|
Aph Plsm RT 24 ACDA 1
|
Facility
|
IP
|
$356.00
|
|
|
Service Code
|
HCPCS P9059
|
| Hospital Charge Code |
6224233
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$181.42 |
| Max. Negotiated Rate |
$340.62 |
| Rate for Payer: Aetna Commercial |
$333.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$318.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$196.23
|
| Rate for Payer: Cash Price |
$106.80
|
| Rate for Payer: Cigna Commercial |
$340.62
|
| Rate for Payer: Health EOS Commercial |
$329.51
|
| Rate for Payer: HFN Commercial |
$340.62
|
| Rate for Payer: Multiplan Commercial |
$296.19
|
| Rate for Payer: Preferred Network Access Commercial |
$340.62
|
| Rate for Payer: Quartz Beloit One Network |
$181.42
|
| Rate for Payer: Quartz Commercial |
$222.14
|
| Rate for Payer: WEA Trust Commercial |
$203.63
|
| Rate for Payer: WPS Commercial |
$274.23
|
|
|
Aph Plsm RT 24 ACDA 1
|
Facility
|
OP
|
$356.00
|
|
|
Service Code
|
HCPCS P9059
|
| Hospital Charge Code |
6224233
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$75.99 |
| Max. Negotiated Rate |
$340.62 |
| Rate for Payer: Aetna Commercial |
$333.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$318.41
|
| Rate for Payer: Aetna Managed Medicare |
$75.99
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$240.66
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$185.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$177.72
|
| Rate for Payer: Anthem Medicare Advantage |
$75.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$196.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$75.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$75.99
|
| Rate for Payer: Cash Price |
$106.80
|
| Rate for Payer: Cash Price |
$106.80
|
| Rate for Payer: Cigna Commercial |
$340.62
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$75.99
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$207.19
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$75.99
|
| Rate for Payer: Health EOS Commercial |
$329.51
|
| Rate for Payer: HFN Commercial |
$340.62
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$282.69
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$75.99
|
| Rate for Payer: Independent Care Health Plan Medicare |
$75.99
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$75.99
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$75.99
|
| Rate for Payer: Multiplan Commercial |
$296.19
|
| Rate for Payer: NAPHCARE Commercial |
$113.99
|
| Rate for Payer: Preferred Network Access Commercial |
$340.62
|
| Rate for Payer: Quartz Beloit One Network |
$181.42
|
| Rate for Payer: Quartz Commercial |
$240.66
|
| Rate for Payer: Quartz Medicare Advantage |
$75.99
|
| Rate for Payer: The Alliance Commercial |
$303.97
|
| Rate for Payer: United Healthcare Medicare Advantage |
$75.99
|
| Rate for Payer: United Healthcare PPO |
$277.68
|
| Rate for Payer: WEA Trust Commercial |
$203.63
|
| Rate for Payer: Wellcare Medicare |
$75.99
|
| Rate for Payer: WPS Commercial |
$274.23
|
|
|
Aph Plsm RT 24 ACDA 2
|
Facility
|
IP
|
$356.00
|
|
|
Service Code
|
HCPCS P9059
|
| Hospital Charge Code |
6224234
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$181.42 |
| Max. Negotiated Rate |
$340.62 |
| Rate for Payer: Aetna Commercial |
$333.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$318.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$196.23
|
| Rate for Payer: Cash Price |
$106.80
|
| Rate for Payer: Cigna Commercial |
$340.62
|
| Rate for Payer: Health EOS Commercial |
$329.51
|
| Rate for Payer: HFN Commercial |
$340.62
|
| Rate for Payer: Multiplan Commercial |
$296.19
|
| Rate for Payer: Preferred Network Access Commercial |
$340.62
|
| Rate for Payer: Quartz Beloit One Network |
$181.42
|
| Rate for Payer: Quartz Commercial |
$222.14
|
| Rate for Payer: WEA Trust Commercial |
$203.63
|
| Rate for Payer: WPS Commercial |
$274.23
|
|
|
Aph Plsm RT 24 ACDA 2
|
Facility
|
OP
|
$356.00
|
|
|
Service Code
|
HCPCS P9059
|
| Hospital Charge Code |
6224234
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$75.99 |
| Max. Negotiated Rate |
$340.62 |
| Rate for Payer: Aetna Commercial |
$333.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$318.41
|
| Rate for Payer: Aetna Managed Medicare |
$75.99
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$240.66
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$185.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$177.72
|
| Rate for Payer: Anthem Medicare Advantage |
$75.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$196.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$75.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$75.99
|
