|
RBC CPD 500
|
Facility
|
OP
|
$615.00
|
|
|
Service Code
|
HCPCS P9021
|
| Hospital Charge Code |
1052854
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$155.10 |
| Max. Negotiated Rate |
$620.38 |
| Rate for Payer: Aetna Commercial |
$575.64
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$550.06
|
| Rate for Payer: Aetna Managed Medicare |
$155.10
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$415.74
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$319.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$307.01
|
| Rate for Payer: Anthem Medicare Advantage |
$155.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$338.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$155.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$155.10
|
| Rate for Payer: Cash Price |
$184.50
|
| Rate for Payer: Cash Price |
$184.50
|
| Rate for Payer: Cigna Commercial |
$588.43
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$155.10
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$357.93
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$155.10
|
| Rate for Payer: Health EOS Commercial |
$569.24
|
| Rate for Payer: HFN Commercial |
$588.43
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$576.95
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$155.10
|
| Rate for Payer: Independent Care Health Plan Medicare |
$155.10
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$155.10
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$155.10
|
| Rate for Payer: Multiplan Commercial |
$511.68
|
| Rate for Payer: NAPHCARE Commercial |
$232.64
|
| Rate for Payer: Preferred Network Access Commercial |
$588.43
|
| Rate for Payer: Quartz Beloit One Network |
$313.40
|
| Rate for Payer: Quartz Commercial |
$415.74
|
| Rate for Payer: Quartz Medicare Advantage |
$155.10
|
| Rate for Payer: The Alliance Commercial |
$620.38
|
| Rate for Payer: United Healthcare Medicare Advantage |
$155.10
|
| Rate for Payer: United Healthcare PPO |
$479.70
|
| Rate for Payer: WEA Trust Commercial |
$351.78
|
| Rate for Payer: Wellcare Medicare |
$155.10
|
| Rate for Payer: WPS Commercial |
$473.73
|
|
|
RBC CPD 500
|
Facility
|
IP
|
$615.00
|
|
|
Service Code
|
HCPCS P9021
|
| Hospital Charge Code |
1052854
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$313.40 |
| Max. Negotiated Rate |
$588.43 |
| Rate for Payer: Aetna Commercial |
$575.64
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$550.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$338.99
|
| Rate for Payer: Cash Price |
$184.50
|
| Rate for Payer: Cigna Commercial |
$588.43
|
| Rate for Payer: Health EOS Commercial |
$569.24
|
| Rate for Payer: HFN Commercial |
$588.43
|
| Rate for Payer: Multiplan Commercial |
$511.68
|
| Rate for Payer: Preferred Network Access Commercial |
$588.43
|
| Rate for Payer: Quartz Beloit One Network |
$313.40
|
| Rate for Payer: Quartz Commercial |
$383.76
|
| Rate for Payer: WEA Trust Commercial |
$351.78
|
| Rate for Payer: WPS Commercial |
$473.73
|
|
|
RBC CPDA1 450
|
Facility
|
IP
|
$615.00
|
|
|
Service Code
|
HCPCS P9021
|
| Hospital Charge Code |
1052799
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$313.40 |
| Max. Negotiated Rate |
$588.43 |
| Rate for Payer: Aetna Commercial |
$575.64
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$550.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$338.99
|
| Rate for Payer: Cash Price |
$184.50
|
| Rate for Payer: Cigna Commercial |
$588.43
|
| Rate for Payer: Health EOS Commercial |
$569.24
|
| Rate for Payer: HFN Commercial |
$588.43
|
| Rate for Payer: Multiplan Commercial |
$511.68
|
| Rate for Payer: Preferred Network Access Commercial |
$588.43
|
| Rate for Payer: Quartz Beloit One Network |
$313.40
|
| Rate for Payer: Quartz Commercial |
$383.76
|
| Rate for Payer: WEA Trust Commercial |
$351.78
|
| Rate for Payer: WPS Commercial |
$473.73
|
|
|
RBC CPDA1 450
|
Facility
|
OP
|
$615.00
|
|
|
Service Code
|
HCPCS P9021
|
| Hospital Charge Code |
1052799
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$155.10 |
| Max. Negotiated Rate |
$620.38 |
| Rate for Payer: Aetna Commercial |
$575.64
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$550.06
|
| Rate for Payer: Aetna Managed Medicare |
$155.10
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$415.74
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$319.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$307.01
|
| Rate for Payer: Anthem Medicare Advantage |
$155.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$338.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$155.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$155.10
