|
Aph Plt Washed 2 Psoralen
|
Facility
OP
|
$3,434.00
|
|
|
Service Code
|
HCPCS P9073
|
| Hospital Charge Code |
5775834
|
|
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 2 Psoralen
|
Facility
IP
|
$3,434.00
|
|
|
Service Code
|
HCPCS P9073
|
| Hospital Charge Code |
5775834
|
|
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 3 Psoralen
|
Facility
OP
|
$3,434.00
|
|
|
Service Code
|
HCPCS P9073
|
| Hospital Charge Code |
5775835
|
|
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 3 Psoralen
|
Facility
IP
|
$3,434.00
|
|
|
Service Code
|
HCPCS P9073
|
| Hospital Charge Code |
5775835
|
|
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 Psoralen
|
Facility
OP
|
$3,434.00
|
|
|
Service Code
|
HCPCS P9073
|
| Hospital Charge Code |
5775844
|
|
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 Psoralen
|
Facility
IP
|
$3,434.00
|
|
|
Service Code
|
HCPCS P9073
|
| Hospital Charge Code |
5775844
|
|
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 RBC ACDA AS3
|
Facility
OP
|
$615.00
|
|
|
Service Code
|
HCPCS P9021
|
| Hospital Charge Code |
1052827
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$141.61 |
| Max. Negotiated Rate |
$2,042.72 |
| Rate for Payer: Aetna Commercial |
$553.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$528.90
|
| Rate for Payer: Aetna Managed Medicare |
$141.61
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$399.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$307.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$295.20
|
| Rate for Payer: Anthem Medicare Advantage |
$141.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$325.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$141.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$141.61
|
| Rate for Payer: Cash Price |
$184.50
|
| Rate for Payer: Cash Price |
$184.50
|
| Rate for Payer: Cigna Commercial |
$565.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$141.61
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$344.15
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$141.61
|
| Rate for Payer: Health EOS Commercial |
$547.35
|
| Rate for Payer: HFN Commercial |
$565.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$526.79
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$141.61
|
| Rate for Payer: Independent Care Health Plan Medicare |
$141.61
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$141.61
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$141.61
|
| Rate for Payer: Multiplan Commercial |
$492.00
|
| Rate for Payer: NAPHCARE Commercial |
$212.42
|
| Rate for Payer: Preferred Network Access Commercial |
$565.80
|
| Rate for Payer: Quartz Beloit One Network |
$301.35
|
| Rate for Payer: Quartz Commercial |
$399.75
|
| Rate for Payer: Quartz Medicare Advantage |
$141.61
|
| Rate for Payer: The Alliance Commercial |
$2,042.72
|
| Rate for Payer: United Healthcare Medicare Advantage |
$141.61
|
| Rate for Payer: United Healthcare PPO |
$461.25
|
| Rate for Payer: WEA Trust Commercial |
$338.25
|
| Rate for Payer: Wellcare Medicare |
$141.61
|
| Rate for Payer: WPS Commercial |
$455.53
|
|
|
Aph RBC ACDA AS3
|
Facility
IP
|
$615.00
|
|
|
Service Code
|
HCPCS P9021
|
| Hospital Charge Code |
1052827
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$301.35 |
| Max. Negotiated Rate |
$565.80 |
| Rate for Payer: Aetna Commercial |
$553.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$325.95
|
| Rate for Payer: Cash Price |
$184.50
|
| Rate for Payer: Cigna Commercial |
$565.80
|
| Rate for Payer: Health EOS Commercial |
$547.35
|
| Rate for Payer: HFN Commercial |
$565.80
|
| Rate for Payer: Multiplan Commercial |
$492.00
|
| Rate for Payer: NAPHCARE Commercial |
$369.00
|
| Rate for Payer: Preferred Network Access Commercial |
$565.80
|
| Rate for Payer: Quartz Beloit One Network |
$301.35
|
| Rate for Payer: Quartz Commercial |
$369.00
|
| Rate for Payer: WEA Trust Commercial |
$338.25
|
| Rate for Payer: WPS Commercial |
$455.53
|
|
|
Aph RBC ACDA AS3 1
|
Facility
IP
|
$615.00
|
|
|
Service Code
|
HCPCS P9021
|
| Hospital Charge Code |
1052800
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$301.35 |
