|
RAZOR PERSONNA ASR TWIN BLADE
|
Facility
|
OP
|
$87.00
|
|
| Hospital Charge Code |
2963919
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$24.36 |
| Max. Negotiated Rate |
$348.00 |
| Rate for Payer: Aetna Commercial |
$78.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$74.82
|
| Rate for Payer: Aetna Managed Medicare |
$24.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$56.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$43.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$41.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$46.11
|
| Rate for Payer: Cash Price |
$26.10
|
| Rate for Payer: Cigna Commercial |
$80.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$48.69
|
| Rate for Payer: Health EOS Commercial |
$77.43
|
| Rate for Payer: HFN Commercial |
$80.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$65.25
|
| Rate for Payer: Multiplan Commercial |
$69.60
|
| Rate for Payer: NAPHCARE Commercial |
$52.20
|
| Rate for Payer: Preferred Network Access Commercial |
$80.04
|
| Rate for Payer: Quartz Beloit One Network |
$42.63
|
| Rate for Payer: Quartz Commercial |
$56.55
|
| Rate for Payer: Quartz Medicare Advantage |
$52.20
|
| Rate for Payer: The Alliance Commercial |
$348.00
|
| Rate for Payer: WEA Trust Commercial |
$47.85
|
| Rate for Payer: WPS Commercial |
$64.44
|
|
|
RAZOR PERSONNA ASR TWIN BLADE
|
Facility
|
IP
|
$87.00
|
|
| Hospital Charge Code |
2963919
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$42.63 |
| Max. Negotiated Rate |
$80.04 |
| Rate for Payer: Aetna Commercial |
$78.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$74.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$46.11
|
| Rate for Payer: Cash Price |
$26.10
|
| Rate for Payer: Cigna Commercial |
$80.04
|
| Rate for Payer: Health EOS Commercial |
$77.43
|
| Rate for Payer: HFN Commercial |
$80.04
|
| Rate for Payer: Multiplan Commercial |
$69.60
|
| Rate for Payer: NAPHCARE Commercial |
$52.20
|
| Rate for Payer: Preferred Network Access Commercial |
$80.04
|
| Rate for Payer: Quartz Beloit One Network |
$42.63
|
| Rate for Payer: Quartz Commercial |
$52.20
|
| Rate for Payer: WEA Trust Commercial |
$47.85
|
| Rate for Payer: WPS Commercial |
$64.44
|
|
|
RBC 500 Irr
|
Facility
|
OP
|
$615.00
|
|
|
Service Code
|
HCPCS P9021
|
| Hospital Charge Code |
1052809
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$141.61 |
| Max. Negotiated Rate |
$566.44 |
| Rate for Payer: Aetna Commercial |
$553.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$528.90
|
| Rate for Payer: Aetna Managed Medicare |
$141.61
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$399.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$307.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$295.20
|
| Rate for Payer: Anthem Medicare Advantage |
$141.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$325.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$141.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$141.61
|
| Rate for Payer: Cash Price |
$184.50
|
| Rate for Payer: Cash Price |
$184.50
|
| Rate for Payer: Cigna Commercial |
$565.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$141.61
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$344.15
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$141.61
|
| Rate for Payer: Health EOS Commercial |
$547.35
|
| Rate for Payer: HFN Commercial |
$565.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$526.79
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$141.61
|
| Rate for Payer: Independent Care Health Plan Medicare |
$141.61
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$141.61
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$141.61
|
| Rate for Payer: Multiplan Commercial |
$492.00
|
| Rate for Payer: NAPHCARE Commercial |
$212.42
|
| Rate for Payer: Preferred Network Access Commercial |
$565.80
|
| Rate for Payer: Quartz Beloit One Network |
$301.35
|
| Rate for Payer: Quartz Commercial |
$399.75
|
| Rate for Payer: Quartz Medicare Advantage |
$141.61
|
| Rate for Payer: The Alliance Commercial |
$566.44
|
| Rate for Payer: United Healthcare Medicare Advantage |
$141.61
|
| Rate for Payer: United Healthcare PPO |
$461.25
|
| Rate for Payer: WEA Trust Commercial |
$338.25
|
| Rate for Payer: Wellcare Medicare |
$141.61
|
| Rate for Payer: WPS Commercial |
$455.53
|
|
|
RBC 500 Irr
|
Facility
|
IP
|
$615.00
|
|
|
Service Code
|
HCPCS P9021
|
| Hospital Charge Code |
1052809
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$301.35 |
| Max. Negotiated Rate |
$565.80 |
| Rate for Payer: Aetna Commercial |