|
| Rate for Payer: Cash Price |
$184.50
|
| Rate for Payer: Cash Price |
$184.50
|
| Rate for Payer: Cigna Commercial |
$588.43
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$155.10
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$357.93
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$155.10
|
| Rate for Payer: Health EOS Commercial |
$569.24
|
| Rate for Payer: HFN Commercial |
$588.43
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$576.95
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$155.10
|
| Rate for Payer: Independent Care Health Plan Medicare |
$155.10
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$155.10
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$155.10
|
| Rate for Payer: Multiplan Commercial |
$511.68
|
| Rate for Payer: NAPHCARE Commercial |
$232.64
|
| Rate for Payer: Preferred Network Access Commercial |
$588.43
|
| Rate for Payer: Quartz Beloit One Network |
$313.40
|
| Rate for Payer: Quartz Commercial |
$415.74
|
| Rate for Payer: Quartz Medicare Advantage |
$155.10
|
| Rate for Payer: The Alliance Commercial |
$620.38
|
| Rate for Payer: United Healthcare Medicare Advantage |
$155.10
|
| Rate for Payer: United Healthcare PPO |
$479.70
|
| Rate for Payer: WEA Trust Commercial |
$351.78
|
| Rate for Payer: Wellcare Medicare |
$155.10
|
| Rate for Payer: WPS Commercial |
$473.73
|
|
|
RBC CPDA1 500
|
Facility
|
IP
|
$615.00
|
|
|
Service Code
|
HCPCS P9021
|
| Hospital Charge Code |
1052815
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$313.40 |
| Max. Negotiated Rate |
$588.43 |
| Rate for Payer: Aetna Commercial |
$575.64
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$550.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$338.99
|
| Rate for Payer: Cash Price |
$184.50
|
| Rate for Payer: Cigna Commercial |
$588.43
|
| Rate for Payer: Health EOS Commercial |
$569.24
|
| Rate for Payer: HFN Commercial |
$588.43
|
| Rate for Payer: Multiplan Commercial |
$511.68
|
| Rate for Payer: Preferred Network Access Commercial |
$588.43
|
| Rate for Payer: Quartz Beloit One Network |
$313.40
|
| Rate for Payer: Quartz Commercial |
$383.76
|
| Rate for Payer: WEA Trust Commercial |
$351.78
|
| Rate for Payer: WPS Commercial |
$473.73
|
|
|
RBC CPDA1 500
|
Facility
|
OP
|
$615.00
|
|
|
Service Code
|
HCPCS P9021
|
| Hospital Charge Code |
1052815
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$155.10 |
| Max. Negotiated Rate |
$620.38 |
| Rate for Payer: Aetna Commercial |
$575.64
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$550.06
|
| Rate for Payer: Aetna Managed Medicare |
$155.10
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$415.74
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$319.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$307.01
|
| Rate for Payer: Anthem Medicare Advantage |
$155.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$338.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$155.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$155.10
|
| Rate for Payer: Cash Price |
$184.50
|
| Rate for Payer: Cash Price |
$184.50
|
| Rate for Payer: Cigna Commercial |
$588.43
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$155.10
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$357.93
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$155.10
|
| Rate for Payer: Health EOS Commercial |
$569.24
|
| Rate for Payer: HFN Commercial |
$588.43
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$576.95
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$155.10
|
| Rate for Payer: Independent Care Health Plan Medicare |
$155.10
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$155.10
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$155.10
|
| Rate for Payer: Multiplan Commercial |
$511.68
|
| Rate for Payer: NAPHCARE Commercial |
$232.64
|
| Rate for Payer: Preferred Network Access Commercial |
$588.43
|
| Rate for Payer: Quartz Beloit One Network |
$313.40
|
| Rate for Payer: Quartz Commercial |
$415.74
|
| Rate for Payer: Quartz Medicare Advantage |
$155.10
|
| Rate for Payer: The Alliance Commercial |
$620.38
|
| Rate for Payer: United Healthcare Medicare Advantage |
$155.10
|
| Rate for Payer: United Healthcare PPO |
$479.70
|
| Rate for Payer: WEA Trust Commercial |
$351.78
|
| Rate for Payer: Wellcare Medicare |
$155.10
|
| Rate for Payer: WPS Commercial |
$473.73
|
|
|
RBC CPD AS1 LR
|
Facility
|
OP
|
$567.00
|
|
|
Service Code
|
HCPCS P9021
|
| Hospital Charge Code |
4221389
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$155.10 |
| Max. Negotiated Rate |
$620.38 |
| Rate for Payer: Aetna Commercial |