| Max. Negotiated Rate |
$565.80 |
| Rate for Payer: Aetna Commercial |
$553.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$325.95
|
| Rate for Payer: Cash Price |
$184.50
|
| Rate for Payer: Cigna Commercial |
$565.80
|
| Rate for Payer: Health EOS Commercial |
$547.35
|
| Rate for Payer: HFN Commercial |
$565.80
|
| Rate for Payer: Multiplan Commercial |
$492.00
|
| Rate for Payer: NAPHCARE Commercial |
$369.00
|
| Rate for Payer: Preferred Network Access Commercial |
$565.80
|
| Rate for Payer: Quartz Beloit One Network |
$301.35
|
| Rate for Payer: Quartz Commercial |
$369.00
|
| Rate for Payer: WEA Trust Commercial |
$338.25
|
| Rate for Payer: WPS Commercial |
$455.53
|
|
|
Aph RBC ACDA AS3 1
|
Facility
OP
|
$615.00
|
|
|
Service Code
|
HCPCS P9021
|
| Hospital Charge Code |
1052800
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$141.61 |
| Max. Negotiated Rate |
$2,042.72 |
| Rate for Payer: Aetna Commercial |
$553.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$528.90
|
| Rate for Payer: Aetna Managed Medicare |
$141.61
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$399.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$307.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$295.20
|
| Rate for Payer: Anthem Medicare Advantage |
$141.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$325.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$141.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$141.61
|
| Rate for Payer: Cash Price |
$184.50
|
| Rate for Payer: Cash Price |
$184.50
|
| Rate for Payer: Cigna Commercial |
$565.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$141.61
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$344.15
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$141.61
|
| Rate for Payer: Health EOS Commercial |
$547.35
|
| Rate for Payer: HFN Commercial |
$565.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$526.79
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$141.61
|
| Rate for Payer: Independent Care Health Plan Medicare |
$141.61
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$141.61
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$141.61
|
| Rate for Payer: Multiplan Commercial |
$492.00
|
| Rate for Payer: NAPHCARE Commercial |
$212.42
|
| Rate for Payer: Preferred Network Access Commercial |
$565.80
|
| Rate for Payer: Quartz Beloit One Network |
$301.35
|
| Rate for Payer: Quartz Commercial |
$399.75
|
| Rate for Payer: Quartz Medicare Advantage |
$141.61
|
| Rate for Payer: The Alliance Commercial |
$2,042.72
|
| Rate for Payer: United Healthcare Medicare Advantage |
$141.61
|
| Rate for Payer: United Healthcare PPO |
$461.25
|
| Rate for Payer: WEA Trust Commercial |
$338.25
|
| Rate for Payer: Wellcare Medicare |
$141.61
|
| Rate for Payer: WPS Commercial |
$455.53
|
|
|
Aph RBC ACDA AS3 2
|
Facility
OP
|
$615.00
|
|
|
Service Code
|
HCPCS P9021
|
| Hospital Charge Code |
1052834
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$141.61 |
| Max. Negotiated Rate |
$2,042.72 |
| Rate for Payer: Aetna Commercial |
$553.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$528.90
|
| Rate for Payer: Aetna Managed Medicare |
$141.61
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$399.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$307.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$295.20
|
| Rate for Payer: Anthem Medicare Advantage |
$141.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$325.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$141.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$141.61
|
| Rate for Payer: Cash Price |
$184.50
|
| Rate for Payer: Cash Price |
$184.50
|
| Rate for Payer: Cigna Commercial |
$565.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$141.61
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$344.15
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$141.61
|
| Rate for Payer: Health EOS Commercial |
$547.35
|
| Rate for Payer: HFN Commercial |
$565.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$526.79
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$141.61