$553.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$528.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$325.95
|
| Rate for Payer: Cash Price |
$184.50
|
| Rate for Payer: Cigna Commercial |
$565.80
|
| Rate for Payer: Health EOS Commercial |
$547.35
|
| Rate for Payer: HFN Commercial |
$565.80
|
| Rate for Payer: Multiplan Commercial |
$492.00
|
| Rate for Payer: NAPHCARE Commercial |
$369.00
|
| Rate for Payer: Preferred Network Access Commercial |
$565.80
|
| Rate for Payer: Quartz Beloit One Network |
$301.35
|
| Rate for Payer: Quartz Commercial |
$369.00
|
| Rate for Payer: WEA Trust Commercial |
$338.25
|
| Rate for Payer: WPS Commercial |
$455.53
|
|
|
RBC 500 Irr 1
|
Facility
|
OP
|
$615.00
|
|
|
Service Code
|
HCPCS P9021
|
| Hospital Charge Code |
1052868
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$141.61 |
| Max. Negotiated Rate |
$566.44 |
| Rate for Payer: Aetna Commercial |
$553.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$528.90
|
| Rate for Payer: Aetna Managed Medicare |
$141.61
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$399.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$307.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$295.20
|
| Rate for Payer: Anthem Medicare Advantage |
$141.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$325.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$141.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$141.61
|
| Rate for Payer: Cash Price |
$184.50
|
| Rate for Payer: Cash Price |
$184.50
|
| Rate for Payer: Cigna Commercial |
$565.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$141.61
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$344.15
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$141.61
|
| Rate for Payer: Health EOS Commercial |
$547.35
|
| Rate for Payer: HFN Commercial |
$565.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$526.79
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$141.61
|
| Rate for Payer: Independent Care Health Plan Medicare |
$141.61
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$141.61
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$141.61
|
| Rate for Payer: Multiplan Commercial |
$492.00
|
| Rate for Payer: NAPHCARE Commercial |
$212.42
|
| Rate for Payer: Preferred Network Access Commercial |
$565.80
|
| Rate for Payer: Quartz Beloit One Network |
$301.35
|
| Rate for Payer: Quartz Commercial |
$399.75
|
| Rate for Payer: Quartz Medicare Advantage |
$141.61
|
| Rate for Payer: The Alliance Commercial |
$566.44
|
| Rate for Payer: United Healthcare Medicare Advantage |
$141.61
|
| Rate for Payer: United Healthcare PPO |
$461.25
|
| Rate for Payer: WEA Trust Commercial |
$338.25
|
| Rate for Payer: Wellcare Medicare |
$141.61
|
| Rate for Payer: WPS Commercial |
$455.53
|
|
|
RBC 500 Irr 1
|
Facility
|
IP
|
$615.00
|
|
|
Service Code
|
HCPCS P9021
|
| Hospital Charge Code |
1052868
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$301.35 |
| Max. Negotiated Rate |
$565.80 |
| Rate for Payer: Aetna Commercial |
$553.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$528.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$325.95
|
| Rate for Payer: Cash Price |
$184.50
|
| Rate for Payer: Cigna Commercial |
$565.80
|
| Rate for Payer: Health EOS Commercial |
$547.35
|
| Rate for Payer: HFN Commercial |
$565.80
|
| Rate for Payer: Multiplan Commercial |
$492.00
|
| Rate for Payer: NAPHCARE Commercial |
$369.00
|
| Rate for Payer: Preferred Network Access Commercial |
$565.80
|
| Rate for Payer: Quartz Beloit One Network |
$301.35
|
| Rate for Payer: Quartz Commercial |
$369.00
|
| Rate for Payer: WEA Trust Commercial |
$338.25
|
| Rate for Payer: WPS Commercial |
$455.53
|
|
|
RBC 500 Irr 2
|
Facility
|
IP
|
$615.00
|
|
|
Service Code
|
HCPCS P9021
|
| Hospital Charge Code |
1052870
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$301.35 |
| Max. Negotiated Rate |
$565.80 |
| Rate for Payer: Aetna Commercial |
$553.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$528.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$325.95
|
| Rate for Payer: Cash Price |
$184.50
|
| Rate for Payer: Cigna Commercial |
$565.80
|
| Rate for Payer: Health EOS Commercial |
$547.35
|
| Rate for Payer: HFN Commercial |
$565.80
|
| Rate for Payer: Multiplan Commercial |
$492.00
|
| Rate for Payer: NAPHCARE Commercial |
$369.00
|
| Rate for Payer: Preferred Network Access Commercial |
$565.80
|
| Rate for Payer: Quartz Beloit One Network |
$301.35
|
| Rate for Payer: Quartz Commercial |
$369.00
|
| Rate for Payer: WEA Trust Commercial |
$338.25
|
| Rate for Payer: WPS Commercial |
$455.53
|
|
|
RBC 500 Irr 2
|
Facility
|
OP
|
$615.00
|
|
|
