|
Aph Plt ACDA LR DS
|
Facility
|
IP
|
$3,434.00
|
|
|
Service Code
|
HCPCS P9019
|
| Hospital Charge Code |
6181773
|
|
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 DS
|
Facility
|
OP
|
$3,434.00
|
|
|
Service Code
|
HCPCS P9019
|
| Hospital Charge Code |
6181773
|
|
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 Irr
|
Facility
|
OP
|
$3,171.00
|
|
|
Service Code
|
HCPCS P9019
|
| Hospital Charge Code |
1052857
|
|
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 Irr
|
Facility
|
IP
|
$3,171.00
|
|
|
Service Code
|
HCPCS P9019
|
| Hospital Charge Code |
1052857
|
|
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 Irr 1
|
Facility
|
OP
|
$3,171.00
|
|
|
Service Code
|
HCPCS P9019
|
| Hospital Charge Code |
1052862
|
|
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 Irr 1
|
Facility
|
IP
|
$3,171.00
|
|
|
Service Code
|
HCPCS P9019
|
| Hospital Charge Code |
1052862
|
|
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 Irr 1 D5
|
Facility
|
IP
|
$3,171.00
|
|
|
Service Code
|
HCPCS P9019
|
| Hospital Charge Code |
5408634
|
|
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 Irr 1 D5
|
Facility
|
OP
|
$3,171.00
|
|
|
Service Code
|
HCPCS P9019
|
| Hospital Charge Code |
5408634
|
|
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 Irr 1 LVDS
|
Facility
|
OP
|
$3,434.00
|
|
|
Service Code
|
HCPCS P9019
|
| Hospital Charge Code |
5811634
|
|
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 Irr 1 LVDS
|
Facility
|
IP
|
$3,434.00
|
|
|
Service Code
|
HCPCS P9019
|
| Hospital Charge Code |
5811634
|
|
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 Irr 2
|
Facility
|
IP
|
$3,171.00
|
|
|
Service Code
|
HCPCS P9019
|
| Hospital Charge Code |
1052810
|
|
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 Irr 2
|
Facility
|
OP
|
$3,171.00
|
|
|
Service Code
|
HCPCS P9019
|
| Hospital Charge Code |
1052810
|
|
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 Irr 2 D5
|
Facility
|
IP
|
$3,434.00
|
|
|
Service Code
|
HCPCS P9019
|
| Hospital Charge Code |
5408639
|
|
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 Irr 2 D5
|
Facility
|
OP
|
$3,434.00
|
|
|
Service Code
|
HCPCS P9019
|
| Hospital Charge Code |
5408639
|
|
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 Irr 2 LVDS
|
Facility
|
IP
|
$3,434.00
|
|
|
Service Code
|
HCPCS P9019
|
| Hospital Charge Code |
5811633
|
|
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 Irr 2 LVDS
|
Facility
|
OP
|
$3,434.00
|
|
|
Service Code
|
HCPCS P9019
|
| Hospital Charge Code |
5811633
|
|
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 Irr 3
|
Facility
|
OP
|
$3,171.00
|
|
|
Service Code
|
HCPCS P9019
|
| Hospital Charge Code |
1052806
|
|
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 Irr 3
|
Facility
|
IP
|
$3,171.00
|
|
|
Service Code
|
HCPCS P9019
|
| Hospital Charge Code |
1052806
|
|
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 Irr 3 D5
|
Facility
|
OP
|
$3,434.00
|
|
|
Service Code
|
HCPCS P9019
|
| Hospital Charge Code |
5408637
|
|
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 Irr 3 D5
|
Facility
|
IP
|
$3,434.00
|
|
|
Service Code
|
HCPCS P9019
|
| Hospital Charge Code |
5408637
|
|
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 Irr 3 LVDS
|
Facility
|
OP
|
$3,434.00
|
|
|
Service Code
|
HCPCS P9019
|
| Hospital Charge Code |
5811635
|
|
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 Irr 3 LVDS
|
Facility
|
IP
|
$3,434.00
|
|
|
Service Code
|
HCPCS P9019
|
| Hospital Charge Code |
5811635
|
|
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 Irr D5
|
Facility
|
OP
|
$3,434.00
|
|
|
Service Code
|
HCPCS P9037
|
| Hospital Charge Code |
5408635
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$701.08 |
| 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 |
$701.08
|
| 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 |
$701.08
|
| 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 |
$701.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$701.08
|
| 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 |
$701.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,998.59
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$701.08
|
| 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 |
$2,608.04
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$701.08
|
| Rate for Payer: Independent Care Health Plan Medicare |
$701.08
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$701.08
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$701.08
|
| Rate for Payer: Multiplan Commercial |
$2,857.09
|
| Rate for Payer: NAPHCARE Commercial |
$1,051.63
|
| 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 |
$701.08
|
| Rate for Payer: The Alliance Commercial |
$2,804.34
|
| Rate for Payer: United Healthcare Medicare Advantage |
$701.08
|
| Rate for Payer: United Healthcare PPO |
$2,678.52
|
| Rate for Payer: WEA Trust Commercial |
$1,964.25
|
| Rate for Payer: Wellcare Medicare |
$701.08
|
| Rate for Payer: WPS Commercial |
$2,645.21
|
|
|
Aph Plt ACDA LR Irr D5
|
Facility
|
IP
|
$3,434.00
|
|
|
Service Code
|
HCPCS P9037
|
| Hospital Charge Code |
5408635
|
|
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 Irr LVDS
|
Facility
|
OP
|
$3,434.00
|
|
|
Service Code
|
HCPCS P9019
|
| Hospital Charge Code |
5811632
|
|
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
|
|