| Rate for Payer: Cash Price |
$106.80
|
| Rate for Payer: Cash Price |
$106.80
|
| Rate for Payer: Cigna Commercial |
$340.62
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$75.99
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$207.19
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$75.99
|
| Rate for Payer: Health EOS Commercial |
$329.51
|
| Rate for Payer: HFN Commercial |
$340.62
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$282.69
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$75.99
|
| Rate for Payer: Independent Care Health Plan Medicare |
$75.99
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$75.99
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$75.99
|
| Rate for Payer: Multiplan Commercial |
$296.19
|
| Rate for Payer: NAPHCARE Commercial |
$113.99
|
| Rate for Payer: Preferred Network Access Commercial |
$340.62
|
| Rate for Payer: Quartz Beloit One Network |
$181.42
|
| Rate for Payer: Quartz Commercial |
$240.66
|
| Rate for Payer: Quartz Medicare Advantage |
$75.99
|
| Rate for Payer: The Alliance Commercial |
$303.97
|
| Rate for Payer: United Healthcare Medicare Advantage |
$75.99
|
| Rate for Payer: United Healthcare PPO |
$277.68
|
| Rate for Payer: WEA Trust Commercial |
$203.63
|
| Rate for Payer: Wellcare Medicare |
$75.99
|
| Rate for Payer: WPS Commercial |
$274.23
|
|
|
Aph Plsm RT 24 ACDA 3
|
Facility
|
OP
|
$356.00
|
|
|
Service Code
|
HCPCS P9059
|
| Hospital Charge Code |
6224230
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$75.99 |
| Max. Negotiated Rate |
$340.62 |
| Rate for Payer: Aetna Commercial |
$333.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$318.41
|
| Rate for Payer: Aetna Managed Medicare |
$75.99
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$240.66
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$185.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$177.72
|
| Rate for Payer: Anthem Medicare Advantage |
$75.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$196.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$75.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$75.99
|
| Rate for Payer: Cash Price |
$106.80
|
| Rate for Payer: Cash Price |
$106.80
|
| Rate for Payer: Cigna Commercial |
$340.62
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$75.99
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$207.19
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$75.99
|
| Rate for Payer: Health EOS Commercial |
$329.51
|
| Rate for Payer: HFN Commercial |
$340.62
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$282.69
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$75.99
|
| Rate for Payer: Independent Care Health Plan Medicare |
$75.99
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$75.99
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$75.99
|
| Rate for Payer: Multiplan Commercial |
$296.19
|
| Rate for Payer: NAPHCARE Commercial |
$113.99
|
| Rate for Payer: Preferred Network Access Commercial |
$340.62
|
| Rate for Payer: Quartz Beloit One Network |
$181.42
|
| Rate for Payer: Quartz Commercial |
$240.66
|
| Rate for Payer: Quartz Medicare Advantage |
$75.99
|
| Rate for Payer: The Alliance Commercial |
$303.97
|
| Rate for Payer: United Healthcare Medicare Advantage |
$75.99
|
| Rate for Payer: United Healthcare PPO |
$277.68
|
| Rate for Payer: WEA Trust Commercial |
$203.63
|
| Rate for Payer: Wellcare Medicare |
$75.99
|
| Rate for Payer: WPS Commercial |
$274.23
|
|
|
Aph Plsm RT 24 ACDA 3
|
Facility
|
IP
|
$356.00
|
|
|
Service Code
|
HCPCS P9059
|
| Hospital Charge Code |
6224230
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$181.42 |
| Max. Negotiated Rate |
$340.62 |
| Rate for Payer: Aetna Commercial |
$333.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$318.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$196.23
|
| Rate for Payer: Cash Price |
$106.80
|
| Rate for Payer: Cigna Commercial |
$340.62
|
| Rate for Payer: Health EOS Commercial |
$329.51
|
| Rate for Payer: HFN Commercial |
$340.62
|
| Rate for Payer: Multiplan Commercial |
$296.19
|
| Rate for Payer: Preferred Network Access Commercial |
$340.62
|
| Rate for Payer: Quartz Beloit One Network |
$181.42
|
| Rate for Payer: Quartz Commercial |
$222.14
|
| Rate for Payer: WEA Trust Commercial |
$203.63
|
| Rate for Payer: WPS Commercial |
$274.23
|
|
|
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 |
$181.42 |
| Max. Negotiated Rate |
$340.62 |
| Rate for Payer: Aetna Commercial |
$333.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$318.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$196.23
|
| Rate for Payer: Cash Price |
$106.80
|
| Rate for Payer: Cigna Commercial |
