.89
|
| Rate for Payer: Cash Price |
$1,030.20
|
| Rate for Payer: Cash Price |
$1,030.20
|
| Rate for Payer: Cigna Commercial |
$3,159.28
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$571.89
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,921.67
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$571.89
|
| Rate for Payer: Health EOS Commercial |
$3,056.26
|
| Rate for Payer: HFN Commercial |
$3,159.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,127.43
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$571.89
|
| Rate for Payer: Independent Care Health Plan Medicare |
$571.89
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$571.89
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$571.89
|
| Rate for Payer: Multiplan Commercial |
$2,747.20
|
| Rate for Payer: NAPHCARE Commercial |
$857.84
|
| Rate for Payer: Preferred Network Access Commercial |
$3,159.28
|
| Rate for Payer: Quartz Beloit One Network |
$1,682.66
|
| Rate for Payer: Quartz Commercial |
$2,232.10
|
| Rate for Payer: Quartz Medicare Advantage |
$571.89
|
| Rate for Payer: The Alliance Commercial |
$3,984.72
|
| Rate for Payer: United Healthcare Medicare Advantage |
$571.89
|
| Rate for Payer: United Healthcare PPO |
$2,575.50
|
| Rate for Payer: WEA Trust Commercial |
$1,888.70
|
| Rate for Payer: Wellcare Medicare |
$571.89
|
| Rate for Payer: WPS Commercial |
$2,543.56
|
|
|
Aph Plt ACDA 2
|
Facility
OP
|
$3,434.00
|
|
|
Service Code
|
HCPCS P9019
|
| Hospital Charge Code |
1052805
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$64.42 |
| Max. Negotiated Rate |
$3,159.28 |
| Rate for Payer: Aetna Commercial |
$3,090.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,953.24
|
| Rate for Payer: Aetna Managed Medicare |
$67.47
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,232.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,717.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,648.32
|
| Rate for Payer: Anthem Medicaid |
$64.42
|
| Rate for Payer: Anthem Medicare Advantage |
$67.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,820.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$67.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$67.47
|
| Rate for Payer: Cash Price |
$1,030.20
|
| Rate for Payer: Cash Price |
$1,030.20
|
| Rate for Payer: Cigna Commercial |
$3,159.28
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$67.47
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$64.42
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,921.67
|
| Rate for Payer: Dean Health Medicaid |
$64.42
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$67.47
|
| Rate for Payer: Health EOS Commercial |
$3,056.26
|
| Rate for Payer: HFN Commercial |
$3,159.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$250.99
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$67.47
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$64.42
|
| Rate for Payer: Independent Care Health Plan Medicare |
$67.47
|
| Rate for Payer: Managed Health Services Medicaid |
$67.00
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$67.47
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$67.47
|
| Rate for Payer: Multiplan Commercial |
$2,747.20
|
| Rate for Payer: NAPHCARE Commercial |
$101.20
|
| Rate for Payer: Preferred Network Access Commercial |
$3,159.28
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$64.42
|
| Rate for Payer: Quartz Beloit One Network |
$1,682.66
|
| Rate for Payer: Quartz Commercial |
$2,232.10
|
| Rate for Payer: Quartz Medicare Advantage |
$67.47
|
| Rate for Payer: The Alliance Commercial |
$2,042.72
|
| Rate for Payer: United Healthcare Medicaid |
$64.42
|
| Rate for Payer: United Healthcare Medicare Advantage |
$67.47
|
| Rate for Payer: United Healthcare PPO |
$2,575.50
|
| Rate for Payer: WEA Trust Commercial |
$1,888.70
|
| Rate for Payer: Wellcare Medicare |
$67.47
|
| Rate for Payer: WMAP Medicaid |
$64.42
|
| Rate for Payer: WPS Commercial |
$2,543.56
|
|
|
Aph Plt ACDA 2
|
Facility
IP
|
$3,434.00
|
|
|
Service Code
|
HCPCS P9019
|
| Hospital Charge Code |
1052805
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$1,682.66 |
| Max. Negotiated Rate |
$3,159.28 |
| Rate for Payer: Aetna Commercial |
$3,090.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,820.02
|
| Rate for Payer: Cash Price |
$1,030.20
|
| Rate for Payer: Cigna Commercial |
$3,159.28
|
| Rate for Payer: Health EOS Commercial |
