|
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
|
|
|
Aph Plt ACDA LR Irr PL Red
|
Facility
|
IP
|
$3,434.00
|
|
|
Service Code
|
HCPCS P9037
|
| Hospital Charge Code |
5593866
|
|
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 PL Red
|
Facility
|
OP
|
$3,434.00
|
|
|
Service Code
|
HCPCS P9037
|
| Hospital Charge Code |
5593866
|
|
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 PL Red 1
|
Facility
|
IP
|
$3,434.00
|
|
|
Service Code
|
HCPCS P9037
|
| Hospital Charge Code |
5593862
|
|
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 PL Red 1
|
Facility
|
OP
|
$3,434.00
|
|
|
Service Code
|
HCPCS P9037
|
| Hospital Charge Code |
5593862
|
|
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 PL Red 2
|
Facility
|
IP
|
$3,434.00
|
|
|
Service Code
|
HCPCS P9037
|
| Hospital Charge Code |
5593861
|
|
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 PL Red 2
|
Facility
|
OP
|
$3,434.00
|
|
|
Service Code
|
HCPCS P9037
|
| Hospital Charge Code |
5593861
|
|
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 PL Red 3
|
Facility
|
IP
|
$3,434.00
|
|
|
Service Code
|
HCPCS P9019
|
| Hospital Charge Code |
5593863
|
|
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 PL Red 3
|
Facility
|
OP
|
$3,434.00
|
|
|
Service Code
|
HCPCS P9019
|
| Hospital Charge Code |
5593863
|
|
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 PL Red
|
Facility
|
IP
|
$3,434.00
|
|
|
Service Code
|
HCPCS P9019
|
| Hospital Charge Code |
5593868
|
|
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 PL Red
|
Facility
|
OP
|
$3,434.00
|
|
|
Service Code
|
HCPCS P9019
|
| Hospital Charge Code |
5593868
|
|
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 PL Red 1
|
Facility
|
IP
|
$3,434.00
|
|
|
Service Code
|
HCPCS P9019
|
| Hospital Charge Code |
5593865
|
|
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 PL Red 1
|
Facility
|
OP
|
$3,434.00
|
|
|
Service Code
|
HCPCS P9019
|
| Hospital Charge Code |
5593865
|
|
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 PL Red 2
|
Facility
|
IP
|
$3,434.00
|
|
|
Service Code
|
HCPCS P9019
|
| Hospital Charge Code |
5593864
|
|
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 PL Red 2
|
Facility
|
OP
|
$3,434.00
|
|
|
Service Code
|
HCPCS P9019
|
| Hospital Charge Code |
5593864
|
|
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 PL Red 3
|
Facility
|
IP
|
$3,434.00
|
|
|
Service Code
|
HCPCS P9019
|
| Hospital Charge Code |
5593867
|
|
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 PL Red 3
|
Facility
|
OP
|
$3,434.00
|
|
|
Service Code
|
HCPCS P9019
|
| Hospital Charge Code |
5593867
|
|
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 PL Red 1 Psoralen
|
Facility
|
IP
|
$3,434.00
|
|
|
Service Code
|
HCPCS P9073
|
| Hospital Charge Code |
5775839
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$1,749.97 |
| 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 PL Red 1 Psoralen
|
Facility
|
OP
|
$3,434.00
|
|
|
Service Code
|
HCPCS P9073
|
| Hospital Charge Code |
5775839
|
|
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 PL Red 2 Psoralen
|
Facility
|
OP
|
$3,434.00
|
|
|
Service Code
|
HCPCS P9073
|
| Hospital Charge Code |
5775841
|
|
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 PL Red 2 Psoralen
|
Facility
|
IP
|
$3,434.00
|
|
|
Service Code
|
HCPCS P9073
|
| Hospital Charge Code |
5775841
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$1,749.97 |
| 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 PL Red 3 Psoralen
|
Facility
|
IP
|
$3,434.00
|
|
|
Service Code
|
HCPCS P9073
|
| Hospital Charge Code |
5775840
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$1,749.97 |
| 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 PL Red 3 Psoralen
|
Facility
|
OP
|
$3,434.00
|
|
|
Service Code
|
HCPCS P9073
|
| Hospital Charge Code |
5775840
|
|
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 PL Red Psoralen
|
Facility
|
OP
|
$3,434.00
|
|
|
Service Code
|
HCPCS P9073
|
| Hospital Charge Code |
5775836
|
|
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 PL Red Psoralen
|
Facility
|
IP
|
$3,434.00
|
|
|
Service Code
|
HCPCS P9073
|
| Hospital Charge Code |
5775836
|
|
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
|
|