Service Code
|
HCPCS P9021
|
| Hospital Charge Code |
1052870
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$141.61 |
| Max. Negotiated Rate |
$566.44 |
| Rate for Payer: Aetna Commercial |
$553.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$528.90
|
| Rate for Payer: Aetna Managed Medicare |
$141.61
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$399.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$307.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$295.20
|
| Rate for Payer: Anthem Medicare Advantage |
$141.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$325.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$141.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$141.61
|
| Rate for Payer: Cash Price |
$184.50
|
| Rate for Payer: Cash Price |
$184.50
|
| Rate for Payer: Cigna Commercial |
$565.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$141.61
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$344.15
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$141.61
|
| Rate for Payer: Health EOS Commercial |
$547.35
|
| Rate for Payer: HFN Commercial |
$565.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$526.79
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$141.61
|
| Rate for Payer: Independent Care Health Plan Medicare |
$141.61
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$141.61
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$141.61
|
| Rate for Payer: Multiplan Commercial |
$492.00
|
| Rate for Payer: NAPHCARE Commercial |
$212.42
|
| Rate for Payer: Preferred Network Access Commercial |
$565.80
|
| Rate for Payer: Quartz Beloit One Network |
$301.35
|
| Rate for Payer: Quartz Commercial |
$399.75
|
| Rate for Payer: Quartz Medicare Advantage |
$141.61
|
| Rate for Payer: The Alliance Commercial |
$566.44
|
| Rate for Payer: United Healthcare Medicare Advantage |
$141.61
|
| Rate for Payer: United Healthcare PPO |
$461.25
|
| Rate for Payer: WEA Trust Commercial |
$338.25
|
| Rate for Payer: Wellcare Medicare |
$141.61
|
| Rate for Payer: WPS Commercial |
$455.53
|
|
|
RBC Count CSF
|
Facility
|
IP
|
$90.00
|
|
|
Service Code
|
CPT 89050
|
| Hospital Charge Code |
1050840
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$44.10 |
| Max. Negotiated Rate |
$82.80 |
| Rate for Payer: Aetna Commercial |
$81.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$77.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$47.70
|
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Cigna Commercial |
$82.80
|
| Rate for Payer: Health EOS Commercial |
$80.10
|
| Rate for Payer: HFN Commercial |
$82.80
|
| Rate for Payer: Multiplan Commercial |
$72.00
|
| Rate for Payer: NAPHCARE Commercial |
$54.00
|
| Rate for Payer: Preferred Network Access Commercial |
$82.80
|
| Rate for Payer: Quartz Beloit One Network |
$44.10
|
| Rate for Payer: Quartz Commercial |
$54.00
|
| Rate for Payer: WEA Trust Commercial |
$49.50
|
| Rate for Payer: WPS Commercial |
$66.66
|
|
|
RBC Count CSF
|
Facility
|
OP
|
$90.00
|
|
|
Service Code
|
CPT 89050
|
| Hospital Charge Code |
1050840
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.72 |
| Max. Negotiated Rate |
$82.80 |
| Rate for Payer: Aetna Commercial |
$81.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$77.40
|
| Rate for Payer: Aetna Managed Medicare |
$4.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$17.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8.26
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7.84
|
| Rate for Payer: Anthem Medicaid |
$4.88
|
| Rate for Payer: Anthem Medicare Advantage |
$4.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$47.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$4.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$4.72
|
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Cigna Commercial |
$82.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$4.72
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$4.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$50.36
|
| Rate for Payer: Dean Health Medicaid |
$4.88
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$4.72
|
| Rate for Payer: Health EOS Commercial |
$80.10
|
| Rate for Payer: HFN Commercial |
$82.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$17.56
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$4.72
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$4.88
|
| Rate for Payer: Independent Care Health Plan Medicare |
$4.72
|
| Rate for Payer: Managed Health Services Medicaid |
$5.08
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$4.72
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$4.72
|