$3,056.26
|
| Rate for Payer: HFN Commercial |
$3,159.28
|
| Rate for Payer: Multiplan Commercial |
$2,747.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,060.40
|
| Rate for Payer: Preferred Network Access Commercial |
$3,159.28
|
| Rate for Payer: Quartz Beloit One Network |
$1,682.66
|
| Rate for Payer: Quartz Commercial |
$2,060.40
|
| Rate for Payer: WEA Trust Commercial |
$1,888.70
|
| Rate for Payer: WPS Commercial |
$2,543.56
|
|
|
Aph Plt ACDA 2 Psoralen
|
Facility
OP
|
$3,434.00
|
|
|
Service Code
|
HCPCS P9073
|
| Hospital Charge Code |
5775843
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$571.89 |
| Max. Negotiated Rate |
$3,984.72 |
| Rate for Payer: Aetna Commercial |
$3,090.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,953.24
|
| Rate for Payer: Aetna Managed Medicare |
$571.89
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,232.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,717.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,648.32
|
| Rate for Payer: Anthem Medicare Advantage |
$571.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,820.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$571.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$571.89
|
| Rate for Payer: Cash Price |
$1,030.20
|
| Rate for Payer: Cash Price |
$1,030.20
|
| Rate for Payer: Cigna Commercial |
$3,159.28
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$571.89
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,921.67
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$571.89
|
| Rate for Payer: Health EOS Commercial |
$3,056.26
|
| Rate for Payer: HFN Commercial |
$3,159.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,127.43
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$571.89
|
| Rate for Payer: Independent Care Health Plan Medicare |
$571.89
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$571.89
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$571.89
|
| Rate for Payer: Multiplan Commercial |
$2,747.20
|
| Rate for Payer: NAPHCARE Commercial |
$857.84
|
| Rate for Payer: Preferred Network Access Commercial |
$3,159.28
|
| Rate for Payer: Quartz Beloit One Network |
$1,682.66
|
| Rate for Payer: Quartz Commercial |
$2,232.10
|
| Rate for Payer: Quartz Medicare Advantage |
$571.89
|
| Rate for Payer: The Alliance Commercial |
$3,984.72
|
| Rate for Payer: United Healthcare Medicare Advantage |
$571.89
|
| Rate for Payer: United Healthcare PPO |
$2,575.50
|
| Rate for Payer: WEA Trust Commercial |
$1,888.70
|
| Rate for Payer: Wellcare Medicare |
$571.89
|
| Rate for Payer: WPS Commercial |
$2,543.56
|
|
|
Aph Plt ACDA 2 Psoralen
|
Facility
IP
|
$3,434.00
|
|
|
Service Code
|
HCPCS P9073
|
| Hospital Charge Code |
5775843
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$1,682.66 |
| Max. Negotiated Rate |
$3,159.28 |
| Rate for Payer: Aetna Commercial |
$3,090.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,820.02
|
| Rate for Payer: Cash Price |
$1,030.20
|
| Rate for Payer: Cigna Commercial |
$3,159.28
|
| Rate for Payer: Health EOS Commercial |
$3,056.26
|
| Rate for Payer: HFN Commercial |
$3,159.28
|
| Rate for Payer: Multiplan Commercial |
$2,747.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,060.40
|
| Rate for Payer: Preferred Network Access Commercial |
$3,159.28
|
| Rate for Payer: Quartz Beloit One Network |
$1,682.66
|
| Rate for Payer: Quartz Commercial |
$2,060.40
|
| Rate for Payer: WEA Trust Commercial |
$1,888.70
|
| Rate for Payer: WPS Commercial |
$2,543.56
|
|
|
Aph Plt ACDA 3
|
Facility
IP
|
$3,434.00
|
|
|
Service Code
|
HCPCS P9019
|
| Hospital Charge Code |
1052826
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$1,682.66 |
| Max. Negotiated Rate |
$3,159.28 |
| Rate for Payer: Aetna Commercial |
$3,090.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,820.02
|
| Rate for Payer: Cash Price |
$1,030.20
|
| Rate for Payer: Cigna Commercial |
$3,159.28
|
| Rate for Payer: Health EOS Commercial |
$3,056.26
|
| Rate for Payer: HFN Commercial |
$3,159.28
|
| Rate for Payer: Multiplan Commercial |
$2,747.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,060.40
|
| Rate for Payer: Preferred Network Access Commercial |
$3,159.28
|
| Rate for Payer: Quartz Beloit One Network |
$1,682.66
|
| Rate for Payer: Quartz Commercial |
$2,060.40
|
| Rate for Payer: WEA Trust Commercial |
$1,888.70
|
| Rate for Payer: WPS Commercial |
$2,543.56
|
|
|