$340.62
|
| Rate for Payer: Health EOS Commercial |
$329.51
|
| Rate for Payer: HFN Commercial |
$340.62
|
| Rate for Payer: Multiplan Commercial |
$296.19
|
| Rate for Payer: Preferred Network Access Commercial |
$340.62
|
| Rate for Payer: Quartz Beloit One Network |
$181.42
|
| Rate for Payer: Quartz Commercial |
$222.14
|
| Rate for Payer: WEA Trust Commercial |
$203.63
|
| Rate for Payer: WPS Commercial |
$274.23
|
|
|
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 |
$75.99 |
| Max. Negotiated Rate |
$340.62 |
| Rate for Payer: Aetna Commercial |
$333.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$318.41
|
| Rate for Payer: Aetna Managed Medicare |
$75.99
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$240.66
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$185.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$177.72
|
| Rate for Payer: Anthem Medicare Advantage |
$75.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$196.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$75.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$75.99
|
| Rate for Payer: Cash Price |
$106.80
|
| Rate for Payer: Cash Price |
$106.80
|
| Rate for Payer: Cigna Commercial |
$340.62
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$75.99
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$207.19
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$75.99
|
| Rate for Payer: Health EOS Commercial |
$329.51
|
| Rate for Payer: HFN Commercial |
$340.62
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$282.69
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$75.99
|
| Rate for Payer: Independent Care Health Plan Medicare |
$75.99
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$75.99
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$75.99
|
| Rate for Payer: Multiplan Commercial |
$296.19
|
| Rate for Payer: NAPHCARE Commercial |
$113.99
|
| Rate for Payer: Preferred Network Access Commercial |
$340.62
|
| Rate for Payer: Quartz Beloit One Network |
$181.42
|
| Rate for Payer: Quartz Commercial |
$240.66
|
| Rate for Payer: Quartz Medicare Advantage |
$75.99
|
| Rate for Payer: The Alliance Commercial |
$303.97
|
| Rate for Payer: United Healthcare Medicare Advantage |
$75.99
|
| Rate for Payer: United Healthcare PPO |
$277.68
|
| Rate for Payer: WEA Trust Commercial |
$203.63
|
| Rate for Payer: Wellcare Medicare |
$75.99
|
| Rate for Payer: WPS Commercial |
$274.23
|
|
|
Aph Plt ACDA
|
Facility
|
OP
|
$3,434.00
|
|
|
Service Code
|
HCPCS P9019
|
| Hospital Charge Code |
1052801
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$54.77 |
| Max. Negotiated Rate |
$3,285.65 |
| Rate for Payer: Aetna Commercial |
$3,214.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,071.37
|
| Rate for Payer: Aetna Managed Medicare |
$54.77
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,321.38
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,785.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,714.25
|
| Rate for Payer: Anthem Medicare Advantage |
$54.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,892.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$54.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$54.77
|
| Rate for Payer: Cash Price |
$1,030.20
|
| Rate for Payer: Cash Price |
$1,030.20
|
| Rate for Payer: Cigna Commercial |
$3,285.65
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$54.77
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,998.59
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$54.77
|
| Rate for Payer: Health EOS Commercial |
$3,178.51
|
| Rate for Payer: HFN Commercial |
$3,285.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$203.73
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$54.77
|
| Rate for Payer: Independent Care Health Plan Medicare |
$54.77
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$54.77
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$54.77
|
| Rate for Payer: Multiplan Commercial |
$2,857.09
|
| Rate for Payer: NAPHCARE Commercial |
$82.15
|
| Rate for Payer: Preferred Network Access Commercial |
$3,285.65
|
| Rate for Payer: Quartz Beloit One Network |
$1,749.97
|
| Rate for Payer: Quartz Commercial |
$2,321.38
|
| Rate for Payer: Quartz Medicare Advantage |
$54.77
|
| Rate for Payer: The Alliance Commercial |
$219.07
|
| Rate for Payer: United Healthcare Medicare Advantage |
$54.77
|
| Rate for Payer: United Healthcare PPO |
$2,678.52
|
| Rate for Payer: WEA Trust Commercial |
$1,964.25
|
| Rate for Payer: Wellcare Medicare |
$54.77
|
| Rate for Payer: WPS Commercial |
$2,645.21
|
|
|
Aph Plt ACDA
|
Facility
|
IP
|
$3,434.00
|
|
|
Service Code
|
HCPCS P9019
|