| Rate for Payer: Multiplan Commercial |
$72.00
|
| Rate for Payer: NAPHCARE Commercial |
$7.08
|
| Rate for Payer: Preferred Network Access Commercial |
$82.80
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$4.88
|
| Rate for Payer: Quartz Beloit One Network |
$44.10
|
| Rate for Payer: Quartz Commercial |
$58.50
|
| Rate for Payer: Quartz Medicare Advantage |
$4.72
|
| Rate for Payer: The Alliance Commercial |
$18.88
|
| Rate for Payer: United Healthcare Medicaid |
$4.88
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4.72
|
| Rate for Payer: United Healthcare PPO |
$67.50
|
| Rate for Payer: WEA Trust Commercial |
$49.50
|
| Rate for Payer: Wellcare Medicare |
$4.72
|
| Rate for Payer: WMAP Medicaid |
$4.88
|
| Rate for Payer: WPS Commercial |
$66.66
|
|
|
RBC Count CSF
|
Professional
|
Both
|
$90.00
|
|
|
Service Code
|
CPT 89050
|
| Hospital Charge Code |
1050840
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.66 |
| Max. Negotiated Rate |
$85.50 |
| Rate for Payer: Aetna Commercial |
$85.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$77.40
|
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Cigna Commercial |
$85.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$45.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$54.00
|
| Rate for Payer: Health EOS Commercial |
$81.90
|
| Rate for Payer: HFN Commercial |
$85.50
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$16.66
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$16.66
|
| Rate for Payer: Multiplan Commercial |
$72.00
|
| Rate for Payer: Preferred Network Access Commercial |
$85.50
|
| Rate for Payer: Quartz Beloit One Network |
$39.60
|
| Rate for Payer: Quartz Commercial |
$51.30
|
| Rate for Payer: The Alliance Commercial |
$45.00
|
| Rate for Payer: WEA Trust Commercial |
$49.50
|
| Rate for Payer: WPS Commercial |
$66.66
|
|
|
RBC CP2D AS3 450 LR Irr
|
Facility
|
IP
|
$615.00
|
|
|
Service Code
|
HCPCS P9021
|
| Hospital Charge Code |
1052817
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$301.35 |
| Max. Negotiated Rate |
$565.80 |
| Rate for Payer: Aetna Commercial |
$553.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$528.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$325.95
|
| Rate for Payer: Cash Price |
$184.50
|
| Rate for Payer: Cigna Commercial |
$565.80
|
| Rate for Payer: Health EOS Commercial |
$547.35
|
| Rate for Payer: HFN Commercial |
$565.80
|
| Rate for Payer: Multiplan Commercial |
$492.00
|
| Rate for Payer: NAPHCARE Commercial |
$369.00
|
| Rate for Payer: Preferred Network Access Commercial |
$565.80
|
| Rate for Payer: Quartz Beloit One Network |
$301.35
|
| Rate for Payer: Quartz Commercial |
$369.00
|
| Rate for Payer: WEA Trust Commercial |
$338.25
|
| Rate for Payer: WPS Commercial |
$455.53
|
|
|
RBC CP2D AS3 450 LR Irr
|
Facility
|
OP
|
$615.00
|
|
|
Service Code
|
HCPCS P9021
|
| Hospital Charge Code |
1052817
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$141.61 |
| Max. Negotiated Rate |
$566.44 |
| Rate for Payer: Aetna Commercial |
$553.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$528.90
|
| Rate for Payer: Aetna Managed Medicare |
$141.61
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$399.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$307.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$295.20
|
| Rate for Payer: Anthem Medicare Advantage |
$141.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$325.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$141.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$141.61
|
| Rate for Payer: Cash Price |
$184.50
|
| Rate for Payer: Cash Price |
$184.50
|
| Rate for Payer: Cigna Commercial |
$565.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$141.61
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$344.15
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$141.61
|
| Rate for Payer: Health EOS Commercial |
$547.35
|
| Rate for Payer: HFN Commercial |
$565.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$526.79
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$141.61
|
| Rate for Payer: Independent Care Health Plan Medicare |
$141.61
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$141.61
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$141.61
|
| Rate for Payer: Multiplan Commercial |
$492.00
|
| Rate for Payer: NAPHCARE Commercial |
$212.42
|
| Rate for Payer: Preferred Network Access Commercial |
$565.80
|
| Rate for Payer: Quartz Beloit One Network |
$301.35
|
| Rate for Payer: Quartz Commercial |
$399.75
|
| Rate for Payer: Quartz Medicare Advantage |
$141.61
|
| Rate for Payer: The Alliance Commercial |
