|
Aph Plt ACDA LR Irr PL Red 2
|
Facility
IP
|
$3,434.00
|
|
|
Service Code
|
HCPCS P9037
|
| Hospital Charge Code |
5593861
|
|
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 Irr PL Red 3
|
Facility
OP
|
$3,434.00
|
|
|
Service Code
|
HCPCS P9019
|
| Hospital Charge Code |
5593863
|
|
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 LR Irr PL Red 3
|
Facility
IP
|
$3,434.00
|
|
|
Service Code
|
HCPCS P9019
|
| Hospital Charge Code |
5593863
|
|
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 PL Red
|
Facility
IP
|
$3,434.00
|
|
|
Service Code
|
HCPCS P9019
|
| Hospital Charge Code |
5593868
|
|
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 PL Red
|
Facility
OP
|
$3,434.00
|
|
|
Service Code
|
HCPCS P9019
|
| Hospital Charge Code |
5593868
|
|
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 LR PL Red 1
|
Facility
OP
|
$3,434.00
|
|
|
Service Code
|
HCPCS P9019
|
| Hospital Charge Code |
5593865
|
|
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 LR PL Red 1
|
Facility
IP
|
$3,434.00
|
|
|
Service Code
|
HCPCS P9019
|
| Hospital Charge Code |
5593865
|
|
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 PL Red 2
|
Facility
OP
|
$3,434.00
|
|
|
Service Code
|
HCPCS P9019
|
| Hospital Charge Code |
5593864
|
|
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 LR PL Red 2
|
Facility
IP
|
$3,434.00
|
|
|
Service Code
|
HCPCS P9019
|
| Hospital Charge Code |
5593864
|
|
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 PL Red 3
|
Facility
IP
|
$3,434.00
|
|
|
Service Code
|
HCPCS P9019
|
| Hospital Charge Code |
5593867
|
|
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 PL Red 3
|
Facility
OP
|
$3,434.00
|
|
|
Service Code
|
HCPCS P9019
|
| Hospital Charge Code |
5593867
|
|
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 PL Red 1 Psoralen
|
Facility
IP
|
$3,434.00
|
|
|
Service Code
|
HCPCS P9073
|
| Hospital Charge Code |
5775839
|
|
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 PL Red 1 Psoralen
|
Facility
OP
|
$3,434.00
|
|
|
Service Code
|
HCPCS P9073
|
| Hospital Charge Code |
5775839
|
|
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 PL Red 2 Psoralen
|
Facility
IP
|
$3,434.00
|
|
|
Service Code
|
HCPCS P9073
|
| Hospital Charge Code |
5775841
|
|
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 PL Red 2 Psoralen
|
Facility
OP
|
$3,434.00
|
|
|
Service Code
|
HCPCS P9073
|
| Hospital Charge Code |
5775841
|
|
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 PL Red 3 Psoralen
|
Facility
OP
|
$3,434.00
|
|
|
Service Code
|
HCPCS P9073
|
| Hospital Charge Code |
5775840
|
|
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 PL Red 3 Psoralen
|
Facility
IP
|
$3,434.00
|
|
|
Service Code
|
HCPCS P9073
|
| Hospital Charge Code |
5775840
|
|
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 PL Red Psoralen
|
Facility
OP
|
$3,434.00
|
|
|
Service Code
|
HCPCS P9073
|
| Hospital Charge Code |
5775836
|
|
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 PL Red Psoralen
|
Facility
IP
|
$3,434.00
|
|
|
Service Code
|
HCPCS P9073
|
| Hospital Charge Code |
5775836
|
|
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 Psoralen
|
Facility
OP
|
$3,434.00
|
|
|
Service Code
|
HCPCS P9073
|
| Hospital Charge Code |
5775837
|
|
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 Psoralen
|
Facility
IP
|
$3,434.00
|
|
|
Service Code
|
HCPCS P9073
|
| Hospital Charge Code |
5775837
|
|
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 Washed
|
Facility
IP
|
$3,434.00
|
|
|
Service Code
|
HCPCS P9019
|
| Hospital Charge Code |
1052807
|
|
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 Washed
|
Facility
OP
|
$3,434.00
|
|
|
Service Code
|
HCPCS P9019
|
| Hospital Charge Code |
1052807
|
|
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 Washed 1 Psoralen
|
Facility
OP
|
$3,434.00
|
|
|
Service Code
|
HCPCS P9073
|
| Hospital Charge Code |
5775833
|
|
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 Washed 1 Psoralen
|
Facility
IP
|
$3,434.00
|
|
|
Service Code
|
HCPCS P9073
|
| Hospital Charge Code |
5775833
|
|
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
|
|