Aph Plt ACDA 3
|
Facility
OP
|
$3,434.00
|
|
|
Service Code
|
HCPCS P9019
|
| Hospital Charge Code |
1052826
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$64.42 |
| Max. Negotiated Rate |
$3,159.28 |
| Rate for Payer: Aetna Commercial |
$3,090.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,953.24
|
| Rate for Payer: Aetna Managed Medicare |
$67.47
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,232.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,717.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,648.32
|
| Rate for Payer: Anthem Medicaid |
$64.42
|
| Rate for Payer: Anthem Medicare Advantage |
$67.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,820.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$67.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$67.47
|
| Rate for Payer: Cash Price |
$1,030.20
|
| Rate for Payer: Cash Price |
$1,030.20
|
| Rate for Payer: Cigna Commercial |
$3,159.28
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$67.47
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$64.42
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,921.67
|
| Rate for Payer: Dean Health Medicaid |
$64.42
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$67.47
|
| Rate for Payer: Health EOS Commercial |
$3,056.26
|
| Rate for Payer: HFN Commercial |
$3,159.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$250.99
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$67.47
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$64.42
|
| Rate for Payer: Independent Care Health Plan Medicare |
$67.47
|
| Rate for Payer: Managed Health Services Medicaid |
$67.00
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$67.47
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$67.47
|
| Rate for Payer: Multiplan Commercial |
$2,747.20
|
| Rate for Payer: NAPHCARE Commercial |
$101.20
|
| Rate for Payer: Preferred Network Access Commercial |
$3,159.28
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$64.42
|
| Rate for Payer: Quartz Beloit One Network |
$1,682.66
|
| Rate for Payer: Quartz Commercial |
$2,232.10
|
| Rate for Payer: Quartz Medicare Advantage |
$67.47
|
| Rate for Payer: The Alliance Commercial |
$2,042.72
|
| Rate for Payer: United Healthcare Medicaid |
$64.42
|
| Rate for Payer: United Healthcare Medicare Advantage |
$67.47
|
| Rate for Payer: United Healthcare PPO |
$2,575.50
|
| Rate for Payer: WEA Trust Commercial |
$1,888.70
|
| Rate for Payer: Wellcare Medicare |
$67.47
|
| Rate for Payer: WMAP Medicaid |
$64.42
|
| Rate for Payer: WPS Commercial |
$2,543.56
|
|
|
Aph Plt ACDA 3 Psoralen
|
Facility
OP
|
$3,434.00
|
|
|
Service Code
|
HCPCS P9073
|
| Hospital Charge Code |
5775842
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$571.89 |
| Max. Negotiated Rate |
$3,984.72 |
| Rate for Payer: Aetna Commercial |
$3,090.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,953.24
|
| Rate for Payer: Aetna Managed Medicare |
$571.89
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,232.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,717.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,648.32
|
| Rate for Payer: Anthem Medicare Advantage |
$571.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,820.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$571.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$571.89
|
| Rate for Payer: Cash Price |
$1,030.20
|
| Rate for Payer: Cash Price |
$1,030.20
|
| Rate for Payer: Cigna Commercial |
$3,159.28
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$571.89
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,921.67
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$571.89
|
| Rate for Payer: Health EOS Commercial |
$3,056.26
|
| Rate for Payer: HFN Commercial |
$3,159.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,127.43
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$571.89
|
| Rate for Payer: Independent Care Health Plan Medicare |
$571.89
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$571.89
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$571.89
|
| Rate for Payer: Multiplan Commercial |
$2,747.20
|
| Rate for Payer: NAPHCARE Commercial |
$857.84
|
| Rate for Payer: Preferred Network Access Commercial |
$3,159.28
|
| Rate for Payer: Quartz Beloit One Network |
$1,682.66
|
| Rate for Payer: Quartz Commercial |
$2,232.10
|
| Rate for Payer: Quartz Medicare Advantage |
$571.89
|