$566.44
|
| Rate for Payer: United Healthcare Medicare Advantage |
$141.61
|
| Rate for Payer: United Healthcare PPO |
$461.25
|
| Rate for Payer: WEA Trust Commercial |
$338.25
|
| Rate for Payer: Wellcare Medicare |
$141.61
|
| Rate for Payer: WPS Commercial |
$455.53
|
|
|
RBC CP2D AS3 500LR
|
Facility
|
IP
|
$591.00
|
|
|
Service Code
|
HCPCS P9021
|
| Hospital Charge Code |
5433148
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$289.59 |
| Max. Negotiated Rate |
$543.72 |
| Rate for Payer: Aetna Commercial |
$531.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$508.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$313.23
|
| Rate for Payer: Cash Price |
$177.30
|
| Rate for Payer: Cigna Commercial |
$543.72
|
| Rate for Payer: Health EOS Commercial |
$525.99
|
| Rate for Payer: HFN Commercial |
$543.72
|
| Rate for Payer: Multiplan Commercial |
$472.80
|
| Rate for Payer: NAPHCARE Commercial |
$354.60
|
| Rate for Payer: Preferred Network Access Commercial |
$543.72
|
| Rate for Payer: Quartz Beloit One Network |
$289.59
|
| Rate for Payer: Quartz Commercial |
$354.60
|
| Rate for Payer: WEA Trust Commercial |
$325.05
|
| Rate for Payer: WPS Commercial |
$437.75
|
|
|
RBC CP2D AS3 500LR
|
Facility
|
OP
|
$591.00
|
|
|
Service Code
|
HCPCS P9021
|
| Hospital Charge Code |
5433148
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$141.61 |
| Max. Negotiated Rate |
$566.44 |
| Rate for Payer: Aetna Commercial |
$531.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$508.26
|
| Rate for Payer: Aetna Managed Medicare |
$141.61
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$384.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$295.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$283.68
|
| Rate for Payer: Anthem Medicare Advantage |
$141.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$313.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$141.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$141.61
|
| Rate for Payer: Cash Price |
$177.30
|
| Rate for Payer: Cash Price |
$177.30
|
| Rate for Payer: Cigna Commercial |
$543.72
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$141.61
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$330.72
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$141.61
|
| Rate for Payer: Health EOS Commercial |
$525.99
|
| Rate for Payer: HFN Commercial |
$543.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$526.79
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$141.61
|
| Rate for Payer: Independent Care Health Plan Medicare |
$141.61
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$141.61
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$141.61
|
| Rate for Payer: Multiplan Commercial |
$472.80
|
| Rate for Payer: NAPHCARE Commercial |
$212.42
|
| Rate for Payer: Preferred Network Access Commercial |
$543.72
|
| Rate for Payer: Quartz Beloit One Network |
$289.59
|
| Rate for Payer: Quartz Commercial |
$384.15
|
| Rate for Payer: Quartz Medicare Advantage |
$141.61
|
| Rate for Payer: The Alliance Commercial |
$566.44
|
| Rate for Payer: United Healthcare Medicare Advantage |
$141.61
|
| Rate for Payer: United Healthcare PPO |
$443.25
|
| Rate for Payer: WEA Trust Commercial |
$325.05
|
| Rate for Payer: Wellcare Medicare |
$141.61
|
| Rate for Payer: WPS Commercial |
$437.75
|
|
|
RBC CPD 450
|
Facility
|
OP
|
$615.00
|
|
|
Service Code
|
HCPCS P9021
|
| Hospital Charge Code |
1052858
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$141.61 |
| Max. Negotiated Rate |
$566.44 |
| Rate for Payer: Aetna Commercial |
$553.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$528.90
|
| Rate for Payer: Aetna Managed Medicare |
$141.61
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$399.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$307.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$295.20
|
| Rate for Payer: Anthem Medicare Advantage |
$141.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$325.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$141.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$141.61
|
| Rate for Payer: Cash Price |
$184.50
|
| Rate for Payer: Cash Price |
$184.50
|
| Rate for Payer: Cigna Commercial |
$565.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$141.61
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$344.15
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$141.61
|
| Rate for Payer: Health EOS Commercial |
$547.35
|
| Rate for Payer: HFN Commercial |
$565.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$526.79
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$141.61
|
