|
RBC CPD AS1 LR Irr
|
Facility
|
OP
|
$615.00
|
|
|
Service Code
|
HCPCS P9021
|
| Hospital Charge Code |
4221388
|
|
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 Irr
|
Facility
|
IP
|
$615.00
|
|
|
Service Code
|
HCPCS P9021
|
| Hospital Charge Code |
4221388
|
|
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 AS5 450
|
Facility
|
IP
|
$615.00
|
|
|
Service Code
|
HCPCS P9021
|
| Hospital Charge Code |
1052874
|
|
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 AS5 450
|
Facility
|
OP
|
$615.00
|
|
|
Service Code
|
HCPCS P9021
|
| Hospital Charge Code |
1052874
|
|
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 AS5 450 Irr
|
Facility
|
IP
|
$615.00
|
|
|
Service Code
|
HCPCS P9021
|
| Hospital Charge Code |
1052872
|
|
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 AS5 450 Irr
|
Facility
|
OP
|
$615.00
|
|
|
Service Code
|
HCPCS P9021
|
| Hospital Charge Code |
1052872
|
|
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 AS5 450 LR
|
Facility
|
OP
|
$615.00
|
|
|
Service Code
|
HCPCS P9021
|
| Hospital Charge Code |
1052840
|
|
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 AS5 450 LR
|
Facility
|
IP
|
$615.00
|
|
|
Service Code
|
HCPCS P9021
|
| Hospital Charge Code |
1052840
|
|
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 AS5 450 LR Irr
|
Facility
|
IP
|
$615.00
|
|
|
Service Code
|
HCPCS P9021
|
| Hospital Charge Code |
1052837
|
|
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 AS5 450 LR Irr
|
Facility
|
OP
|
$615.00
|
|
|
Service Code
|
HCPCS P9021
|
| Hospital Charge Code |
1052837
|
|
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 AS5 500
|
Facility
|
IP
|
$615.00
|
|
|
Service Code
|
HCPCS P9021
|
| Hospital Charge Code |
1052850
|
|
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 AS5 500
|
Facility
|
OP
|
$615.00
|
|
|
Service Code
|
HCPCS P9021
|
| Hospital Charge Code |
1052850
|
|
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 AS5 500 Irr
|
Facility
|
IP
|
$615.00
|
|
|
Service Code
|
HCPCS P9021
|
| Hospital Charge Code |
1052825
|
|
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 AS5 500 Irr
|
Facility
|
OP
|
$615.00
|
|
|
Service Code
|
HCPCS P9021
|
| Hospital Charge Code |
1052825
|
|
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 AS5 500 LR
|
Facility
|
OP
|
$567.00
|
|
|
Service Code
|
HCPCS P9021
|
| Hospital Charge Code |
1052822
|
|
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 AS5 500 LR
|
Facility
|
IP
|
$567.00
|
|
|
Service Code
|
HCPCS P9021
|
| Hospital Charge Code |
1052822
|
|
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
|
|
|
RBC CPD AS5 500 LR Irr
|
Facility
|
OP
|
$567.00
|
|
|
Service Code
|
HCPCS P9021
|
| Hospital Charge Code |
1052833
|
|
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 AS5 500 LR Irr
|
Facility
|
IP
|
$567.00
|
|
|
Service Code
|
HCPCS P9021
|
| Hospital Charge Code |
1052833
|
|
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
|
|
|
RBC CPD AS5 LV
|
Facility
|
OP
|
$615.00
|
|
|
Service Code
|
HCPCS P9021
|
| Hospital Charge Code |
1052835
|
|
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 AS5 LV
|
Facility
|
IP
|
$615.00
|
|
|
Service Code
|
HCPCS P9021
|
| Hospital Charge Code |
1052835
|
|
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 Deglyc
|
Facility
|
IP
|
$783.00
|
|
|
Service Code
|
HCPCS P9054
|
| Hospital Charge Code |
1052819
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$383.67 |
| Max. Negotiated Rate |
$720.36 |
| Rate for Payer: Aetna Commercial |
$704.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$673.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$414.99
|
| Rate for Payer: Cash Price |
$234.90
|
| Rate for Payer: Cigna Commercial |
$720.36
|
| Rate for Payer: Health EOS Commercial |
$696.87
|
| Rate for Payer: HFN Commercial |
$720.36
|
| Rate for Payer: Multiplan Commercial |
$626.40
|
| Rate for Payer: NAPHCARE Commercial |
$469.80
|
| Rate for Payer: Preferred Network Access Commercial |
$720.36
|
| Rate for Payer: Quartz Beloit One Network |
$383.67
|
| Rate for Payer: Quartz Commercial |
$469.80
|
| Rate for Payer: WEA Trust Commercial |
$430.65
|
| Rate for Payer: WPS Commercial |
$579.97
|
|
|
RBC Deglyc
|
Facility
|
OP
|
$783.00
|
|
|
Service Code
|
HCPCS P9054
|
| Hospital Charge Code |
1052819
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$223.25 |
| Max. Negotiated Rate |
$893.00 |
| Rate for Payer: Aetna Commercial |
$704.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$673.38
|
| Rate for Payer: Aetna Managed Medicare |
$223.25
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$508.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$391.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$375.84
|
| Rate for Payer: Anthem Medicare Advantage |
$223.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$414.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$223.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$223.25
|
| Rate for Payer: Cash Price |
$234.90
|
| Rate for Payer: Cash Price |
$234.90
|
| Rate for Payer: Cigna Commercial |
$720.36
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$223.25
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$438.17
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$223.25
|
| Rate for Payer: Health EOS Commercial |
$696.87
|
| Rate for Payer: HFN Commercial |
$720.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$830.49
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$223.25
|
| Rate for Payer: Independent Care Health Plan Medicare |
$223.25
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$223.25
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$223.25
|
| Rate for Payer: Multiplan Commercial |
$626.40
|
| Rate for Payer: NAPHCARE Commercial |
