|
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
|
|
|
Aph Plt ACDA Irr 3
|
Facility
|
IP
|
$3,434.00
|
|
|
Service Code
|
HCPCS P9019
|
| Hospital Charge Code |
1052829
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$1,749.97 |
| 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 3
|
Facility
|
OP
|
$3,434.00
|
|
|
Service Code
|
HCPCS P9019
|
| Hospital Charge Code |
1052829
|
|
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 LR
|
Facility
|
IP
|
$3,171.00
|
|
|
Service Code
|
HCPCS P9019
|
| Hospital Charge Code |
1052839
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$1,615.94 |
| Max. Negotiated Rate |
$3,034.01 |
| Rate for Payer: Aetna Commercial |
$2,968.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,836.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,747.86
|
| Rate for Payer: Cash Price |
$951.30
|
| Rate for Payer: Cigna Commercial |
$3,034.01
|
| Rate for Payer: Health EOS Commercial |
$2,935.08
|
| Rate for Payer: HFN Commercial |
$3,034.01
|
| Rate for Payer: Multiplan Commercial |
$2,638.27
|
| Rate for Payer: Preferred Network Access Commercial |
$3,034.01
|
| Rate for Payer: Quartz Beloit One Network |
$1,615.94
|
| Rate for Payer: Quartz Commercial |
$1,978.70
|
| Rate for Payer: WEA Trust Commercial |
$1,813.81
|
| Rate for Payer: WPS Commercial |
$2,442.62
|
|
|
Aph Plt ACDA LR
|
Facility
|
OP
|
$3,171.00
|
|
|
Service Code
|
HCPCS P9019
|
| Hospital Charge Code |
1052839
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$54.77 |
| Max. Negotiated Rate |
$3,034.01 |
| Rate for Payer: Aetna Commercial |
$2,968.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,836.14
|
| Rate for Payer: Aetna Managed Medicare |
$54.77
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,143.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,648.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,582.96
|
| Rate for Payer: Anthem Medicare Advantage |
$54.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,747.86
|
| 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 |
$951.30
|
| Rate for Payer: Cash Price |
$951.30
|
| Rate for Payer: Cigna Commercial |
$3,034.01
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$54.77
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,845.52
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$54.77
|
| Rate for Payer: Health EOS Commercial |
$2,935.08
|
| Rate for Payer: HFN Commercial |
$3,034.01
|
| 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 |
$2,638.27
|
| Rate for Payer: NAPHCARE Commercial |
$82.15
|
| Rate for Payer: Preferred Network Access Commercial |
$3,034.01
|
| Rate for Payer: Quartz Beloit One Network |
$1,615.94
|
| Rate for Payer: Quartz Commercial |
$2,143.60
|
| 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 |
$2,473.38
|
| Rate for Payer: WEA Trust Commercial |
$1,813.81
|
| Rate for Payer: Wellcare Medicare |
$54.77
|
| Rate for Payer: WPS Commercial |
$2,442.62
|
|
|
Aph Plt ACDA LR 1
|
Facility
|
OP
|
$3,171.00
|
|
|
Service Code
|
HCPCS P9019
|
| Hospital Charge Code |
1052853
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$54.77 |
| Max. Negotiated Rate |
$3,034.01 |
| Rate for Payer: Aetna Commercial |
$2,968.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,836.14
|
| Rate for Payer: Aetna Managed Medicare |
$54.77
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,143.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,648.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,582.96
|
| Rate for Payer: Anthem Medicare Advantage |
$54.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,747.86
|
| 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 |
$951.30
|
| Rate for Payer: Cash Price |
$951.30
|
| Rate for Payer: Cigna Commercial |
$3,034.01
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$54.77
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,845.52
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$54.77
|
| Rate for Payer: Health EOS Commercial |
$2,935.08
|
| Rate for Payer: HFN Commercial |
$3,034.01
|
| 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 |
$2,638.27
|
| Rate for Payer: NAPHCARE Commercial |
$82.15
|
| Rate for Payer: Preferred Network Access Commercial |
$3,034.01
|
| Rate for Payer: Quartz Beloit One Network |
$1,615.94