| Rate for Payer: The Alliance Commercial |
$3,984.72
|
| Rate for Payer: United Healthcare Medicare Advantage |
$571.89
|
| Rate for Payer: United Healthcare PPO |
$2,575.50
|
| Rate for Payer: WEA Trust Commercial |
$1,888.70
|
| Rate for Payer: Wellcare Medicare |
$571.89
|
| Rate for Payer: WPS Commercial |
$2,543.56
|
|
|
Aph Plt ACDA 3 Psoralen
|
Facility
IP
|
$3,434.00
|
|
|
Service Code
|
HCPCS P9073
|
| Hospital Charge Code |
5775842
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$1,682.66 |
| Max. Negotiated Rate |
$3,159.28 |
| Rate for Payer: Aetna Commercial |
$3,090.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,820.02
|
| Rate for Payer: Cash Price |
$1,030.20
|
| Rate for Payer: Cigna Commercial |
$3,159.28
|
| Rate for Payer: Health EOS Commercial |
$3,056.26
|
| Rate for Payer: HFN Commercial |
$3,159.28
|
| Rate for Payer: Multiplan Commercial |
$2,747.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,060.40
|
| Rate for Payer: Preferred Network Access Commercial |
$3,159.28
|
| Rate for Payer: Quartz Beloit One Network |
$1,682.66
|
| Rate for Payer: Quartz Commercial |
$2,060.40
|
| Rate for Payer: WEA Trust Commercial |
$1,888.70
|
| Rate for Payer: WPS Commercial |
$2,543.56
|
|
|
Aph Plt ACDA Irr 1
|
Facility
IP
|
$3,434.00
|
|
|
Service Code
|
HCPCS P9019
|
| Hospital Charge Code |
1052823
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$1,682.66 |
| Max. Negotiated Rate |
$3,159.28 |
| Rate for Payer: Aetna Commercial |
$3,090.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,820.02
|
| Rate for Payer: Cash Price |
$1,030.20
|
| Rate for Payer: Cigna Commercial |
$3,159.28
|
| Rate for Payer: Health EOS Commercial |
$3,056.26
|
| Rate for Payer: HFN Commercial |
$3,159.28
|
| Rate for Payer: Multiplan Commercial |
$2,747.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,060.40
|
| Rate for Payer: Preferred Network Access Commercial |
$3,159.28
|
| Rate for Payer: Quartz Beloit One Network |
$1,682.66
|
| Rate for Payer: Quartz Commercial |
$2,060.40
|
| Rate for Payer: WEA Trust Commercial |
$1,888.70
|
| Rate for Payer: WPS Commercial |
$2,543.56
|
|
|
Aph Plt ACDA Irr 1
|
Facility
OP
|
$3,434.00
|
|
|
Service Code
|
HCPCS P9019
|
| Hospital Charge Code |
1052823
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$64.42 |
| Max. Negotiated Rate |
$3,159.28 |
| Rate for Payer: Aetna Commercial |
$3,090.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,953.24
|
| Rate for Payer: Aetna Managed Medicare |
$67.47
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,232.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,717.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,648.32
|
| Rate for Payer: Anthem Medicaid |
$64.42
|
| Rate for Payer: Anthem Medicare Advantage |
$67.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,820.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$67.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$67.47
|
| Rate for Payer: Cash Price |
$1,030.20
|
| Rate for Payer: Cash Price |
$1,030.20
|
| Rate for Payer: Cigna Commercial |
$3,159.28
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$67.47
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$64.42
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,921.67
|
| Rate for Payer: Dean Health Medicaid |
$64.42
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$67.47
|
| Rate for Payer: Health EOS Commercial |
$3,056.26
|
| Rate for Payer: HFN Commercial |
$3,159.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$250.99
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$67.47
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$64.42
|
| Rate for Payer: Independent Care Health Plan Medicare |
$67.47
|
| Rate for Payer: Managed Health Services Medicaid |
$67.00
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$67.47
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$67.47
|
| Rate for Payer: Multiplan Commercial |
$2,747.20
|
| Rate for Payer: NAPHCARE Commercial |
$101.20
|
| Rate for Payer: Preferred Network Access Commercial |
$3,159.28
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$64.42
|
| Rate for Payer: Quartz Beloit One Network |
$1,682.66
|
| Rate for Payer: Quartz Commercial |
$2,232.10
|
| Rate for Payer: Quartz Medicare Advantage |
$67.47
|
| Rate for Payer: The Alliance Commercial |
$2,042.72
|
| Rate for Payer: United Healthcare Medicaid |
$64.42
|
| Rate for Payer: United Healthcare Medicare Advantage |