$530.71
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$507.12
|
| Rate for Payer: Aetna Managed Medicare |
$155.10
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$383.29
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$294.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$283.05
|
| Rate for Payer: Anthem Medicare Advantage |
$155.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$312.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$155.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$155.10
|
| Rate for Payer: Cash Price |
$170.10
|
| Rate for Payer: Cash Price |
$170.10
|
| Rate for Payer: Cigna Commercial |
$542.51
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$155.10
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$329.99
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$155.10
|
| Rate for Payer: Health EOS Commercial |
$524.82
|
| Rate for Payer: HFN Commercial |
$542.51
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$576.95
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$155.10
|
| Rate for Payer: Independent Care Health Plan Medicare |
$155.10
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$155.10
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$155.10
|
| Rate for Payer: Multiplan Commercial |
$471.74
|
| Rate for Payer: NAPHCARE Commercial |
$232.64
|
| Rate for Payer: Preferred Network Access Commercial |
$542.51
|
| Rate for Payer: Quartz Beloit One Network |
$288.94
|
| Rate for Payer: Quartz Commercial |
$383.29
|
| Rate for Payer: Quartz Medicare Advantage |
$155.10
|
| Rate for Payer: The Alliance Commercial |
$620.38
|
| Rate for Payer: United Healthcare Medicare Advantage |
$155.10
|
| Rate for Payer: United Healthcare PPO |
$442.26
|
| Rate for Payer: WEA Trust Commercial |
$324.32
|
| Rate for Payer: Wellcare Medicare |
$155.10
|
| Rate for Payer: WPS Commercial |
$436.76
|
|
|
RBC CPD AS1 LR
|
Facility
|
IP
|
$567.00
|
|
|
Service Code
|
HCPCS P9021
|
| Hospital Charge Code |
4221389
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$288.94 |
| Max. Negotiated Rate |
$542.51 |
| Rate for Payer: Aetna Commercial |
$530.71
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$507.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$312.53
|
| Rate for Payer: Cash Price |
$170.10
|
| Rate for Payer: Cigna Commercial |
$542.51
|
| Rate for Payer: Health EOS Commercial |
$524.82
|
| Rate for Payer: HFN Commercial |
$542.51
|
| Rate for Payer: Multiplan Commercial |
$471.74
|
| Rate for Payer: Preferred Network Access Commercial |
$542.51
|
| Rate for Payer: Quartz Beloit One Network |
$288.94
|
| Rate for Payer: Quartz Commercial |
$353.81
|
| Rate for Payer: WEA Trust Commercial |
$324.32
|
| Rate for Payer: WPS Commercial |
$436.76
|
|
|
RBC CPD AS1 LR Irr
|
Facility
|
OP
|
$615.00
|
|
|
Service Code
|
HCPCS P9021
|
| Hospital Charge Code |
4221388
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$155.10 |
| Max. Negotiated Rate |
$620.38 |
| Rate for Payer: Aetna Commercial |
$575.64
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$550.06
|
| Rate for Payer: Aetna Managed Medicare |
$155.10
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$415.74
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$319.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$307.01
|
| Rate for Payer: Anthem Medicare Advantage |
$155.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$338.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$155.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$155.10
|
| Rate for Payer: Cash Price |
$184.50
|
| Rate for Payer: Cash Price |
$184.50
|
| Rate for Payer: Cigna Commercial |
$588.43
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$155.10
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$357.93
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$155.10
|
| Rate for Payer: Health EOS Commercial |
$569.24
|
| Rate for Payer: HFN Commercial |
$588.43
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$576.95
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$155.10
|
| Rate for Payer: Independent Care Health Plan Medicare |
$155.10
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$155.10
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$155.10
|
| Rate for Payer: Multiplan Commercial |
$511.68
|
| Rate for Payer: NAPHCARE Commercial |
$232.64
|
| Rate for Payer: Preferred Network Access Commercial |
$588.43
|
| Rate for Payer: Quartz Beloit One Network |
$313.40
|
| Rate for Payer: Quartz Commercial |
$415.74
|
| Rate for Payer: Quartz Medicare Advantage |
$155.10
|
| Rate for Payer: The Alliance Commercial |