|
| Rate for Payer: Independent Care Health Plan Medicare |
$141.61
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$141.61
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$141.61
|
| Rate for Payer: Multiplan Commercial |
$492.00
|
| Rate for Payer: NAPHCARE Commercial |
$212.42
|
| Rate for Payer: Preferred Network Access Commercial |
$565.80
|
| Rate for Payer: Quartz Beloit One Network |
$301.35
|
| Rate for Payer: Quartz Commercial |
$399.75
|
| Rate for Payer: Quartz Medicare Advantage |
$141.61
|
| Rate for Payer: The Alliance Commercial |
$2,042.72
|
| Rate for Payer: United Healthcare Medicare Advantage |
$141.61
|
| Rate for Payer: United Healthcare PPO |
$461.25
|
| Rate for Payer: WEA Trust Commercial |
$338.25
|
| Rate for Payer: Wellcare Medicare |
$141.61
|
| Rate for Payer: WPS Commercial |
$455.53
|
|
|
Aph RBC ACDA AS3 2
|
Facility
IP
|
$615.00
|
|
|
Service Code
|
HCPCS P9021
|
| Hospital Charge Code |
1052834
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$301.35 |
| Max. Negotiated Rate |
$565.80 |
| Rate for Payer: Aetna Commercial |
$553.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$325.95
|
| Rate for Payer: Cash Price |
$184.50
|
| Rate for Payer: Cigna Commercial |
$565.80
|
| Rate for Payer: Health EOS Commercial |
$547.35
|
| Rate for Payer: HFN Commercial |
$565.80
|
| Rate for Payer: Multiplan Commercial |
$492.00
|
| Rate for Payer: NAPHCARE Commercial |
$369.00
|
| Rate for Payer: Preferred Network Access Commercial |
$565.80
|
| Rate for Payer: Quartz Beloit One Network |
$301.35
|
| Rate for Payer: Quartz Commercial |
$369.00
|
| Rate for Payer: WEA Trust Commercial |
$338.25
|
| Rate for Payer: WPS Commercial |
$455.53
|
|
|
Aph RBC ACDA AS3 LR
|
Facility
OP
|
$567.00
|
|
|
Service Code
|
HCPCS P9021
|
| Hospital Charge Code |
1052869
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$141.61 |
| Max. Negotiated Rate |
$2,042.72 |
| Rate for Payer: WEA Trust Commercial |
$311.85
|
| Rate for Payer: Aetna Commercial |
$510.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$487.62
|
| Rate for Payer: Aetna Managed Medicare |
$141.61
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$368.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$283.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$272.16
|
| Rate for Payer: Anthem Medicare Advantage |
$141.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$300.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$141.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$141.61
|
| Rate for Payer: Cash Price |
$170.10
|
| Rate for Payer: Cash Price |
$170.10
|
| Rate for Payer: Cigna Commercial |
$521.64
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$141.61
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$317.29
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$141.61
|
| Rate for Payer: Health EOS Commercial |
$504.63
|
| Rate for Payer: HFN Commercial |
$521.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$526.79
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$141.61
|
| Rate for Payer: Independent Care Health Plan Medicare |
$141.61
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$141.61
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$141.61
|
| Rate for Payer: Multiplan Commercial |
$453.60
|
| Rate for Payer: NAPHCARE Commercial |
$212.42
|
| Rate for Payer: Preferred Network Access Commercial |
$521.64
|
| Rate for Payer: Quartz Beloit One Network |
$277.83
|
| Rate for Payer: Quartz Commercial |
$368.55
|
| Rate for Payer: Quartz Medicare Advantage |
$141.61
|
| Rate for Payer: The Alliance Commercial |
$2,042.72
|
| Rate for Payer: United Healthcare Medicare Advantage |
$141.61
|
| Rate for Payer: United Healthcare PPO |
$425.25
|
| Rate for Payer: Wellcare Medicare |
$141.61
|
| Rate for Payer: WPS Commercial |
$419.98
|
|
|
Aph RBC ACDA AS3 LR
|
Facility
IP
|
$567.00
|
|
|
Service Code
|
HCPCS P9021
|
| Hospital Charge Code |
1052869
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$277.83 |
| Max. Negotiated Rate |
$521.64 |
| Rate for Payer: Aetna Commercial |