$67.47
|
| Rate for Payer: United Healthcare PPO |
$2,575.50
|
| Rate for Payer: WEA Trust Commercial |
$1,888.70
|
| Rate for Payer: Wellcare Medicare |
$67.47
|
| Rate for Payer: WMAP Medicaid |
$64.42
|
| Rate for Payer: WPS Commercial |
$2,543.56
|
|
|
Aph Plt ACDA Irr 2
|
Facility
IP
|
$3,434.00
|
|
|
Service Code
|
HCPCS P9019
|
| Hospital Charge Code |
1052830
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$1,682.66 |
| Max. Negotiated Rate |
$3,159.28 |
| Rate for Payer: Aetna Commercial |
$3,090.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,820.02
|
| Rate for Payer: Cash Price |
$1,030.20
|
| Rate for Payer: Cigna Commercial |
$3,159.28
|
| Rate for Payer: Health EOS Commercial |
$3,056.26
|
| Rate for Payer: HFN Commercial |
$3,159.28
|
| Rate for Payer: Multiplan Commercial |
$2,747.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,060.40
|
| Rate for Payer: Preferred Network Access Commercial |
$3,159.28
|
| Rate for Payer: Quartz Beloit One Network |
$1,682.66
|
| Rate for Payer: Quartz Commercial |
$2,060.40
|
| Rate for Payer: WEA Trust Commercial |
$1,888.70
|
| Rate for Payer: WPS Commercial |
$2,543.56
|
|
|
Aph Plt ACDA Irr 2
|
Facility
OP
|
$3,434.00
|
|
|
Service Code
|
HCPCS P9019
|
| Hospital Charge Code |
1052830
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$64.42 |
| Max. Negotiated Rate |
$3,159.28 |
| Rate for Payer: Aetna Commercial |
$3,090.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,953.24
|
| Rate for Payer: Aetna Managed Medicare |
$67.47
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,232.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,717.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,648.32
|
| Rate for Payer: Anthem Medicaid |
$64.42
|
| Rate for Payer: Anthem Medicare Advantage |
$67.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,820.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$67.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$67.47
|
| Rate for Payer: Cash Price |
$1,030.20
|
| Rate for Payer: Cash Price |
$1,030.20
|
| Rate for Payer: Cigna Commercial |
$3,159.28
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$67.47
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$64.42
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,921.67
|
| Rate for Payer: Dean Health Medicaid |
$64.42
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$67.47
|
| Rate for Payer: Health EOS Commercial |
$3,056.26
|
| Rate for Payer: HFN Commercial |
$3,159.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$250.99
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$67.47
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$64.42
|
| Rate for Payer: Independent Care Health Plan Medicare |
$67.47
|
| Rate for Payer: Managed Health Services Medicaid |
$67.00
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$67.47
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$67.47
|
| Rate for Payer: Multiplan Commercial |
$2,747.20
|
| Rate for Payer: NAPHCARE Commercial |
$101.20
|
| Rate for Payer: Preferred Network Access Commercial |
$3,159.28
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$64.42
|
| Rate for Payer: Quartz Beloit One Network |
$1,682.66
|
| Rate for Payer: Quartz Commercial |
$2,232.10
|
| Rate for Payer: Quartz Medicare Advantage |
$67.47
|
| Rate for Payer: The Alliance Commercial |
$2,042.72
|
| Rate for Payer: United Healthcare Medicaid |
$64.42
|
| Rate for Payer: United Healthcare Medicare Advantage |
$67.47
|
| Rate for Payer: United Healthcare PPO |
$2,575.50
|
| Rate for Payer: WEA Trust Commercial |
$1,888.70
|
| Rate for Payer: Wellcare Medicare |
$67.47
|
| Rate for Payer: WMAP Medicaid |
$64.42
|
| Rate for Payer: WPS Commercial |
$2,543.56
|
|
|
Aph Plt ACDA Irr 3
|
Facility
OP
|
$3,434.00
|
|
|
Service Code
|
HCPCS P9019
|
| Hospital Charge Code |
1052829
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$64.42 |
| Max. Negotiated Rate |
$3,159.28 |
| Rate for Payer: Aetna Commercial |
$3,090.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,953.24
|
| Rate for Payer: Aetna Managed Medicare |
$67.47
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,232.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,717.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,648.32
|
| Rate for Payer: Anthem Medicaid |
$64.42
|
| Rate for Payer: Anthem Medicare Advantage |