| Rate for Payer: Independent Care Health Plan Medicare |
$141.61
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$141.61
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$141.61
|
| Rate for Payer: Multiplan Commercial |
$492.00
|
| Rate for Payer: NAPHCARE Commercial |
$212.42
|
| Rate for Payer: Preferred Network Access Commercial |
$565.80
|
| Rate for Payer: Quartz Beloit One Network |
$301.35
|
| Rate for Payer: Quartz Commercial |
$399.75
|
| Rate for Payer: Quartz Medicare Advantage |
$141.61
|
| Rate for Payer: The Alliance Commercial |
$566.44
|
| Rate for Payer: United Healthcare Medicare Advantage |
$141.61
|
| Rate for Payer: United Healthcare PPO |
$461.25
|
| Rate for Payer: WEA Trust Commercial |
$338.25
|
| Rate for Payer: Wellcare Medicare |
$141.61
|
| Rate for Payer: WPS Commercial |
$455.53
|
|
|
RBC CPD 450
|
Facility
|
IP
|
$615.00
|
|
|
Service Code
|
HCPCS P9021
|
| Hospital Charge Code |
1052858
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$301.35 |
| Max. Negotiated Rate |
$565.80 |
| Rate for Payer: Aetna Commercial |
$553.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$528.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$325.95
|
| Rate for Payer: Cash Price |
$184.50
|
| Rate for Payer: Cigna Commercial |
$565.80
|
| Rate for Payer: Health EOS Commercial |
$547.35
|
| Rate for Payer: HFN Commercial |
$565.80
|
| Rate for Payer: Multiplan Commercial |
$492.00
|
| Rate for Payer: NAPHCARE Commercial |
$369.00
|
| Rate for Payer: Preferred Network Access Commercial |
$565.80
|
| Rate for Payer: Quartz Beloit One Network |
$301.35
|
| Rate for Payer: Quartz Commercial |
$369.00
|
| Rate for Payer: WEA Trust Commercial |
$338.25
|
| Rate for Payer: WPS Commercial |
$455.53
|
|
|
RBC CPD 500
|
Facility
|
IP
|
$615.00
|
|
|
Service Code
|
HCPCS P9021
|
| Hospital Charge Code |
1052854
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$301.35 |
| Max. Negotiated Rate |
$565.80 |
| Rate for Payer: Aetna Commercial |
$553.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$528.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$325.95
|
| Rate for Payer: Cash Price |
$184.50
|
| Rate for Payer: Cigna Commercial |
$565.80
|
| Rate for Payer: Health EOS Commercial |
$547.35
|
| Rate for Payer: HFN Commercial |
$565.80
|
| Rate for Payer: Multiplan Commercial |
$492.00
|
| Rate for Payer: NAPHCARE Commercial |
$369.00
|
| Rate for Payer: Preferred Network Access Commercial |
$565.80
|
| Rate for Payer: Quartz Beloit One Network |
$301.35
|
| Rate for Payer: Quartz Commercial |
$369.00
|
| Rate for Payer: WEA Trust Commercial |
$338.25
|
| Rate for Payer: WPS Commercial |
$455.53
|
|
|
RBC CPD 500
|
Facility
|
OP
|
$615.00
|
|
|
Service Code
|
HCPCS P9021
|
| Hospital Charge Code |
1052854
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$141.61 |
| Max. Negotiated Rate |
$566.44 |
| Rate for Payer: Aetna Commercial |
$553.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$528.90
|
| Rate for Payer: Aetna Managed Medicare |
$141.61
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$399.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$307.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$295.20
|
| Rate for Payer: Anthem Medicare Advantage |
$141.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$325.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$141.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$141.61
|
| Rate for Payer: Cash Price |
$184.50
|
| Rate for Payer: Cash Price |
$184.50
|
| Rate for Payer: Cigna Commercial |
$565.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$141.61
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$344.15
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$141.61
|
| Rate for Payer: Health EOS Commercial |
$547.35
|
| Rate for Payer: HFN Commercial |
$565.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$526.79
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$141.61
|
| Rate for Payer: Independent Care Health Plan Medicare |
$141.61
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$141.61
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$141.61
|
| Rate for Payer: Multiplan Commercial |
$492.00
|
| Rate for Payer: NAPHCARE Commercial |
$212.42
|
| Rate for Payer: Preferred Network Access Commercial |
$565.80
|
| Rate for Payer: Quartz Beloit One Network |
$301.35
|
| Rate for Payer: Quartz Commercial |
$399.75
|
| Rate for Payer: Quartz Medicare Advantage |
$141.61
|
| Rate for Payer: The Alliance Commercial |
$566.44
|
| Rate for Payer: United Healthcare Medicare Advantage |
$141.61
|
| Rate for Payer: United Healthcare PPO |
$461.25
|