$334.88
|
| Rate for Payer: Preferred Network Access Commercial |
$720.36
|
| Rate for Payer: Quartz Beloit One Network |
$383.67
|
| Rate for Payer: Quartz Commercial |
$508.95
|
| Rate for Payer: Quartz Medicare Advantage |
$223.25
|
| Rate for Payer: The Alliance Commercial |
$893.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$223.25
|
| Rate for Payer: United Healthcare PPO |
$587.25
|
| Rate for Payer: WEA Trust Commercial |
$430.65
|
| Rate for Payer: Wellcare Medicare |
$223.25
|
| Rate for Payer: WPS Commercial |
$579.97
|
|
|
RBC LR Washed
|
Facility
|
IP
|
$1,472.00
|
|
|
Service Code
|
HCPCS P9022
|
| Hospital Charge Code |
1052864
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$721.28 |
| Max. Negotiated Rate |
$1,354.24 |
| Rate for Payer: Aetna Commercial |
$1,324.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,265.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$780.16
|
| Rate for Payer: Cash Price |
$441.60
|
| Rate for Payer: Cigna Commercial |
$1,354.24
|
| Rate for Payer: Health EOS Commercial |
$1,310.08
|
| Rate for Payer: HFN Commercial |
$1,354.24
|
| Rate for Payer: Multiplan Commercial |
$1,177.60
|
| Rate for Payer: NAPHCARE Commercial |
$883.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,354.24
|
| Rate for Payer: Quartz Beloit One Network |
$721.28
|
| Rate for Payer: Quartz Commercial |
$883.20
|
| Rate for Payer: WEA Trust Commercial |
$809.60
|
| Rate for Payer: WPS Commercial |
$1,090.31
|
|
|
RBC LR Washed
|
Facility
|
OP
|
$1,472.00
|
|
|
Service Code
|
HCPCS P9022
|
| Hospital Charge Code |
1052864
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$411.96 |
| Max. Negotiated Rate |
$1,647.84 |
| Rate for Payer: Aetna Commercial |
$1,324.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,265.92
|
| Rate for Payer: Aetna Managed Medicare |
$411.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$956.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$736.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$706.56
|
| Rate for Payer: Anthem Medicare Advantage |
$411.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$780.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$411.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$411.96
|
| Rate for Payer: Cash Price |
$441.60
|
| Rate for Payer: Cash Price |
$441.60
|
| Rate for Payer: Cigna Commercial |
$1,354.24
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$411.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$823.73
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$411.96
|
| Rate for Payer: Health EOS Commercial |
$1,310.08
|
| Rate for Payer: HFN Commercial |
$1,354.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,532.49
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$411.96
|
| Rate for Payer: Independent Care Health Plan Medicare |
$411.96
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$411.96
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$411.96
|
| Rate for Payer: Multiplan Commercial |
$1,177.60
|
| Rate for Payer: NAPHCARE Commercial |
$617.94
|
| Rate for Payer: Preferred Network Access Commercial |
$1,354.24
|
| Rate for Payer: Quartz Beloit One Network |
$721.28
|
| Rate for Payer: Quartz Commercial |
$956.80
|
| Rate for Payer: Quartz Medicare Advantage |
$411.96
|
| Rate for Payer: The Alliance Commercial |
$1,647.84
|
| Rate for Payer: United Healthcare Medicare Advantage |
$411.96
|
| Rate for Payer: United Healthcare PPO |
$1,104.00
|
| Rate for Payer: WEA Trust Commercial |
$809.60
|
| Rate for Payer: Wellcare Medicare |
$411.96
|
| Rate for Payer: WPS Commercial |
$1,090.31
|
|
|
RBC Washed
|
Facility
|
OP
|
$1,472.00
|
|
|
Service Code
|
HCPCS P9022
|
| Hospital Charge Code |
1052871
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$411.96 |
| Max. Negotiated Rate |
$1,647.84 |
| Rate for Payer: Aetna Commercial |
$1,324.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,265.92
|
| Rate for Payer: Aetna Managed Medicare |
$411.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$956.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$736.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$706.56
|
| Rate for Payer: Anthem Medicare Advantage |
$411.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$780.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$411.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$411.96
|
| Rate for Payer: Cash Price |
$441.60
|
| Rate for Payer: Cash Price |
$441.60
|
| Rate for Payer: Cigna Commercial |
$1,354.24
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$411.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$823.73
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$411.96
|
| Rate for Payer: Health EOS Commercial |
$1,310.08
|
| Rate for Payer: HFN Commercial |
$1,354.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,532.49
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$411.96
|
| Rate for Payer: Independent Care Health Plan Medicare |
$411.96
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$411.96
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$411.96
|
| Rate for Payer: Multiplan Commercial |
$1,177.60
|
| Rate for Payer: NAPHCARE Commercial |
$617.94
|
| Rate for Payer: Preferred Network Access Commercial |
$1,354.24
|
| Rate for Payer: Quartz Beloit One Network |
$721.28
|
| Rate for Payer: Quartz Commercial |
$956.80
|
| Rate for Payer: Quartz Medicare Advantage |
$411.96
|
| Rate for Payer: The Alliance Commercial |
$1,647.84
|
| Rate for Payer: United Healthcare Medicare Advantage |
$411.96
|
| Rate for Payer: United Healthcare PPO |
$1,104.00
|
| Rate for Payer: WEA Trust Commercial |
$809.60
|
| Rate for Payer: Wellcare Medicare |
$411.96
|
| Rate for Payer: WPS Commercial |
$1,090.31
|
|