$67.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,820.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$67.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$67.47
|
| Rate for Payer: Cash Price |
$1,030.20
|
| Rate for Payer: Cash Price |
$1,030.20
|
| Rate for Payer: Cigna Commercial |
$3,159.28
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$67.47
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$64.42
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,921.67
|
| Rate for Payer: Dean Health Medicaid |
$64.42
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$67.47
|
| Rate for Payer: Health EOS Commercial |
$3,056.26
|
| Rate for Payer: HFN Commercial |
$3,159.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$250.99
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$67.47
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$64.42
|
| Rate for Payer: Independent Care Health Plan Medicare |
$67.47
|
| Rate for Payer: Managed Health Services Medicaid |
$67.00
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$67.47
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$67.47
|
| Rate for Payer: Multiplan Commercial |
$2,747.20
|
| Rate for Payer: NAPHCARE Commercial |
$101.20
|
| Rate for Payer: Preferred Network Access Commercial |
$3,159.28
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$64.42
|
| Rate for Payer: Quartz Beloit One Network |
$1,682.66
|
| Rate for Payer: Quartz Commercial |
$2,232.10
|
| Rate for Payer: Quartz Medicare Advantage |
$67.47
|
| Rate for Payer: The Alliance Commercial |
$2,042.72
|
| Rate for Payer: United Healthcare Medicaid |
$64.42
|
| Rate for Payer: United Healthcare Medicare Advantage |
$67.47
|
| Rate for Payer: United Healthcare PPO |
$2,575.50
|
| Rate for Payer: WEA Trust Commercial |
$1,888.70
|
| Rate for Payer: Wellcare Medicare |
$67.47
|
| Rate for Payer: WMAP Medicaid |
$64.42
|
| Rate for Payer: WPS Commercial |
$2,543.56
|
|
|
Aph Plt ACDA Irr 3
|
Facility
IP
|
$3,434.00
|
|
|
Service Code
|
HCPCS P9019
|
| Hospital Charge Code |
1052829
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$1,682.66 |
| Max. Negotiated Rate |
$3,159.28 |
| Rate for Payer: Aetna Commercial |
$3,090.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,820.02
|
| Rate for Payer: Cash Price |
$1,030.20
|
| Rate for Payer: Cigna Commercial |
$3,159.28
|
| Rate for Payer: Health EOS Commercial |
$3,056.26
|
| Rate for Payer: HFN Commercial |
$3,159.28
|
| Rate for Payer: Multiplan Commercial |
$2,747.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,060.40
|
| Rate for Payer: Preferred Network Access Commercial |
$3,159.28
|
| Rate for Payer: Quartz Beloit One Network |
$1,682.66
|
| Rate for Payer: Quartz Commercial |
$2,060.40
|
| Rate for Payer: WEA Trust Commercial |
$1,888.70
|
| Rate for Payer: WPS Commercial |
$2,543.56
|
|
|
Aph Plt ACDA LR
|
Facility
OP
|
$3,171.00
|
|
|
Service Code
|
HCPCS P9019
|
| Hospital Charge Code |
1052839
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$64.42 |
| Max. Negotiated Rate |
$2,917.32 |
| Rate for Payer: Aetna Commercial |
$2,853.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,727.06
|
| Rate for Payer: Aetna Managed Medicare |
$67.47
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,061.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,585.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,522.08
|
| Rate for Payer: Anthem Medicaid |
$64.42
|
| Rate for Payer: Anthem Medicare Advantage |
$67.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,680.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$67.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$67.47
|
| Rate for Payer: Cash Price |
$951.30
|
| Rate for Payer: Cash Price |
$951.30
|
| Rate for Payer: Cigna Commercial |
$2,917.32
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$67.47
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$64.42
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,774.49
|
| Rate for Payer: Dean Health Medicaid |
$64.42
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$67.47
|
| Rate for Payer: Health EOS Commercial |
$2,822.19
|
| Rate for Payer: HFN Commercial |
$2,917.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$250.99
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$67.47
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$64.42
|
| Rate for Payer: Independent Care Health Plan Medicare |
$67.47
|