$510.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$300.51
|
| Rate for Payer: Cash Price |
$170.10
|
| Rate for Payer: Cigna Commercial |
$521.64
|
| Rate for Payer: Health EOS Commercial |
$504.63
|
| Rate for Payer: HFN Commercial |
$521.64
|
| Rate for Payer: Multiplan Commercial |
$453.60
|
| Rate for Payer: NAPHCARE Commercial |
$340.20
|
| Rate for Payer: Preferred Network Access Commercial |
$521.64
|
| Rate for Payer: Quartz Beloit One Network |
$277.83
|
| Rate for Payer: Quartz Commercial |
$340.20
|
| Rate for Payer: WEA Trust Commercial |
$311.85
|
| Rate for Payer: WPS Commercial |
$419.98
|
|
|
Aph RBC ACDA AS3 LR 1
|
Facility
IP
|
$567.00
|
|
|
Service Code
|
HCPCS P9021
|
| Hospital Charge Code |
1052843
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$277.83 |
| Max. Negotiated Rate |
$521.64 |
| Rate for Payer: Aetna Commercial |
$510.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$300.51
|
| Rate for Payer: Cash Price |
$170.10
|
| Rate for Payer: Cigna Commercial |
$521.64
|
| Rate for Payer: Health EOS Commercial |
$504.63
|
| Rate for Payer: HFN Commercial |
$521.64
|
| Rate for Payer: Multiplan Commercial |
$453.60
|
| Rate for Payer: NAPHCARE Commercial |
$340.20
|
| Rate for Payer: Preferred Network Access Commercial |
$521.64
|
| Rate for Payer: Quartz Beloit One Network |
$277.83
|
| Rate for Payer: Quartz Commercial |
$340.20
|
| Rate for Payer: WEA Trust Commercial |
$311.85
|
| Rate for Payer: WPS Commercial |
$419.98
|
|
|
Aph RBC ACDA AS3 LR 1
|
Facility
OP
|
$567.00
|
|
|
Service Code
|
HCPCS P9021
|
| Hospital Charge Code |
1052843
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$141.61 |
| Max. Negotiated Rate |
$2,042.72 |
| Rate for Payer: Aetna Commercial |
$510.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$487.62
|
| Rate for Payer: Aetna Managed Medicare |
$141.61
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$368.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$283.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$272.16
|
| Rate for Payer: Anthem Medicare Advantage |
$141.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$300.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$141.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$141.61
|
| Rate for Payer: Cash Price |
$170.10
|
| Rate for Payer: Cash Price |
$170.10
|
| Rate for Payer: Cigna Commercial |
$521.64
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$141.61
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$317.29
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$141.61
|
| Rate for Payer: Health EOS Commercial |
$504.63
|
| Rate for Payer: HFN Commercial |
$521.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$526.79
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$141.61
|
| Rate for Payer: Independent Care Health Plan Medicare |
$141.61
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$141.61
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$141.61
|
| Rate for Payer: Multiplan Commercial |
$453.60
|
| Rate for Payer: NAPHCARE Commercial |
$212.42
|
| Rate for Payer: Preferred Network Access Commercial |
$521.64
|
| Rate for Payer: Quartz Beloit One Network |
$277.83
|
| Rate for Payer: Quartz Commercial |
$368.55
|
| Rate for Payer: Quartz Medicare Advantage |
$141.61
|
| Rate for Payer: The Alliance Commercial |
$2,042.72
|
| Rate for Payer: United Healthcare Medicare Advantage |
$141.61
|
| Rate for Payer: United Healthcare PPO |
$425.25
|
| Rate for Payer: WEA Trust Commercial |
$311.85
|
| Rate for Payer: Wellcare Medicare |
$141.61
|
| Rate for Payer: WPS Commercial |
$419.98
|
|
|
Aph RBC ACDA AS3 LR 2
|
Facility
OP
|
$567.00
|
|
|
Service Code
|
HCPCS P9021
|
| Hospital Charge Code |
1052814
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$141.61 |
| Max. Negotiated Rate |
$2,042.72 |
| Rate for Payer: Aetna Commercial |
$510.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$487.62
|
| Rate for Payer: Aetna Managed Medicare |
$141.61
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$368.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$283.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$272.16