$620.38
|
| Rate for Payer: United Healthcare Medicare Advantage |
$155.10
|
| Rate for Payer: United Healthcare PPO |
$479.70
|
| Rate for Payer: WEA Trust Commercial |
$351.78
|
| Rate for Payer: Wellcare Medicare |
$155.10
|
| Rate for Payer: WPS Commercial |
$473.73
|
|
|
RBC CPD AS1 LR Irr
|
Facility
|
IP
|
$615.00
|
|
|
Service Code
|
HCPCS P9021
|
| Hospital Charge Code |
4221388
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$313.40 |
| Max. Negotiated Rate |
$588.43 |
| Rate for Payer: Aetna Commercial |
$575.64
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$550.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$338.99
|
| Rate for Payer: Cash Price |
$184.50
|
| Rate for Payer: Cigna Commercial |
$588.43
|
| Rate for Payer: Health EOS Commercial |
$569.24
|
| Rate for Payer: HFN Commercial |
$588.43
|
| Rate for Payer: Multiplan Commercial |
$511.68
|
| Rate for Payer: Preferred Network Access Commercial |
$588.43
|
| Rate for Payer: Quartz Beloit One Network |
$313.40
|
| Rate for Payer: Quartz Commercial |
$383.76
|
| Rate for Payer: WEA Trust Commercial |
$351.78
|
| Rate for Payer: WPS Commercial |
$473.73
|
|
|
RBC CPD AS5 450
|
Facility
|
OP
|
$615.00
|
|
|
Service Code
|
HCPCS P9021
|
| Hospital Charge Code |
1052874
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$155.10 |
| Max. Negotiated Rate |
$620.38 |
| Rate for Payer: Aetna Commercial |
$575.64
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$550.06
|
| Rate for Payer: Aetna Managed Medicare |
$155.10
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$415.74
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$319.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$307.01
|
| Rate for Payer: Anthem Medicare Advantage |
$155.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$338.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$155.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$155.10
|
| Rate for Payer: Cash Price |
$184.50
|
| Rate for Payer: Cash Price |
$184.50
|
| Rate for Payer: Cigna Commercial |
$588.43
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$155.10
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$357.93
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$155.10
|
| Rate for Payer: Health EOS Commercial |
$569.24
|
| Rate for Payer: HFN Commercial |
$588.43
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$576.95
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$155.10
|
| Rate for Payer: Independent Care Health Plan Medicare |
$155.10
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$155.10
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$155.10
|
| Rate for Payer: Multiplan Commercial |
$511.68
|
| Rate for Payer: NAPHCARE Commercial |
$232.64
|
| Rate for Payer: Preferred Network Access Commercial |
$588.43
|
| Rate for Payer: Quartz Beloit One Network |
$313.40
|
| Rate for Payer: Quartz Commercial |
$415.74
|
| Rate for Payer: Quartz Medicare Advantage |
$155.10
|
| Rate for Payer: The Alliance Commercial |
$620.38
|
| Rate for Payer: United Healthcare Medicare Advantage |
$155.10
|
| Rate for Payer: United Healthcare PPO |
$479.70
|
| Rate for Payer: WEA Trust Commercial |
$351.78
|
| Rate for Payer: Wellcare Medicare |
$155.10
|
| Rate for Payer: WPS Commercial |
$473.73
|
|
|
RBC CPD AS5 450
|
Facility
|
IP
|
$615.00
|
|
|
Service Code
|
HCPCS P9021
|
| Hospital Charge Code |
1052874
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$313.40 |
| Max. Negotiated Rate |
$588.43 |
| Rate for Payer: Aetna Commercial |
$575.64
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$550.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$338.99
|
| Rate for Payer: Cash Price |
$184.50
|
| Rate for Payer: Cigna Commercial |
$588.43
|
| Rate for Payer: Health EOS Commercial |
$569.24
|
| Rate for Payer: HFN Commercial |
$588.43
|
| Rate for Payer: Multiplan Commercial |
$511.68
|
| Rate for Payer: Preferred Network Access Commercial |
$588.43
|
| Rate for Payer: Quartz Beloit One Network |
$313.40
|
| Rate for Payer: Quartz Commercial |
$383.76
|
| Rate for Payer: WEA Trust Commercial |
$351.78
|
| Rate for Payer: WPS Commercial |
$473.73
|
|
|
RBC CPD AS5 450 Irr
|
Facility
|
IP
|
$615.00
|
|
|
Service Code
|
HCPCS P9021
|
| Hospital Charge Code |
1052872
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$313.40 |
| Max. Negotiated Rate |
$588.43 |
| Rate for Payer: Aetna Commercial |
$575.64
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$550.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$338.99
|
| Rate for Payer: Cash Price |
$184.50
|
| Rate for Payer: Cigna Commercial |
$588.43
|