| Rate for Payer: Managed Health Services Medicaid |
$67.00
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$67.47
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$67.47
|
| Rate for Payer: Multiplan Commercial |
$2,536.80
|
| Rate for Payer: NAPHCARE Commercial |
$101.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,917.32
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$64.42
|
| Rate for Payer: Quartz Beloit One Network |
$1,553.79
|
| Rate for Payer: Quartz Commercial |
$2,061.15
|
| Rate for Payer: Quartz Medicare Advantage |
$67.47
|
| Rate for Payer: The Alliance Commercial |
$2,042.72
|
| Rate for Payer: United Healthcare Medicaid |
$64.42
|
| Rate for Payer: United Healthcare Medicare Advantage |
$67.47
|
| Rate for Payer: United Healthcare PPO |
$2,378.25
|
| Rate for Payer: WEA Trust Commercial |
$1,744.05
|
| Rate for Payer: Wellcare Medicare |
$67.47
|
| Rate for Payer: WMAP Medicaid |
$64.42
|
| Rate for Payer: WPS Commercial |
$2,348.76
|
|
|
Aph Plt ACDA LR
|
Facility
IP
|
$3,171.00
|
|
|
Service Code
|
HCPCS P9019
|
| Hospital Charge Code |
1052839
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$1,553.79 |
| Max. Negotiated Rate |
$2,917.32 |
| Rate for Payer: Aetna Commercial |
$2,853.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,680.63
|
| Rate for Payer: Cash Price |
$951.30
|
| Rate for Payer: Cigna Commercial |
$2,917.32
|
| Rate for Payer: Health EOS Commercial |
$2,822.19
|
| Rate for Payer: HFN Commercial |
$2,917.32
|
| Rate for Payer: Multiplan Commercial |
$2,536.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,902.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,917.32
|
| Rate for Payer: Quartz Beloit One Network |
$1,553.79
|
| Rate for Payer: Quartz Commercial |
$1,902.60
|
| Rate for Payer: WEA Trust Commercial |
$1,744.05
|
| Rate for Payer: WPS Commercial |
$2,348.76
|
|
|
Aph Plt ACDA LR 1
|
Facility
OP
|
$3,171.00
|
|
|
Service Code
|
HCPCS P9019
|
| Hospital Charge Code |
1052853
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$64.42 |
| Max. Negotiated Rate |
$2,917.32 |
| Rate for Payer: Aetna Commercial |
$2,853.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,727.06
|
| Rate for Payer: Aetna Managed Medicare |
$67.47
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,061.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,585.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,522.08
|
| Rate for Payer: Anthem Medicaid |
$64.42
|
| Rate for Payer: Anthem Medicare Advantage |
$67.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,680.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$67.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$67.47
|
| Rate for Payer: Cash Price |
$951.30
|
| Rate for Payer: Cash Price |
$951.30
|
| Rate for Payer: Cigna Commercial |
$2,917.32
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$67.47
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$64.42
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,774.49
|
| Rate for Payer: Dean Health Medicaid |
$64.42
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$67.47
|
| Rate for Payer: Health EOS Commercial |
$2,822.19
|
| Rate for Payer: HFN Commercial |
$2,917.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$250.99
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$67.47
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$64.42
|
| Rate for Payer: Independent Care Health Plan Medicare |
$67.47
|
| Rate for Payer: Managed Health Services Medicaid |
$67.00
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$67.47
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$67.47
|
| Rate for Payer: Multiplan Commercial |
$2,536.80
|
| Rate for Payer: NAPHCARE Commercial |
$101.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,917.32
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$64.42
|
| Rate for Payer: Quartz Beloit One Network |
$1,553.79
|
| Rate for Payer: Quartz Commercial |
$2,061.15
|
| Rate for Payer: Quartz Medicare Advantage |
$67.47
|
| Rate for Payer: The Alliance Commercial |
$2,042.72
|
| Rate for Payer: United Healthcare Medicaid |
$64.42
|
| Rate for Payer: United Healthcare Medicare Advantage |
$67.47
|
| Rate for Payer: United Healthcare PPO |
$2,378.25
|
| Rate for Payer: WEA Trust Commercial |
$1,744.05
|
| Rate for Payer: Wellcare Medicare |
$67.47
|
| Rate for Payer: WMAP Medicaid |
$64.42
|
| Rate for Payer: WPS Commercial |
$2,348.76
|
|