|
| Rate for Payer: Anthem Medicare Advantage |
$141.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$300.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$141.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$141.61
|
| Rate for Payer: Cash Price |
$170.10
|
| Rate for Payer: Cash Price |
$170.10
|
| Rate for Payer: Cigna Commercial |
$521.64
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$141.61
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$317.29
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$141.61
|
| Rate for Payer: Health EOS Commercial |
$504.63
|
| Rate for Payer: HFN Commercial |
$521.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$526.79
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$141.61
|
| Rate for Payer: Independent Care Health Plan Medicare |
$141.61
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$141.61
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$141.61
|
| Rate for Payer: Multiplan Commercial |
$453.60
|
| Rate for Payer: NAPHCARE Commercial |
$212.42
|
| Rate for Payer: Preferred Network Access Commercial |
$521.64
|
| Rate for Payer: Quartz Beloit One Network |
$277.83
|
| Rate for Payer: Quartz Commercial |
$368.55
|
| Rate for Payer: Quartz Medicare Advantage |
$141.61
|
| Rate for Payer: The Alliance Commercial |
$2,042.72
|
| Rate for Payer: United Healthcare Medicare Advantage |
$141.61
|
| Rate for Payer: United Healthcare PPO |
$425.25
|
| Rate for Payer: WEA Trust Commercial |
$311.85
|
| Rate for Payer: Wellcare Medicare |
$141.61
|
| Rate for Payer: WPS Commercial |
$419.98
|
|
|
Aph RBC ACDA AS3 LR 2
|
Facility
IP
|
$567.00
|
|
|
Service Code
|
HCPCS P9021
|
| Hospital Charge Code |
1052814
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$277.83 |
| Max. Negotiated Rate |
$521.64 |
| Rate for Payer: Aetna Commercial |
$510.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$300.51
|
| Rate for Payer: Cash Price |
$170.10
|
| Rate for Payer: Cigna Commercial |
$521.64
|
| Rate for Payer: Health EOS Commercial |
$504.63
|
| Rate for Payer: HFN Commercial |
$521.64
|
| Rate for Payer: Multiplan Commercial |
$453.60
|
| Rate for Payer: NAPHCARE Commercial |
$340.20
|
| Rate for Payer: Preferred Network Access Commercial |
$521.64
|
| Rate for Payer: Quartz Beloit One Network |
$277.83
|
| Rate for Payer: Quartz Commercial |
$340.20
|
| Rate for Payer: WEA Trust Commercial |
$311.85
|
| Rate for Payer: WPS Commercial |
$419.98
|
|
|
Aph RBC ACDA AS3 LR Irr
|
Facility
IP
|
$567.00
|
|
|
Service Code
|
HCPCS P9021
|
| Hospital Charge Code |
1052836
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$277.83 |
| Max. Negotiated Rate |
$521.64 |
| Rate for Payer: Aetna Commercial |
$510.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$300.51
|
| Rate for Payer: Cash Price |
$170.10
|
| Rate for Payer: Cigna Commercial |
$521.64
|
| Rate for Payer: Health EOS Commercial |
$504.63
|
| Rate for Payer: HFN Commercial |
$521.64
|
| Rate for Payer: Multiplan Commercial |
$453.60
|
| Rate for Payer: NAPHCARE Commercial |
$340.20
|
| Rate for Payer: Preferred Network Access Commercial |
$521.64
|
| Rate for Payer: Quartz Beloit One Network |
$277.83
|
| Rate for Payer: Quartz Commercial |
$340.20
|
| Rate for Payer: WEA Trust Commercial |
$311.85
|
| Rate for Payer: WPS Commercial |
$419.98
|
|
|
Aph RBC ACDA AS3 LR Irr
|
Facility
OP
|
$567.00
|
|
|
Service Code
|
HCPCS P9021
|
| Hospital Charge Code |
1052836
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$141.61 |
| Max. Negotiated Rate |
$2,042.72 |
| Rate for Payer: Aetna Commercial |
$510.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$487.62
|
| Rate for Payer: Aetna Managed Medicare |
$141.61
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$368.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$283.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$272.16
|
| Rate for Payer: Anthem Medicare Advantage |
$141.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$300.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$141.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$141.61
|