| Rate for Payer: Health EOS Commercial |
$569.24
|
| Rate for Payer: HFN Commercial |
$588.43
|
| Rate for Payer: Multiplan Commercial |
$511.68
|
| Rate for Payer: Preferred Network Access Commercial |
$588.43
|
| Rate for Payer: Quartz Beloit One Network |
$313.40
|
| Rate for Payer: Quartz Commercial |
$383.76
|
| Rate for Payer: WEA Trust Commercial |
$351.78
|
| Rate for Payer: WPS Commercial |
$473.73
|
|
|
RBC CPD AS5 450 Irr
|
Facility
|
OP
|
$615.00
|
|
|
Service Code
|
HCPCS P9021
|
| Hospital Charge Code |
1052872
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$155.10 |
| Max. Negotiated Rate |
$620.38 |
| Rate for Payer: Aetna Commercial |
$575.64
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$550.06
|
| Rate for Payer: Aetna Managed Medicare |
$155.10
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$415.74
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$319.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$307.01
|
| Rate for Payer: Anthem Medicare Advantage |
$155.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$338.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$155.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$155.10
|
| Rate for Payer: Cash Price |
$184.50
|
| Rate for Payer: Cash Price |
$184.50
|
| Rate for Payer: Cigna Commercial |
$588.43
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$155.10
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$357.93
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$155.10
|
| Rate for Payer: Health EOS Commercial |
$569.24
|
| Rate for Payer: HFN Commercial |
$588.43
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$576.95
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$155.10
|
| Rate for Payer: Independent Care Health Plan Medicare |
$155.10
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$155.10
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$155.10
|
| Rate for Payer: Multiplan Commercial |
$511.68
|
| Rate for Payer: NAPHCARE Commercial |
$232.64
|
| Rate for Payer: Preferred Network Access Commercial |
$588.43
|
| Rate for Payer: Quartz Beloit One Network |
$313.40
|
| Rate for Payer: Quartz Commercial |
$415.74
|
| Rate for Payer: Quartz Medicare Advantage |
$155.10
|
| Rate for Payer: The Alliance Commercial |
$620.38
|
| Rate for Payer: United Healthcare Medicare Advantage |
$155.10
|
| Rate for Payer: United Healthcare PPO |
$479.70
|
| Rate for Payer: WEA Trust Commercial |
$351.78
|
| Rate for Payer: Wellcare Medicare |
$155.10
|
| Rate for Payer: WPS Commercial |
$473.73
|
|
|
RBC CPD AS5 450 LR
|
Facility
|
OP
|
$615.00
|
|
|
Service Code
|
HCPCS P9021
|
| Hospital Charge Code |
1052840
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$155.10 |
| Max. Negotiated Rate |
$620.38 |
| Rate for Payer: Aetna Commercial |
$575.64
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$550.06
|
| Rate for Payer: Aetna Managed Medicare |
$155.10
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$415.74
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$319.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$307.01
|
| Rate for Payer: Anthem Medicare Advantage |
$155.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$338.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$155.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$155.10
|
| Rate for Payer: Cash Price |
$184.50
|
| Rate for Payer: Cash Price |
$184.50
|
| Rate for Payer: Cigna Commercial |
$588.43
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$155.10
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$357.93
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$155.10
|
| Rate for Payer: Health EOS Commercial |
$569.24
|
| Rate for Payer: HFN Commercial |
$588.43
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$576.95
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$155.10
|
| Rate for Payer: Independent Care Health Plan Medicare |
$155.10
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$155.10
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$155.10
|
| Rate for Payer: Multiplan Commercial |
$511.68
|
| Rate for Payer: NAPHCARE Commercial |
$232.64
|
| Rate for Payer: Preferred Network Access Commercial |
$588.43
|
| Rate for Payer: Quartz Beloit One Network |
$313.40
|
| Rate for Payer: Quartz Commercial |
$415.74
|
| Rate for Payer: Quartz Medicare Advantage |
$155.10
|
| Rate for Payer: The Alliance Commercial |
$620.38
|
| Rate for Payer: United Healthcare Medicare Advantage |
$155.10
|
| Rate for Payer: United Healthcare PPO |
$479.70
|
| Rate for Payer: WEA Trust Commercial |
$351.78
|
| Rate for Payer: Wellcare Medicare |