| Hospital Charge Code |
1052801
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$1,749.97 |
| Max. Negotiated Rate |
$3,285.65 |
| Rate for Payer: Aetna Commercial |
$3,214.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,071.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,892.82
|
| Rate for Payer: Cash Price |
$1,030.20
|
| Rate for Payer: Cigna Commercial |
$3,285.65
|
| Rate for Payer: Health EOS Commercial |
$3,178.51
|
| Rate for Payer: HFN Commercial |
$3,285.65
|
| Rate for Payer: Multiplan Commercial |
$2,857.09
|
| Rate for Payer: Preferred Network Access Commercial |
$3,285.65
|
| Rate for Payer: Quartz Beloit One Network |
$1,749.97
|
| Rate for Payer: Quartz Commercial |
$2,142.82
|
| Rate for Payer: WEA Trust Commercial |
$1,964.25
|
| Rate for Payer: WPS Commercial |
$2,645.21
|
|
|
Aph Plt ACDA 1
|
Facility
|
OP
|
$3,434.00
|
|
|
Service Code
|
HCPCS P9019
|
| Hospital Charge Code |
1052811
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$54.77 |
| Max. Negotiated Rate |
$3,285.65 |
| Rate for Payer: Aetna Commercial |
$3,214.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,071.37
|
| Rate for Payer: Aetna Managed Medicare |
$54.77
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,321.38
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,785.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,714.25
|
| Rate for Payer: Anthem Medicare Advantage |
$54.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,892.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$54.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$54.77
|
| Rate for Payer: Cash Price |
$1,030.20
|
| Rate for Payer: Cash Price |
$1,030.20
|
| Rate for Payer: Cigna Commercial |
$3,285.65
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$54.77
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,998.59
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$54.77
|
| Rate for Payer: Health EOS Commercial |
$3,178.51
|
| Rate for Payer: HFN Commercial |
$3,285.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$203.73
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$54.77
|
| Rate for Payer: Independent Care Health Plan Medicare |
$54.77
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$54.77
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$54.77
|
| Rate for Payer: Multiplan Commercial |
$2,857.09
|
| Rate for Payer: NAPHCARE Commercial |
$82.15
|
| Rate for Payer: Preferred Network Access Commercial |
$3,285.65
|
| Rate for Payer: Quartz Beloit One Network |
$1,749.97
|
| Rate for Payer: Quartz Commercial |
$2,321.38
|
| Rate for Payer: Quartz Medicare Advantage |
$54.77
|
| Rate for Payer: The Alliance Commercial |
$219.07
|
| Rate for Payer: United Healthcare Medicare Advantage |
$54.77
|
| Rate for Payer: United Healthcare PPO |
$2,678.52
|
| Rate for Payer: WEA Trust Commercial |
$1,964.25
|
| Rate for Payer: Wellcare Medicare |
$54.77
|
| Rate for Payer: WPS Commercial |
$2,645.21
|
|
|
Aph Plt ACDA 1
|
Facility
|
IP
|
$3,434.00
|
|
|
Service Code
|
HCPCS P9019
|
| Hospital Charge Code |
1052811
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$1,749.97 |
| Max. Negotiated Rate |
$3,285.65 |
| Rate for Payer: Aetna Commercial |
$3,214.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,071.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,892.82
|
| Rate for Payer: Cash Price |
$1,030.20
|
| Rate for Payer: Cigna Commercial |
$3,285.65
|
| Rate for Payer: Health EOS Commercial |
$3,178.51
|
| Rate for Payer: HFN Commercial |
$3,285.65
|
| Rate for Payer: Multiplan Commercial |
$2,857.09
|
| Rate for Payer: Preferred Network Access Commercial |
$3,285.65
|
| Rate for Payer: Quartz Beloit One Network |
$1,749.97
|
| Rate for Payer: Quartz Commercial |
$2,142.82
|
| Rate for Payer: WEA Trust Commercial |
$1,964.25
|
| Rate for Payer: WPS Commercial |
$2,645.21
|
|
|
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 |
$1,749.97 |
| Max. Negotiated Rate |
$3,285.65 |
| Rate for Payer: Aetna Commercial |
$3,214.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,071.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,892.82
|
| Rate for Payer: Cash Price |
$1,030.20
|
| Rate for Payer: Cigna Commercial |
$3,285.65
|
| Rate for Payer: Health EOS Commercial |
$3,178.51
|
| Rate for Payer: HFN Commercial |
$3,285.65
|
| Rate for Payer: Multiplan Commercial |
$2,857.09
|
| Rate for Payer: Preferred Network Access Commercial |
$3,285.65
|
| Rate for Payer: Quartz Beloit One Network |
$1,749.97
|
| Rate for Payer: Quartz Commercial |
$2,142.82
|
| Rate for Payer: WEA Trust Commercial |
$1,964.25
|
| Rate for Payer: WPS Commercial |
$2,645.21
|
|
|