|
| Rate for Payer: Quartz Commercial |
$2,143.60
|
| 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 |
$2,473.38
|
| Rate for Payer: WEA Trust Commercial |
$1,813.81
|
| Rate for Payer: Wellcare Medicare |
$54.77
|
| Rate for Payer: WPS Commercial |
$2,442.62
|
|
|
Aph Plt ACDA LR 1
|
Facility
|
IP
|
$3,171.00
|
|
|
Service Code
|
HCPCS P9019
|
| Hospital Charge Code |
1052853
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$1,615.94 |
| Max. Negotiated Rate |
$3,034.01 |
| Rate for Payer: Aetna Commercial |
$2,968.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,836.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,747.86
|
| Rate for Payer: Cash Price |
$951.30
|
| Rate for Payer: Cigna Commercial |
$3,034.01
|
| Rate for Payer: Health EOS Commercial |
$2,935.08
|
| Rate for Payer: HFN Commercial |
$3,034.01
|
| Rate for Payer: Multiplan Commercial |
$2,638.27
|
| Rate for Payer: Preferred Network Access Commercial |
$3,034.01
|
| Rate for Payer: Quartz Beloit One Network |
$1,615.94
|
| Rate for Payer: Quartz Commercial |
$1,978.70
|
| Rate for Payer: WEA Trust Commercial |
$1,813.81
|
| Rate for Payer: WPS Commercial |
$2,442.62
|
|
|
Aph Plt ACDA LR 1 D5
|
Facility
|
IP
|
$3,434.00
|
|
|
Service Code
|
HCPCS P9019
|
| Hospital Charge Code |
5408632
|
|
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 LR 1 D5
|
Facility
|
OP
|
$3,434.00
|
|
|
Service Code
|
HCPCS P9019
|
| Hospital Charge Code |
5408632
|
|
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 LR 1 DS
|
Facility
|
IP
|
$3,434.00
|
|
|
Service Code
|
HCPCS P9019
|
| Hospital Charge Code |
6181774
|
|
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 LR 1 DS
|
Facility
|
OP
|
$3,434.00
|
|
|
Service Code
|
HCPCS P9019
|
| Hospital Charge Code |
6181774
|
|
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 LR 2
|
Facility
|
IP
|
$3,171.00
|
|
|
Service Code
|
HCPCS P9019
|
| Hospital Charge Code |
1052842
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$1,615.94 |
| Max. Negotiated Rate |
$3,034.01 |
| Rate for Payer: Aetna Commercial |
$2,968.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,836.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,747.86
|
| Rate for Payer: Cash Price |
$951.30
|
| Rate for Payer: Cigna Commercial |
$3,034.01
|
| Rate for Payer: Health EOS Commercial |
$2,935.08
|
| Rate for Payer: HFN Commercial |
$3,034.01
|
| Rate for Payer: Multiplan Commercial |
$2,638.27
|
| Rate for Payer: Preferred Network Access Commercial |
$3,034.01
|
| Rate for Payer: Quartz Beloit One Network |
$1,615.94
|
| Rate for Payer: Quartz Commercial |
$1,978.70
|
| Rate for Payer: WEA Trust Commercial |
$1,813.81
|
| Rate for Payer: WPS Commercial |
$2,442.62
|
|
|
Aph Plt ACDA LR 2
|
Facility
|
OP
|
$3,171.00
|
|
|
Service Code
|
HCPCS P9019
|
| Hospital Charge Code |
1052842
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$54.77 |
| Max. Negotiated Rate |
$3,034.01 |
| Rate for Payer: Aetna Commercial |
$2,968.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,836.14
|
| Rate for Payer: Aetna Managed Medicare |
$54.77
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,143.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,648.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,582.96
|
| Rate for Payer: Anthem Medicare Advantage |
$54.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,747.86
|
| 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 |
$951.30
|
| Rate for Payer: Cash Price |
$951.30
|
| Rate for Payer: Cigna Commercial |
$3,034.01
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$54.77
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,845.52
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$54.77
|
| Rate for Payer: Health EOS Commercial |
$2,935.08
|
| Rate for Payer: HFN Commercial |
$3,034.01
|
| 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 |
$2,638.27
|
| Rate for Payer: NAPHCARE Commercial |
$82.15
|
| Rate for Payer: Preferred Network Access Commercial |
$3,034.01
|
| Rate for Payer: Quartz Beloit One Network |
$1,615.94
|
| Rate for Payer: Quartz Commercial |
$2,143.60
|
| 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 |
$2,473.38
|
| Rate for Payer: WEA Trust Commercial |
$1,813.81
|
| Rate for Payer: Wellcare Medicare |
$54.77
|