| Rate for Payer: Cash Price |
$170.10
|
| Rate for Payer: Cash Price |
$170.10
|
| Rate for Payer: Cigna Commercial |
$521.64
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$141.61
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$317.29
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$141.61
|
| Rate for Payer: Health EOS Commercial |
$504.63
|
| Rate for Payer: HFN Commercial |
$521.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$526.79
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$141.61
|
| Rate for Payer: Independent Care Health Plan Medicare |
$141.61
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$141.61
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$141.61
|
| Rate for Payer: Multiplan Commercial |
$453.60
|
| Rate for Payer: NAPHCARE Commercial |
$212.42
|
| Rate for Payer: Preferred Network Access Commercial |
$521.64
|
| Rate for Payer: Quartz Beloit One Network |
$277.83
|
| Rate for Payer: Quartz Commercial |
$368.55
|
| Rate for Payer: Quartz Medicare Advantage |
$141.61
|
| Rate for Payer: The Alliance Commercial |
$2,042.72
|
| Rate for Payer: United Healthcare Medicare Advantage |
$141.61
|
| Rate for Payer: United Healthcare PPO |
$425.25
|
| Rate for Payer: WEA Trust Commercial |
$311.85
|
| Rate for Payer: Wellcare Medicare |
$141.61
|
| Rate for Payer: WPS Commercial |
$419.98
|
|
|
Aph RBC ACDA AS3 LR Irr 1
|
Facility
OP
|
$567.00
|
|
|
Service Code
|
HCPCS P9021
|
| Hospital Charge Code |
1052845
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$141.61 |
| Max. Negotiated Rate |
$2,042.72 |
| Rate for Payer: Aetna Commercial |
$510.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$487.62
|
| Rate for Payer: Aetna Managed Medicare |
$141.61
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$368.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$283.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$272.16
|
| Rate for Payer: Anthem Medicare Advantage |
$141.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$300.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$141.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$141.61
|
| Rate for Payer: Cash Price |
$170.10
|
| Rate for Payer: Cash Price |
$170.10
|
| Rate for Payer: Cigna Commercial |
$521.64
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$141.61
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$317.29
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$141.61
|
| Rate for Payer: Health EOS Commercial |
$504.63
|
| Rate for Payer: HFN Commercial |
$521.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$526.79
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$141.61
|
| Rate for Payer: Independent Care Health Plan Medicare |
$141.61
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$141.61
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$141.61
|
| Rate for Payer: Multiplan Commercial |
$453.60
|
| Rate for Payer: NAPHCARE Commercial |
$212.42
|
| Rate for Payer: Preferred Network Access Commercial |
$521.64
|
| Rate for Payer: Quartz Beloit One Network |
$277.83
|
| Rate for Payer: Quartz Commercial |
$368.55
|
| Rate for Payer: Quartz Medicare Advantage |
$141.61
|
| Rate for Payer: The Alliance Commercial |
$2,042.72
|
| Rate for Payer: United Healthcare Medicare Advantage |
$141.61
|
| Rate for Payer: United Healthcare PPO |
$425.25
|
| Rate for Payer: WEA Trust Commercial |
$311.85
|
| Rate for Payer: Wellcare Medicare |
$141.61
|
| Rate for Payer: WPS Commercial |
$419.98
|
|
|
Aph RBC ACDA AS3 LR Irr 1
|
Facility
IP
|
$567.00
|
|
|
Service Code
|
HCPCS P9021
|
| Hospital Charge Code |
1052845
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$277.83 |
| Max. Negotiated Rate |
$521.64 |
| Rate for Payer: Aetna Commercial |
$510.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$300.51
|
| Rate for Payer: Cash Price |
$170.10
|
| Rate for Payer: Cigna Commercial |
$521.64
|
| Rate for Payer: Health EOS Commercial |
$504.63
|
| Rate for Payer: HFN Commercial |
$521.64
|
| Rate for Payer: Multiplan Commercial |
$453.60
|
| Rate for Payer: NAPHCARE Commercial |
$340.20
|