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 |
$625.71 |
| Max. Negotiated Rate |
$3,285.65 |
| Rate for Payer: Aetna Commercial |
$3,214.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,071.37
|
| Rate for Payer: Aetna Managed Medicare |
$625.71
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,321.38
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,785.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,714.25
|
| Rate for Payer: Anthem Medicare Advantage |
$625.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,892.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$625.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$625.71
|
| Rate for Payer: Cash Price |
$1,030.20
|
| Rate for Payer: Cash Price |
$1,030.20
|
| Rate for Payer: Cigna Commercial |
$3,285.65
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$625.71
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,998.59
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$625.71
|
| Rate for Payer: Health EOS Commercial |
$3,178.51
|
| Rate for Payer: HFN Commercial |
$3,285.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,327.62
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$625.71
|
| Rate for Payer: Independent Care Health Plan Medicare |
$625.71
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$625.71
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$625.71
|
| Rate for Payer: Multiplan Commercial |
$2,857.09
|
| Rate for Payer: NAPHCARE Commercial |
$938.56
|
| Rate for Payer: Preferred Network Access Commercial |
$3,285.65
|
| Rate for Payer: Quartz Beloit One Network |
$1,749.97
|
| Rate for Payer: Quartz Commercial |
$2,321.38
|
| Rate for Payer: Quartz Medicare Advantage |
$625.71
|
| Rate for Payer: The Alliance Commercial |
$2,502.82
|
| Rate for Payer: United Healthcare Medicare Advantage |
$625.71
|
| Rate for Payer: United Healthcare PPO |
$2,678.52
|
| Rate for Payer: WEA Trust Commercial |
$1,964.25
|
| Rate for Payer: Wellcare Medicare |
$625.71
|
| Rate for Payer: WPS Commercial |
$2,645.21
|
|
|
Aph Plt ACDA 2
|
Facility
|
OP
|
$3,434.00
|
|
|
Service Code
|
HCPCS P9019
|
| Hospital Charge Code |
1052805
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$54.77 |
| Max. Negotiated Rate |
$3,285.65 |
| Rate for Payer: Aetna Commercial |
$3,214.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,071.37
|
| Rate for Payer: Aetna Managed Medicare |
$54.77
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,321.38
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,785.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,714.25
|
| Rate for Payer: Anthem Medicare Advantage |
$54.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,892.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$54.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$54.77
|
| Rate for Payer: Cash Price |
$1,030.20
|
| Rate for Payer: Cash Price |
$1,030.20
|
| Rate for Payer: Cigna Commercial |
$3,285.65
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$54.77
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,998.59
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$54.77
|
| Rate for Payer: Health EOS Commercial |
$3,178.51
|
| Rate for Payer: HFN Commercial |
$3,285.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$203.73
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$54.77
|
| Rate for Payer: Independent Care Health Plan Medicare |
$54.77
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$54.77
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$54.77
|
| Rate for Payer: Multiplan Commercial |
$2,857.09
|
| Rate for Payer: NAPHCARE Commercial |
$82.15
|
| Rate for Payer: Preferred Network Access Commercial |
$3,285.65
|
| Rate for Payer: Quartz Beloit One Network |
$1,749.97
|
| Rate for Payer: Quartz Commercial |
$2,321.38
|
| Rate for Payer: Quartz Medicare Advantage |
$54.77
|
| Rate for Payer: The Alliance Commercial |
$219.07
|
| Rate for Payer: United Healthcare Medicare Advantage |
$54.77
|
| Rate for Payer: United Healthcare PPO |
$2,678.52
|
| Rate for Payer: WEA Trust Commercial |
$1,964.25
|
| Rate for Payer: Wellcare Medicare |
$54.77
|
| Rate for Payer: WPS Commercial |
$2,645.21
|
|
|
Aph Plt ACDA 2
|
Facility
|
IP
|
$3,434.00
|
|
|
Service Code
|
HCPCS P9019
|
| Hospital Charge Code |
1052805
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$1,749.97 |
| Max. Negotiated Rate |
$3,285.65 |
| Rate for Payer: Aetna Commercial |
$3,214.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,071.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,892.82
|
| Rate for Payer: Cash Price |
$1,030.20
|
| Rate for Payer: Cigna Commercial |
$3,285.65
|