$155.10
|
| Rate for Payer: WPS Commercial |
$473.73
|
|
|
RBC CPD AS5 450 LR
|
Facility
|
IP
|
$615.00
|
|
|
Service Code
|
HCPCS P9021
|
| Hospital Charge Code |
1052840
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$313.40 |
| Max. Negotiated Rate |
$588.43 |
| Rate for Payer: Aetna Commercial |
$575.64
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$550.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$338.99
|
| Rate for Payer: Cash Price |
$184.50
|
| Rate for Payer: Cigna Commercial |
$588.43
|
| Rate for Payer: Health EOS Commercial |
$569.24
|
| Rate for Payer: HFN Commercial |
$588.43
|
| Rate for Payer: Multiplan Commercial |
$511.68
|
| Rate for Payer: Preferred Network Access Commercial |
$588.43
|
| Rate for Payer: Quartz Beloit One Network |
$313.40
|
| Rate for Payer: Quartz Commercial |
$383.76
|
| Rate for Payer: WEA Trust Commercial |
$351.78
|
| Rate for Payer: WPS Commercial |
$473.73
|
|
|
RBC CPD AS5 450 LR Irr
|
Facility
|
IP
|
$615.00
|
|
|
Service Code
|
HCPCS P9021
|
| Hospital Charge Code |
1052837
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$313.40 |
| Max. Negotiated Rate |
$588.43 |
| Rate for Payer: Aetna Commercial |
$575.64
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$550.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$338.99
|
| Rate for Payer: Cash Price |
$184.50
|
| Rate for Payer: Cigna Commercial |
$588.43
|
| Rate for Payer: Health EOS Commercial |
$569.24
|
| Rate for Payer: HFN Commercial |
$588.43
|
| Rate for Payer: Multiplan Commercial |
$511.68
|
| Rate for Payer: Preferred Network Access Commercial |
$588.43
|
| Rate for Payer: Quartz Beloit One Network |
$313.40
|
| Rate for Payer: Quartz Commercial |
$383.76
|
| Rate for Payer: WEA Trust Commercial |
$351.78
|
| Rate for Payer: WPS Commercial |
$473.73
|
|
|
RBC CPD AS5 450 LR Irr
|
Facility
|
OP
|
$615.00
|
|
|
Service Code
|
HCPCS P9021
|
| Hospital Charge Code |
1052837
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$155.10 |
| Max. Negotiated Rate |
$620.38 |
| Rate for Payer: Aetna Commercial |
$575.64
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$550.06
|
| Rate for Payer: Aetna Managed Medicare |
$155.10
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$415.74
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$319.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$307.01
|
| Rate for Payer: Anthem Medicare Advantage |
$155.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$338.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$155.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$155.10
|
| Rate for Payer: Cash Price |
$184.50
|
| Rate for Payer: Cash Price |
$184.50
|
| Rate for Payer: Cigna Commercial |
$588.43
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$155.10
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$357.93
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$155.10
|
| Rate for Payer: Health EOS Commercial |
$569.24
|
| Rate for Payer: HFN Commercial |
$588.43
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$576.95
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$155.10
|
| Rate for Payer: Independent Care Health Plan Medicare |
$155.10
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$155.10
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$155.10
|
| Rate for Payer: Multiplan Commercial |
$511.68
|
| Rate for Payer: NAPHCARE Commercial |
$232.64
|
| Rate for Payer: Preferred Network Access Commercial |
$588.43
|
| Rate for Payer: Quartz Beloit One Network |
$313.40
|
| Rate for Payer: Quartz Commercial |
$415.74
|
| Rate for Payer: Quartz Medicare Advantage |
$155.10
|
| Rate for Payer: The Alliance Commercial |
$620.38
|
| Rate for Payer: United Healthcare Medicare Advantage |
$155.10
|
| Rate for Payer: United Healthcare PPO |
$479.70
|
| Rate for Payer: WEA Trust Commercial |
$351.78
|
| Rate for Payer: Wellcare Medicare |
$155.10
|
| Rate for Payer: WPS Commercial |
$473.73
|
|
|
RBC CPD AS5 500
|
Facility
|
OP
|
$615.00
|
|
|
Service Code
|
HCPCS P9021
|
| Hospital Charge Code |
1052850
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$155.10 |
| Max. Negotiated Rate |
$620.38 |
| Rate for Payer: Aetna Commercial |
$575.64
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$550.06
|
| Rate for Payer: Aetna Managed Medicare |
$155.10
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$415.74
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$319.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$307.01
|
| Rate for Payer: Anthem Medicare Advantage |