| Rate for Payer: WEA Trust Commercial |
$338.25
|
| Rate for Payer: Wellcare Medicare |
$141.61
|
| Rate for Payer: WPS Commercial |
$455.53
|
|
|
RBC CPDA1 450
|
Facility
|
OP
|
$615.00
|
|
|
Service Code
|
HCPCS P9021
|
| Hospital Charge Code |
1052799
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$141.61 |
| Max. Negotiated Rate |
$566.44 |
| Rate for Payer: Aetna Commercial |
$553.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$528.90
|
| Rate for Payer: Aetna Managed Medicare |
$141.61
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$399.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$307.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$295.20
|
| Rate for Payer: Anthem Medicare Advantage |
$141.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$325.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$141.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$141.61
|
| Rate for Payer: Cash Price |
$184.50
|
| Rate for Payer: Cash Price |
$184.50
|
| Rate for Payer: Cigna Commercial |
$565.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$141.61
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$344.15
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$141.61
|
| Rate for Payer: Health EOS Commercial |
$547.35
|
| Rate for Payer: HFN Commercial |
$565.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$526.79
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$141.61
|
| Rate for Payer: Independent Care Health Plan Medicare |
$141.61
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$141.61
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$141.61
|
| Rate for Payer: Multiplan Commercial |
$492.00
|
| Rate for Payer: NAPHCARE Commercial |
$212.42
|
| Rate for Payer: Preferred Network Access Commercial |
$565.80
|
| Rate for Payer: Quartz Beloit One Network |
$301.35
|
| Rate for Payer: Quartz Commercial |
$399.75
|
| Rate for Payer: Quartz Medicare Advantage |
$141.61
|
| Rate for Payer: The Alliance Commercial |
$566.44
|
| Rate for Payer: United Healthcare Medicare Advantage |
$141.61
|
| Rate for Payer: United Healthcare PPO |
$461.25
|
| Rate for Payer: WEA Trust Commercial |
$338.25
|
| Rate for Payer: Wellcare Medicare |
$141.61
|
| Rate for Payer: WPS Commercial |
$455.53
|
|
|
RBC CPDA1 450
|
Facility
|
IP
|
$615.00
|
|
|
Service Code
|
HCPCS P9021
|
| Hospital Charge Code |
1052799
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$301.35 |
| Max. Negotiated Rate |
$565.80 |
| Rate for Payer: Aetna Commercial |
$553.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$528.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$325.95
|
| Rate for Payer: Cash Price |
$184.50
|
| Rate for Payer: Cigna Commercial |
$565.80
|
| Rate for Payer: Health EOS Commercial |
$547.35
|
| Rate for Payer: HFN Commercial |
$565.80
|
| Rate for Payer: Multiplan Commercial |
$492.00
|
| Rate for Payer: NAPHCARE Commercial |
$369.00
|
| Rate for Payer: Preferred Network Access Commercial |
$565.80
|
| Rate for Payer: Quartz Beloit One Network |
$301.35
|
| Rate for Payer: Quartz Commercial |
$369.00
|
| Rate for Payer: WEA Trust Commercial |
$338.25
|
| Rate for Payer: WPS Commercial |
$455.53
|
|
|
RBC CPDA1 500
|
Facility
|
IP
|
$615.00
|
|
|
Service Code
|
HCPCS P9021
|
| Hospital Charge Code |
1052815
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$301.35 |
| Max. Negotiated Rate |
$565.80 |
| Rate for Payer: Aetna Commercial |
$553.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$528.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$325.95
|
| Rate for Payer: Cash Price |
$184.50
|
| Rate for Payer: Cigna Commercial |
$565.80
|
| Rate for Payer: Health EOS Commercial |
$547.35
|
| Rate for Payer: HFN Commercial |
$565.80
|
| Rate for Payer: Multiplan Commercial |
$492.00
|
| Rate for Payer: NAPHCARE Commercial |
$369.00
|
| Rate for Payer: Preferred Network Access Commercial |
$565.80
|
| Rate for Payer: Quartz Beloit One Network |
$301.35
|
| Rate for Payer: Quartz Commercial |
$369.00
|
| Rate for Payer: WEA Trust Commercial |
$338.25
|
| Rate for Payer: WPS Commercial |
$455.53
|
|
|
RBC CPDA1 500
|
Facility
|
OP
|
$615.00
|
|
|
Service Code
|
HCPCS P9021
|
| Hospital Charge Code |
1052815
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$141.61 |
| Max. Negotiated Rate |
$566.44 |
| Rate for Payer: Aetna Commercial |
$553.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$528.90
|
| Rate for Payer: Aetna Managed Medicare |
$141.61
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$399.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$307.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$295.20