| Rate for Payer: Health EOS Commercial |
$3,178.51
|
| Rate for Payer: HFN Commercial |
$3,285.65
|
| Rate for Payer: Multiplan Commercial |
$2,857.09
|
| Rate for Payer: Preferred Network Access Commercial |
$3,285.65
|
| Rate for Payer: Quartz Beloit One Network |
$1,749.97
|
| Rate for Payer: Quartz Commercial |
$2,142.82
|
| Rate for Payer: WEA Trust Commercial |
$1,964.25
|
| Rate for Payer: WPS Commercial |
$2,645.21
|
|
|
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 |
$625.71 |
| Max. Negotiated Rate |
$3,285.65 |
| Rate for Payer: Aetna Commercial |
$3,214.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,071.37
|
| Rate for Payer: Aetna Managed Medicare |
$625.71
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,321.38
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,785.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,714.25
|
| Rate for Payer: Anthem Medicare Advantage |
$625.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,892.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$625.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$625.71
|
| Rate for Payer: Cash Price |
$1,030.20
|
| Rate for Payer: Cash Price |
$1,030.20
|
| Rate for Payer: Cigna Commercial |
$3,285.65
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$625.71
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,998.59
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$625.71
|
| Rate for Payer: Health EOS Commercial |
$3,178.51
|
| Rate for Payer: HFN Commercial |
$3,285.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,327.62
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$625.71
|
| Rate for Payer: Independent Care Health Plan Medicare |
$625.71
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$625.71
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$625.71
|
| Rate for Payer: Multiplan Commercial |
$2,857.09
|
| Rate for Payer: NAPHCARE Commercial |
$938.56
|
| Rate for Payer: Preferred Network Access Commercial |
$3,285.65
|
| Rate for Payer: Quartz Beloit One Network |
$1,749.97
|
| Rate for Payer: Quartz Commercial |
$2,321.38
|
| Rate for Payer: Quartz Medicare Advantage |
$625.71
|
| Rate for Payer: The Alliance Commercial |
$2,502.82
|
| Rate for Payer: United Healthcare Medicare Advantage |
$625.71
|
| Rate for Payer: United Healthcare PPO |
$2,678.52
|
| Rate for Payer: WEA Trust Commercial |
$1,964.25
|
| Rate for Payer: Wellcare Medicare |
$625.71
|
| Rate for Payer: WPS Commercial |
$2,645.21
|
|
|
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 |
$1,749.97 |
| Max. Negotiated Rate |
$3,285.65 |
| Rate for Payer: Aetna Commercial |
$3,214.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,071.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,892.82
|
| Rate for Payer: Cash Price |
$1,030.20
|
| Rate for Payer: Cigna Commercial |
$3,285.65
|
| Rate for Payer: Health EOS Commercial |
$3,178.51
|
| Rate for Payer: HFN Commercial |
$3,285.65
|
| Rate for Payer: Multiplan Commercial |
$2,857.09
|
| Rate for Payer: Preferred Network Access Commercial |
$3,285.65
|
| Rate for Payer: Quartz Beloit One Network |
$1,749.97
|
| Rate for Payer: Quartz Commercial |
$2,142.82
|
| Rate for Payer: WEA Trust Commercial |
$1,964.25
|
| Rate for Payer: WPS Commercial |
$2,645.21
|
|
|
Aph Plt ACDA 3
|
Facility
|
IP
|
$3,434.00
|
|
|
Service Code
|
HCPCS P9019
|
| Hospital Charge Code |
1052826
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$1,749.97 |
| Max. Negotiated Rate |
$3,285.65 |
| Rate for Payer: Aetna Commercial |
$3,214.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,071.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,892.82
|
| Rate for Payer: Cash Price |
$1,030.20
|
| Rate for Payer: Cigna Commercial |
$3,285.65
|
| Rate for Payer: Health EOS Commercial |
$3,178.51
|
| Rate for Payer: HFN Commercial |
$3,285.65
|
| Rate for Payer: Multiplan Commercial |
$2,857.09
|
| Rate for Payer: Preferred Network Access Commercial |
$3,285.65
|
| Rate for Payer: Quartz Beloit One Network |
$1,749.97
|
| Rate for Payer: Quartz Commercial |
$2,142.82
|
| Rate for Payer: WEA Trust Commercial |
$1,964.25
|
| Rate for Payer: WPS Commercial |
$2,645.21
|
|
|
Aph Plt ACDA 3
|
Facility
|
OP
|
$3,434.00
|
|
|
Service Code
|
HCPCS P9019
|
| Hospital Charge Code |
1052826
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$54.77 |
| Max. Negotiated Rate |
$3,285.65 |
| Rate for Payer: Aetna Commercial |
$3,214.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,071.37
|
| Rate for Payer: Aetna Managed Medicare |
$54.77
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,321.38
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,785.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,714.25