| Rate for Payer: Preferred Network Access Commercial |
$521.64
|
| Rate for Payer: Quartz Beloit One Network |
$277.83
|
| Rate for Payer: Quartz Commercial |
$340.20
|
| Rate for Payer: WEA Trust Commercial |
$311.85
|
| Rate for Payer: WPS Commercial |
$419.98
|
|
|
Aph RBC ACDA AS3 LR Irr 2
|
Facility
OP
|
$567.00
|
|
|
Service Code
|
HCPCS P9021
|
| Hospital Charge Code |
1052847
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$141.61 |
| Max. Negotiated Rate |
$2,042.72 |
| Rate for Payer: Aetna Commercial |
$510.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$487.62
|
| Rate for Payer: Aetna Managed Medicare |
$141.61
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$368.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$283.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$272.16
|
| Rate for Payer: Anthem Medicare Advantage |
$141.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$300.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$141.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$141.61
|
| Rate for Payer: Cash Price |
$170.10
|
| Rate for Payer: Cash Price |
$170.10
|
| Rate for Payer: Cigna Commercial |
$521.64
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$141.61
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$317.29
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$141.61
|
| Rate for Payer: Health EOS Commercial |
$504.63
|
| Rate for Payer: HFN Commercial |
$521.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$526.79
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$141.61
|
| Rate for Payer: Independent Care Health Plan Medicare |
$141.61
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$141.61
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$141.61
|
| Rate for Payer: Multiplan Commercial |
$453.60
|
| Rate for Payer: NAPHCARE Commercial |
$212.42
|
| Rate for Payer: Preferred Network Access Commercial |
$521.64
|
| Rate for Payer: Quartz Beloit One Network |
$277.83
|
| Rate for Payer: Quartz Commercial |
$368.55
|
| Rate for Payer: Quartz Medicare Advantage |
$141.61
|
| Rate for Payer: The Alliance Commercial |
$2,042.72
|
| Rate for Payer: United Healthcare Medicare Advantage |
$141.61
|
| Rate for Payer: United Healthcare PPO |
$425.25
|
| Rate for Payer: WEA Trust Commercial |
$311.85
|
| Rate for Payer: Wellcare Medicare |
$141.61
|
| Rate for Payer: WPS Commercial |
$419.98
|
|
|
Aph RBC ACDA AS3 LR Irr 2
|
Facility
IP
|
$567.00
|
|
|
Service Code
|
HCPCS P9021
|
| Hospital Charge Code |
1052847
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$277.83 |
| Max. Negotiated Rate |
$521.64 |
| Rate for Payer: Aetna Commercial |
$510.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$300.51
|
| Rate for Payer: Cash Price |
$170.10
|
| Rate for Payer: Cigna Commercial |
$521.64
|
| Rate for Payer: Health EOS Commercial |
$504.63
|
| Rate for Payer: HFN Commercial |
$521.64
|
| Rate for Payer: Multiplan Commercial |
$453.60
|
| Rate for Payer: NAPHCARE Commercial |
$340.20
|
| Rate for Payer: Preferred Network Access Commercial |
$521.64
|
| Rate for Payer: Quartz Beloit One Network |
$277.83
|
| Rate for Payer: Quartz Commercial |
$340.20
|
| Rate for Payer: WEA Trust Commercial |
$311.85
|
| Rate for Payer: WPS Commercial |
$419.98
|
|
|
Aph RBC CP2D AS3
|
Facility
IP
|
$615.00
|
|
|
Service Code
|
HCPCS P9021
|
| Hospital Charge Code |
1052849
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$301.35 |
| Max. Negotiated Rate |
$565.80 |
| Rate for Payer: Aetna Commercial |
$553.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$325.95
|
| Rate for Payer: Cash Price |
$184.50
|
| Rate for Payer: Cigna Commercial |
$565.80
|
| Rate for Payer: Health EOS Commercial |
$547.35
|
| Rate for Payer: HFN Commercial |
$565.80
|
| Rate for Payer: Multiplan Commercial |
$492.00
|
| Rate for Payer: NAPHCARE Commercial |
$369.00
|
| Rate for Payer: Preferred Network Access Commercial |
$565.80
|
| Rate for Payer: Quartz Beloit One Network |
$301.35
|
| Rate for Payer: Quartz Commercial |
$369.00
|
| Rate for Payer: WEA Trust Commercial |
$338.25
|
| Rate for Payer: WPS Commercial |
$455.53
|
|