|
| Rate for Payer: Anthem Medicare Advantage |
$141.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$325.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$141.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$141.61
|
| Rate for Payer: Cash Price |
$184.50
|
| Rate for Payer: Cash Price |
$184.50
|
| Rate for Payer: Cigna Commercial |
$565.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$141.61
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$344.15
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$141.61
|
| Rate for Payer: Health EOS Commercial |
$547.35
|
| Rate for Payer: HFN Commercial |
$565.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$526.79
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$141.61
|
| Rate for Payer: Independent Care Health Plan Medicare |
$141.61
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$141.61
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$141.61
|
| Rate for Payer: Multiplan Commercial |
$492.00
|
| Rate for Payer: NAPHCARE Commercial |
$212.42
|
| Rate for Payer: Preferred Network Access Commercial |
$565.80
|
| Rate for Payer: Quartz Beloit One Network |
$301.35
|
| Rate for Payer: Quartz Commercial |
$399.75
|
| Rate for Payer: Quartz Medicare Advantage |
$141.61
|
| Rate for Payer: The Alliance Commercial |
$566.44
|
| Rate for Payer: United Healthcare Medicare Advantage |
$141.61
|
| Rate for Payer: United Healthcare PPO |
$461.25
|
| Rate for Payer: WEA Trust Commercial |
$338.25
|
| Rate for Payer: Wellcare Medicare |
$141.61
|
| Rate for Payer: WPS Commercial |
$455.53
|
|
|
RBC CPD AS1 LR
|
Facility
|
OP
|
$567.00
|
|
|
Service Code
|
HCPCS P9021
|
| Hospital Charge Code |
4221389
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$141.61 |
| Max. Negotiated Rate |
$566.44 |
| Rate for Payer: Aetna Commercial |
$510.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$487.62
|
| Rate for Payer: Aetna Managed Medicare |
$141.61
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$368.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$283.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$272.16
|
| Rate for Payer: Anthem Medicare Advantage |
$141.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$300.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$141.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$141.61
|
| Rate for Payer: Cash Price |
$170.10
|
| Rate for Payer: Cash Price |
$170.10
|
| Rate for Payer: Cigna Commercial |
$521.64
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$141.61
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$317.29
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$141.61
|
| Rate for Payer: Health EOS Commercial |
$504.63
|
| Rate for Payer: HFN Commercial |
$521.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$526.79
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$141.61
|
| Rate for Payer: Independent Care Health Plan Medicare |
$141.61
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$141.61
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$141.61
|
| Rate for Payer: Multiplan Commercial |
$453.60
|
| Rate for Payer: NAPHCARE Commercial |
$212.42
|
| Rate for Payer: Preferred Network Access Commercial |
$521.64
|
| Rate for Payer: Quartz Beloit One Network |
$277.83
|
| Rate for Payer: Quartz Commercial |
$368.55
|
| Rate for Payer: Quartz Medicare Advantage |
$141.61
|
| Rate for Payer: The Alliance Commercial |
$566.44
|
| Rate for Payer: United Healthcare Medicare Advantage |
$141.61
|
| Rate for Payer: United Healthcare PPO |
$425.25
|
| Rate for Payer: WEA Trust Commercial |
$311.85
|
| Rate for Payer: Wellcare Medicare |
$141.61
|
| Rate for Payer: WPS Commercial |
$419.98
|
|
|
RBC CPD AS1 LR
|
Facility
|
IP
|
$567.00
|
|
|
Service Code
|
HCPCS P9021
|
| Hospital Charge Code |
4221389
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$277.83 |
| Max. Negotiated Rate |
$521.64 |
| Rate for Payer: Aetna Commercial |
$510.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$487.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$300.51
|
| Rate for Payer: Cash Price |
$170.10
|
| Rate for Payer: Cigna Commercial |
$521.64
|
| Rate for Payer: Health EOS Commercial |
$504.63
|
| Rate for Payer: HFN Commercial |
$521.64
|
| Rate for Payer: Multiplan Commercial |
$453.60
|
| Rate for Payer: NAPHCARE Commercial |
$340.20
|
| Rate for Payer: Preferred Network Access Commercial |
$521.64
|
| Rate for Payer: Quartz Beloit One Network |
$277.83
|
| Rate for Payer: Quartz Commercial |
$340.20
|
| Rate for Payer: WEA Trust Commercial |
$311.85
|
| Rate for Payer: WPS Commercial |
$419.98
|
|