|
| Rate for Payer: Anthem Medicare Advantage |
$54.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,892.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$54.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$54.77
|
| Rate for Payer: Cash Price |
$1,030.20
|
| Rate for Payer: Cash Price |
$1,030.20
|
| Rate for Payer: Cigna Commercial |
$3,285.65
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$54.77
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,998.59
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$54.77
|
| Rate for Payer: Health EOS Commercial |
$3,178.51
|
| Rate for Payer: HFN Commercial |
$3,285.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$203.73
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$54.77
|
| Rate for Payer: Independent Care Health Plan Medicare |
$54.77
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$54.77
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$54.77
|
| Rate for Payer: Multiplan Commercial |
$2,857.09
|
| Rate for Payer: NAPHCARE Commercial |
$82.15
|
| Rate for Payer: Preferred Network Access Commercial |
$3,285.65
|
| Rate for Payer: Quartz Beloit One Network |
$1,749.97
|
| Rate for Payer: Quartz Commercial |
$2,321.38
|
| Rate for Payer: Quartz Medicare Advantage |
$54.77
|
| Rate for Payer: The Alliance Commercial |
$219.07
|
| Rate for Payer: United Healthcare Medicare Advantage |
$54.77
|
| Rate for Payer: United Healthcare PPO |
$2,678.52
|
| Rate for Payer: WEA Trust Commercial |
$1,964.25
|
| Rate for Payer: Wellcare Medicare |
$54.77
|
| Rate for Payer: WPS Commercial |
$2,645.21
|
|
|
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 |
$1,749.97 |
| Max. Negotiated Rate |
$3,285.65 |
| Rate for Payer: Aetna Commercial |
$3,214.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,071.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,892.82
|
| Rate for Payer: Cash Price |
$1,030.20
|
| Rate for Payer: Cigna Commercial |
$3,285.65
|
| Rate for Payer: Health EOS Commercial |
$3,178.51
|
| Rate for Payer: HFN Commercial |
$3,285.65
|
| Rate for Payer: Multiplan Commercial |
$2,857.09
|
| Rate for Payer: Preferred Network Access Commercial |
$3,285.65
|
| Rate for Payer: Quartz Beloit One Network |
$1,749.97
|
| Rate for Payer: Quartz Commercial |
$2,142.82
|
| Rate for Payer: WEA Trust Commercial |
$1,964.25
|
| Rate for Payer: WPS Commercial |
$2,645.21
|
|
|
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 |
$625.71 |
| Max. Negotiated Rate |
$3,285.65 |
| Rate for Payer: Aetna Commercial |
$3,214.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,071.37
|
| Rate for Payer: Aetna Managed Medicare |
$625.71
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,321.38
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,785.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,714.25
|
| Rate for Payer: Anthem Medicare Advantage |
$625.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,892.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$625.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$625.71
|
| Rate for Payer: Cash Price |
$1,030.20
|
| Rate for Payer: Cash Price |
$1,030.20
|
| Rate for Payer: Cigna Commercial |
$3,285.65
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$625.71
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,998.59
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$625.71
|
| Rate for Payer: Health EOS Commercial |
$3,178.51
|
| Rate for Payer: HFN Commercial |
$3,285.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,327.62
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$625.71
|
| Rate for Payer: Independent Care Health Plan Medicare |
$625.71
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$625.71
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$625.71
|
| Rate for Payer: Multiplan Commercial |
$2,857.09
|
| Rate for Payer: NAPHCARE Commercial |
$938.56
|
| Rate for Payer: Preferred Network Access Commercial |
$3,285.65
|
| Rate for Payer: Quartz Beloit One Network |
$1,749.97
|
| Rate for Payer: Quartz Commercial |
$2,321.38
|
| Rate for Payer: Quartz Medicare Advantage |
$625.71
|
| Rate for Payer: The Alliance Commercial |
$2,502.82
|
| Rate for Payer: United Healthcare Medicare Advantage |
$625.71
|
| Rate for Payer: United Healthcare PPO |
$2,678.52
|
| Rate for Payer: WEA Trust Commercial |
$1,964.25
|
| Rate for Payer: Wellcare Medicare |
$625.71
|
| Rate for Payer: WPS Commercial |
$2,645.21
|
|
|
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 |
$1,749.97 |
| Max. Negotiated Rate |
$3,285.65 |
| Rate for Payer: Aetna Commercial |