$155.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$338.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$155.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$155.10
|
| Rate for Payer: Cash Price |
$184.50
|
| Rate for Payer: Cash Price |
$184.50
|
| Rate for Payer: Cigna Commercial |
$588.43
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$155.10
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$357.93
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$155.10
|
| Rate for Payer: Health EOS Commercial |
$569.24
|
| Rate for Payer: HFN Commercial |
$588.43
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$576.95
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$155.10
|
| Rate for Payer: Independent Care Health Plan Medicare |
$155.10
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$155.10
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$155.10
|
| Rate for Payer: Multiplan Commercial |
$511.68
|
| Rate for Payer: NAPHCARE Commercial |
$232.64
|
| Rate for Payer: Preferred Network Access Commercial |
$588.43
|
| Rate for Payer: Quartz Beloit One Network |
$313.40
|
| Rate for Payer: Quartz Commercial |
$415.74
|
| Rate for Payer: Quartz Medicare Advantage |
$155.10
|
| Rate for Payer: The Alliance Commercial |
$620.38
|
| Rate for Payer: United Healthcare Medicare Advantage |
$155.10
|
| Rate for Payer: United Healthcare PPO |
$479.70
|
| Rate for Payer: WEA Trust Commercial |
$351.78
|
| Rate for Payer: Wellcare Medicare |
$155.10
|
| Rate for Payer: WPS Commercial |
$473.73
|
|
|
RBC CPD AS5 500
|
Facility
|
IP
|
$615.00
|
|
|
Service Code
|
HCPCS P9021
|
| Hospital Charge Code |
1052850
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$313.40 |
| Max. Negotiated Rate |
$588.43 |
| Rate for Payer: Aetna Commercial |
$575.64
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$550.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$338.99
|
| Rate for Payer: Cash Price |
$184.50
|
| Rate for Payer: Cigna Commercial |
$588.43
|
| Rate for Payer: Health EOS Commercial |
$569.24
|
| Rate for Payer: HFN Commercial |
$588.43
|
| Rate for Payer: Multiplan Commercial |
$511.68
|
| Rate for Payer: Preferred Network Access Commercial |
$588.43
|
| Rate for Payer: Quartz Beloit One Network |
$313.40
|
| Rate for Payer: Quartz Commercial |
$383.76
|
| Rate for Payer: WEA Trust Commercial |
$351.78
|
| Rate for Payer: WPS Commercial |
$473.73
|
|
|
RBC CPD AS5 500 Irr
|
Facility
|
OP
|
$615.00
|
|
|
Service Code
|
HCPCS P9021
|
| Hospital Charge Code |
1052825
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$155.10 |
| Max. Negotiated Rate |
$620.38 |
| Rate for Payer: Aetna Commercial |
$575.64
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$550.06
|
| Rate for Payer: Aetna Managed Medicare |
$155.10
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$415.74
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$319.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$307.01
|
| Rate for Payer: Anthem Medicare Advantage |
$155.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$338.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$155.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$155.10
|
| Rate for Payer: Cash Price |
$184.50
|
| Rate for Payer: Cash Price |
$184.50
|
| Rate for Payer: Cigna Commercial |
$588.43
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$155.10
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$357.93
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$155.10
|
| Rate for Payer: Health EOS Commercial |
$569.24
|
| Rate for Payer: HFN Commercial |
$588.43
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$576.95
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$155.10
|
| Rate for Payer: Independent Care Health Plan Medicare |
$155.10
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$155.10
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$155.10
|
| Rate for Payer: Multiplan Commercial |
$511.68
|
| Rate for Payer: NAPHCARE Commercial |
$232.64
|
| Rate for Payer: Preferred Network Access Commercial |
$588.43
|
| Rate for Payer: Quartz Beloit One Network |
$313.40
|
| Rate for Payer: Quartz Commercial |
$415.74
|
| Rate for Payer: Quartz Medicare Advantage |
$155.10
|
| Rate for Payer: The Alliance Commercial |
$620.38
|
| Rate for Payer: United Healthcare Medicare Advantage |
$155.10
|
| Rate for Payer: United Healthcare PPO |
$479.70
|
| Rate for Payer: WEA Trust Commercial |
$351.78
|
| Rate for Payer: Wellcare Medicare |
$155.10
|
| Rate for Payer: WPS Commercial |
$473.73
|
|
|
RBC CPD AS5 500 Irr
|
Facility
|
IP
|
$615.00
|
|
|
Service Code
|
HCPCS P9021
|
| Hospital Charge Code |
1052825
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$313.40 |