| Rate for Payer: WPS Commercial |
$2,442.62
|
|
|
Aph Plt ACDA LR 2 D5
|
Facility
|
IP
|
$3,172.00
|
|
|
Service Code
|
HCPCS P9019
|
| Hospital Charge Code |
5408638
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$1,616.45 |
| Max. Negotiated Rate |
$3,034.97 |
| Rate for Payer: Aetna Commercial |
$2,968.99
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,837.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,748.41
|
| Rate for Payer: Cash Price |
$951.60
|
| Rate for Payer: Cigna Commercial |
$3,034.97
|
| Rate for Payer: Health EOS Commercial |
$2,936.00
|
| Rate for Payer: HFN Commercial |
$3,034.97
|
| Rate for Payer: Multiplan Commercial |
$2,639.10
|
| Rate for Payer: Preferred Network Access Commercial |
$3,034.97
|
| Rate for Payer: Quartz Beloit One Network |
$1,616.45
|
| Rate for Payer: Quartz Commercial |
$1,979.33
|
| Rate for Payer: WEA Trust Commercial |
$1,814.38
|
| Rate for Payer: WPS Commercial |
$2,443.39
|
|
|
Aph Plt ACDA LR 2 D5
|
Facility
|
OP
|
$3,172.00
|
|
|
Service Code
|
HCPCS P9019
|
| Hospital Charge Code |
5408638
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$54.77 |
| Max. Negotiated Rate |
$3,034.97 |
| Rate for Payer: Aetna Commercial |
$2,968.99
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,837.04
|
| Rate for Payer: Aetna Managed Medicare |
$54.77
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,144.27
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,649.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,583.46
|
| Rate for Payer: Anthem Medicare Advantage |
$54.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,748.41
|
| 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 |
$951.60
|
| Rate for Payer: Cash Price |
$951.60
|
| Rate for Payer: Cigna Commercial |
$3,034.97
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$54.77
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,846.10
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$54.77
|
| Rate for Payer: Health EOS Commercial |
$2,936.00
|
| Rate for Payer: HFN Commercial |
$3,034.97
|
| 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 |
$2,639.10
|
| Rate for Payer: NAPHCARE Commercial |
$82.15
|
| Rate for Payer: Preferred Network Access Commercial |
$3,034.97
|
| Rate for Payer: Quartz Beloit One Network |
$1,616.45
|
| Rate for Payer: Quartz Commercial |
$2,144.27
|
| 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 |
$2,474.16
|
| Rate for Payer: WEA Trust Commercial |
$1,814.38
|
| Rate for Payer: Wellcare Medicare |
$54.77
|
| Rate for Payer: WPS Commercial |
$2,443.39
|
|
|
Aph Plt ACDA LR 2 DS
|
Facility
|
OP
|
$3,434.00
|
|
|
Service Code
|
HCPCS P9019
|
| Hospital Charge Code |
6181776
|
|
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 LR 2 DS
|
Facility
|
IP
|
$3,434.00
|
|
|
Service Code
|
HCPCS P9019
|
| Hospital Charge Code |
6181776
|
|
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 LR 3
|
Facility
|
OP
|
$3,171.00
|
|
|
Service Code
|
HCPCS P9019
|
| Hospital Charge Code |
1052841
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$54.77 |
| Max. Negotiated Rate |
$3,034.01 |
| Rate for Payer: Aetna Commercial |
$2,968.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,836.14
|
| Rate for Payer: Aetna Managed Medicare |
$54.77
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,143.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,648.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,582.96
|
| Rate for Payer: Anthem Medicare Advantage |
$54.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,747.86
|
| 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 |
$951.30
|
| Rate for Payer: Cash Price |
$951.30
|
| Rate for Payer: Cigna Commercial |
$3,034.01
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$54.77
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,845.52
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$54.77
|
| Rate for Payer: Health EOS Commercial |
$2,935.08
|
| Rate for Payer: HFN Commercial |
$3,034.01
|
| 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 |
$2,638.27
|
| Rate for Payer: NAPHCARE Commercial |
$82.15
|
| Rate for Payer: Preferred Network Access Commercial |
$3,034.01
|
| Rate for Payer: Quartz Beloit One Network |
$1,615.94
|
| Rate for Payer: Quartz Commercial |
$2,143.60
|