$3,214.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,071.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,892.82
|
| Rate for Payer: Cash Price |
$1,030.20
|
| Rate for Payer: Cigna Commercial |
$3,285.65
|
| Rate for Payer: Health EOS Commercial |
$3,178.51
|
| Rate for Payer: HFN Commercial |
$3,285.65
|
| Rate for Payer: Multiplan Commercial |
$2,857.09
|
| Rate for Payer: Preferred Network Access Commercial |
$3,285.65
|
| Rate for Payer: Quartz Beloit One Network |
$1,749.97
|
| Rate for Payer: Quartz Commercial |
$2,142.82
|
| Rate for Payer: WEA Trust Commercial |
$1,964.25
|
| Rate for Payer: WPS Commercial |
$2,645.21
|
|
|
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 |
$54.77 |
| Max. Negotiated Rate |
$3,285.65 |
| Rate for Payer: Aetna Commercial |
$3,214.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,071.37
|
| Rate for Payer: Aetna Managed Medicare |
$54.77
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,321.38
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,785.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,714.25
|
| Rate for Payer: Anthem Medicare Advantage |
$54.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,892.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$54.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$54.77
|
| Rate for Payer: Cash Price |
$1,030.20
|
| Rate for Payer: Cash Price |
$1,030.20
|
| Rate for Payer: Cigna Commercial |
$3,285.65
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$54.77
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,998.59
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$54.77
|
| Rate for Payer: Health EOS Commercial |
$3,178.51
|
| Rate for Payer: HFN Commercial |
$3,285.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$203.73
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$54.77
|
| Rate for Payer: Independent Care Health Plan Medicare |
$54.77
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$54.77
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$54.77
|
| Rate for Payer: Multiplan Commercial |
$2,857.09
|
| Rate for Payer: NAPHCARE Commercial |
$82.15
|
| Rate for Payer: Preferred Network Access Commercial |
$3,285.65
|
| Rate for Payer: Quartz Beloit One Network |
$1,749.97
|
| Rate for Payer: Quartz Commercial |
$2,321.38
|
| Rate for Payer: Quartz Medicare Advantage |
$54.77
|
| Rate for Payer: The Alliance Commercial |
$219.07
|
| Rate for Payer: United Healthcare Medicare Advantage |
$54.77
|
| Rate for Payer: United Healthcare PPO |
$2,678.52
|
| Rate for Payer: WEA Trust Commercial |
$1,964.25
|
| Rate for Payer: Wellcare Medicare |
$54.77
|
| Rate for Payer: WPS Commercial |
$2,645.21
|
|
|
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 |
$54.77 |
| Max. Negotiated Rate |
$3,285.65 |
| Rate for Payer: Aetna Commercial |
$3,214.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,071.37
|
| Rate for Payer: Aetna Managed Medicare |
$54.77
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,321.38
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,785.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,714.25
|
| Rate for Payer: Anthem Medicare Advantage |
$54.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,892.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$54.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$54.77
|
| Rate for Payer: Cash Price |
$1,030.20
|
| Rate for Payer: Cash Price |
$1,030.20
|
| Rate for Payer: Cigna Commercial |
$3,285.65
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$54.77
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,998.59
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$54.77
|
| Rate for Payer: Health EOS Commercial |
$3,178.51
|
| Rate for Payer: HFN Commercial |
$3,285.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$203.73
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$54.77
|
| Rate for Payer: Independent Care Health Plan Medicare |
$54.77
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$54.77
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$54.77
|
| Rate for Payer: Multiplan Commercial |
$2,857.09
|
| Rate for Payer: NAPHCARE Commercial |
$82.15
|
| Rate for Payer: Preferred Network Access Commercial |
$3,285.65
|
| Rate for Payer: Quartz Beloit One Network |
$1,749.97
|
| Rate for Payer: Quartz Commercial |
$2,321.38
|
| Rate for Payer: Quartz Medicare Advantage |
$54.77
|
| Rate for Payer: The Alliance Commercial |
$219.07
|
| Rate for Payer: United Healthcare Medicare Advantage |
$54.77
|
| Rate for Payer: United Healthcare PPO |
$2,678.52
|
| Rate for Payer: WEA Trust Commercial |
$1,964.25
|
| Rate for Payer: Wellcare Medicare |
$54.77
|
| Rate for Payer: WPS Commercial |
$2,645.21
|
|