| Max. Negotiated Rate |
$588.43 |
| Rate for Payer: Aetna Commercial |
$575.64
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$550.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$338.99
|
| Rate for Payer: Cash Price |
$184.50
|
| Rate for Payer: Cigna Commercial |
$588.43
|
| Rate for Payer: Health EOS Commercial |
$569.24
|
| Rate for Payer: HFN Commercial |
$588.43
|
| Rate for Payer: Multiplan Commercial |
$511.68
|
| Rate for Payer: Preferred Network Access Commercial |
$588.43
|
| Rate for Payer: Quartz Beloit One Network |
$313.40
|
| Rate for Payer: Quartz Commercial |
$383.76
|
| Rate for Payer: WEA Trust Commercial |
$351.78
|
| Rate for Payer: WPS Commercial |
$473.73
|
|
|
RBC CPD AS5 500 LR
|
Facility
|
OP
|
$567.00
|
|
|
Service Code
|
HCPCS P9021
|
| Hospital Charge Code |
1052822
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$155.10 |
| Max. Negotiated Rate |
$620.38 |
| Rate for Payer: Aetna Commercial |
$530.71
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$507.12
|
| Rate for Payer: Aetna Managed Medicare |
$155.10
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$383.29
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$294.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$283.05
|
| Rate for Payer: Anthem Medicare Advantage |
$155.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$312.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$155.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$155.10
|
| Rate for Payer: Cash Price |
$170.10
|
| Rate for Payer: Cash Price |
$170.10
|
| Rate for Payer: Cigna Commercial |
$542.51
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$155.10
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$329.99
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$155.10
|
| Rate for Payer: Health EOS Commercial |
$524.82
|
| Rate for Payer: HFN Commercial |
$542.51
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$576.95
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$155.10
|
| Rate for Payer: Independent Care Health Plan Medicare |
$155.10
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$155.10
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$155.10
|
| Rate for Payer: Multiplan Commercial |
$471.74
|
| Rate for Payer: NAPHCARE Commercial |
$232.64
|
| Rate for Payer: Preferred Network Access Commercial |
$542.51
|
| Rate for Payer: Quartz Beloit One Network |
$288.94
|
| Rate for Payer: Quartz Commercial |
$383.29
|
| Rate for Payer: Quartz Medicare Advantage |
$155.10
|
| Rate for Payer: The Alliance Commercial |
$620.38
|
| Rate for Payer: United Healthcare Medicare Advantage |
$155.10
|
| Rate for Payer: United Healthcare PPO |
$442.26
|
| Rate for Payer: WEA Trust Commercial |
$324.32
|
| Rate for Payer: Wellcare Medicare |
$155.10
|
| Rate for Payer: WPS Commercial |
$436.76
|
|
|
RBC CPD AS5 500 LR
|
Facility
|
IP
|
$567.00
|
|
|
Service Code
|
HCPCS P9021
|
| Hospital Charge Code |
1052822
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$288.94 |
| Max. Negotiated Rate |
$542.51 |
| Rate for Payer: Aetna Commercial |
$530.71
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$507.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$312.53
|
| Rate for Payer: Cash Price |
$170.10
|
| Rate for Payer: Cigna Commercial |
$542.51
|
| Rate for Payer: Health EOS Commercial |
$524.82
|
| Rate for Payer: HFN Commercial |
$542.51
|
| Rate for Payer: Multiplan Commercial |
$471.74
|
| Rate for Payer: Preferred Network Access Commercial |
$542.51
|
| Rate for Payer: Quartz Beloit One Network |
$288.94
|
| Rate for Payer: Quartz Commercial |
$353.81
|
| Rate for Payer: WEA Trust Commercial |
$324.32
|
| Rate for Payer: WPS Commercial |
$436.76
|
|
|
RBC CPD AS5 500 LR Irr
|
Facility
|
IP
|
$567.00
|
|
|
Service Code
|
HCPCS P9021
|
| Hospital Charge Code |
1052833
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$288.94 |
| Max. Negotiated Rate |
$542.51 |
| Rate for Payer: Aetna Commercial |
$530.71
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$507.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$312.53
|
| Rate for Payer: Cash Price |
$170.10
|
| Rate for Payer: Cigna Commercial |
$542.51
|
| Rate for Payer: Health EOS Commercial |
$524.82
|
| Rate for Payer: HFN Commercial |
$542.51
|
| Rate for Payer: Multiplan Commercial |
$471.74
|
| Rate for Payer: Preferred Network Access Commercial |
$542.51
|
| Rate for Payer: Quartz Beloit One Network |
$288.94
|
| Rate for Payer: Quartz Commercial |
$353.81
|
| Rate for Payer: WEA Trust Commercial |
$324.32
|
| Rate for Payer: WPS Commercial |
$436.76
|
|