| 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 |
$2,473.38
|
| Rate for Payer: WEA Trust Commercial |
$1,813.81
|
| Rate for Payer: Wellcare Medicare |
$54.77
|
| Rate for Payer: WPS Commercial |
$2,442.62
|
|
|
Aph Plt ACDA LR 3
|
Facility
|
IP
|
$3,171.00
|
|
|
Service Code
|
HCPCS P9019
|
| Hospital Charge Code |
1052841
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$1,615.94 |
| Max. Negotiated Rate |
$3,034.01 |
| Rate for Payer: Aetna Commercial |
$2,968.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,836.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,747.86
|
| Rate for Payer: Cash Price |
$951.30
|
| Rate for Payer: Cigna Commercial |
$3,034.01
|
| Rate for Payer: Health EOS Commercial |
$2,935.08
|
| Rate for Payer: HFN Commercial |
$3,034.01
|
| Rate for Payer: Multiplan Commercial |
$2,638.27
|
| Rate for Payer: Preferred Network Access Commercial |
$3,034.01
|
| Rate for Payer: Quartz Beloit One Network |
$1,615.94
|
| Rate for Payer: Quartz Commercial |
$1,978.70
|
| Rate for Payer: WEA Trust Commercial |
$1,813.81
|
| Rate for Payer: WPS Commercial |
$2,442.62
|
|
|
Aph Plt ACDA LR 3 D5
|
Facility
|
OP
|
$3,434.00
|
|
|
Service Code
|
HCPCS P9019
|
| Hospital Charge Code |
5408636
|
|
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 LR 3 D5
|
Facility
|
IP
|
$3,434.00
|
|
|
Service Code
|
HCPCS P9019
|
| Hospital Charge Code |
5408636
|
|
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 LR 3 DS
|
Facility
|
OP
|
$3,434.00
|
|
|
Service Code
|
HCPCS P9019
|
| Hospital Charge Code |
6181775
|
|
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 LR 3 DS
|
Facility
|
IP
|
$3,434.00
|
|
|
Service Code
|
HCPCS P9019
|
| Hospital Charge Code |
6181775
|
|
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 LR D5
|
Facility
|
OP
|
$3,172.00
|
|
|
Service Code
|
HCPCS P9019
|
| Hospital Charge Code |
5408633
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$54.77 |
| Max. Negotiated Rate |
$3,034.97 |
| Rate for Payer: Aetna Commercial |
$2,968.99
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,837.04
|
| Rate for Payer: Aetna Managed Medicare |
$54.77
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,144.27
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,649.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,583.46
|
| Rate for Payer: Anthem Medicare Advantage |
$54.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,748.41
|
| 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 |
$951.60
|
| Rate for Payer: Cash Price |
$951.60
|
| Rate for Payer: Cigna Commercial |
$3,034.97
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$54.77
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,846.10
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$54.77
|
| Rate for Payer: Health EOS Commercial |
$2,936.00
|
| Rate for Payer: HFN Commercial |
$3,034.97
|
| 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 |
$2,639.10
|
| Rate for Payer: NAPHCARE Commercial |
$82.15
|
| Rate for Payer: Preferred Network Access Commercial |
$3,034.97
|
| Rate for Payer: Quartz Beloit One Network |
$1,616.45
|
| Rate for Payer: Quartz Commercial |
$2,144.27
|
| 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 |
$2,474.16
|
| Rate for Payer: WEA Trust Commercial |
$1,814.38
|
| Rate for Payer: Wellcare Medicare |
$54.77
|
| Rate for Payer: WPS Commercial |
$2,443.39
|
|
|
Aph Plt ACDA LR D5
|
Facility
|
IP
|
$3,172.00
|
|
|
Service Code
|
HCPCS P9019
|
| Hospital Charge Code |
5408633
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$1,616.45 |
| Max. Negotiated Rate |
$3,034.97 |
| Rate for Payer: Aetna Commercial |
$2,968.99
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,837.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,748.41
|
| Rate for Payer: Cash Price |
$951.60
|
| Rate for Payer: Cigna Commercial |
$3,034.97
|
| Rate for Payer: Health EOS Commercial |
$2,936.00
|
| Rate for Payer: HFN Commercial |
$3,034.97
|
| Rate for Payer: Multiplan Commercial |
$2,639.10
|
| Rate for Payer: Preferred Network Access Commercial |
$3,034.97
|
| Rate for Payer: Quartz Beloit One Network |
$1,616.45
|
| Rate for Payer: Quartz Commercial |
$1,979.33
|
| Rate for Payer: WEA Trust Commercial |
$1,814.38
|
| Rate for Payer: WPS Commercial |
$2,443.39
|
|
