|
SEIZURE
|
Facility
|
IP
|
$20,517.85
|
|
|
Service Code
|
APR-DRG 0534
|
| Min. Negotiated Rate |
$18,225.23 |
| Max. Negotiated Rate |
$20,517.85 |
| Rate for Payer: Anthem Medicaid |
$19,646.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$19,646.97
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$19,646.97
|
| Rate for Payer: Dean Health Medicaid |
$19,646.97
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$18,225.23
|
| Rate for Payer: Managed Health Services Medicaid |
$20,517.85
|
| Rate for Payer: Molina Healthcare Medicaid |
$19,646.97
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$19,646.97
|
| Rate for Payer: United Healthcare Medicaid |
$19,646.97
|
|
|
SEIZURES WITH MCC
|
Facility
|
IP
|
$55,148.08
|
|
|
Service Code
|
MSDRG 100
|
| Min. Negotiated Rate |
$15,339.18 |
| Max. Negotiated Rate |
$55,148.08 |
| Rate for Payer: Aetna Managed Medicare |
$15,339.18
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$42,259.43
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$32,391.51
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$30,774.05
|
| Rate for Payer: Anthem Medicare Advantage |
$15,339.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$15,339.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$15,339.18
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$15,339.18
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$34,162.01
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$15,339.18
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$40,205.10
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$15,339.18
|
| Rate for Payer: Independent Care Health Plan Medicare |
$15,339.18
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$15,339.18
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$15,339.18
|
| Rate for Payer: NAPHCARE Commercial |
$23,008.77
|
| Rate for Payer: Quartz Medicare Advantage |
$15,339.18
|
| Rate for Payer: The Alliance Commercial |
$55,148.08
|
| Rate for Payer: United Healthcare Medicare Advantage |
$15,339.18
|
| Rate for Payer: United Healthcare PPO |
$31,300.18
|
| Rate for Payer: Wellcare Medicare |
$15,339.18
|
|
|
SEIZURES WITHOUT MCC
|
Facility
|
IP
|
$25,483.12
|
|
|
Service Code
|
MSDRG 101
|
| Min. Negotiated Rate |
$7,419.07 |
| Max. Negotiated Rate |
$25,483.12 |
| Rate for Payer: Aetna Managed Medicare |
$7,419.07
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$19,694.01
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$15,095.30
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$14,341.52
|
| Rate for Payer: Anthem Medicare Advantage |
$7,419.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$7,419.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$7,419.07
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$7,419.07
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$15,920.40
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$7,419.07
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$18,446.69
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$7,419.07
|
| Rate for Payer: Independent Care Health Plan Medicare |
$7,419.07
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$7,419.07
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$7,419.07
|
| Rate for Payer: NAPHCARE Commercial |
$11,128.60
|
| Rate for Payer: Quartz Medicare Advantage |
$7,419.07
|
| Rate for Payer: The Alliance Commercial |
$25,483.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$7,419.07
|
| Rate for Payer: United Healthcare PPO |
$14,360.99
|
| Rate for Payer: Wellcare Medicare |
$7,419.07
|
|
|
SELECTIVE CATHETER PLACEMENT, ARTERIAL SYSTEM; EACH FIRST ORDER THORACIC OR BRACHIOCEPHALIC BRANCH, WITHIN A VASCULAR FAMILY
|
Facility
|
OP
|
$4,386.95
|
|
|
Service Code
|
CPT 36215
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$717.18 |
| Max. Negotiated Rate |
$4,386.95 |
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: The Alliance Commercial |
$717.18
|
|
|
Selenium Level
|
Facility
|
OP
|
$319.00
|
|
|
Service Code
|
CPT 84255
|
| Hospital Charge Code |
978063
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$26.55 |
| Max. Negotiated Rate |
$305.22 |
| Rate for Payer: Aetna Commercial |
$298.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$285.31
|
| Rate for Payer: Aetna Managed Medicare |
$26.55
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$99.57
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$46.46
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$44.07
|
| Rate for Payer: Anthem Medicare Advantage |
$26.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$175.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$26.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$26.55
|
| Rate for Payer: Cash Price |
$95.70
|
| Rate for Payer: Cash Price |
$95.70
|
| Rate for Payer: Cigna Commercial |
$305.22
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$26.55
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$185.66
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$26.55
|
| Rate for Payer: Health EOS Commercial |
$295.27
|
| Rate for Payer: HFN Commercial |
$305.22
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$98.77
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$26.55
|
| Rate for Payer: Independent Care Health Plan Medicare |
$26.55
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$26.55
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$26.55
|
| Rate for Payer: Multiplan Commercial |
$265.41
|
| Rate for Payer: NAPHCARE Commercial |
$39.83
|
| Rate for Payer: Preferred Network Access Commercial |
$305.22
|
| Rate for Payer: Quartz Beloit One Network |
$162.56
|
| Rate for Payer: Quartz Commercial |
$215.64
|
| Rate for Payer: Quartz Medicare Advantage |
$26.55
|
| Rate for Payer: The Alliance Commercial |
$106.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$26.55
|
| Rate for Payer: United Healthcare PPO |
$248.82
|
| Rate for Payer: WEA Trust Commercial |
$182.47
|
| Rate for Payer: Wellcare Medicare |
$26.55
|
| Rate for Payer: WPS Commercial |
$245.73
|
|
|
Selenium Level
|
Facility
|
IP
|
$319.00
|
|
|
Service Code
|
CPT 84255
|
| Hospital Charge Code |
978063
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$162.56 |
| Max. Negotiated Rate |
$305.22 |
| Rate for Payer: Aetna Commercial |
$298.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$285.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$175.83
|
| Rate for Payer: Cash Price |
$95.70
|
| Rate for Payer: Cigna Commercial |
$305.22
|
| Rate for Payer: Health EOS Commercial |
$295.27
|
| Rate for Payer: HFN Commercial |
$305.22
|
| Rate for Payer: Multiplan Commercial |
$265.41
|
| Rate for Payer: Preferred Network Access Commercial |
$305.22
|
| Rate for Payer: Quartz Beloit One Network |
$162.56
|
| Rate for Payer: Quartz Commercial |
$199.06
|
| Rate for Payer: WEA Trust Commercial |
$182.47
|
| Rate for Payer: WPS Commercial |
$245.73
|
|
|
Selenium Level
|
Professional
|
Both
|
$319.00
|
|
|
Service Code
|
CPT 84255
|
| Hospital Charge Code |
978063
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$26.55 |
| Max. Negotiated Rate |
$315.17 |
| Rate for Payer: Aetna Commercial |
$315.17
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$285.31
|
| Rate for Payer: Aetna Managed Medicare |
$26.55
|
| Rate for Payer: Anthem Medicare Advantage |
$26.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$26.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$26.55
|
| Rate for Payer: Cash Price |
$95.70
|
| Rate for Payer: Cash Price |
$95.70
|
| Rate for Payer: Cigna Commercial |
$315.17
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$165.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$26.55
|
| Rate for Payer: Health EOS Commercial |
$301.90
|
| Rate for Payer: HFN Commercial |
$315.17
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$93.72
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$93.72
|
| Rate for Payer: Independent Care Health Plan Medicare |
$26.55
|
| Rate for Payer: Multiplan Commercial |
$265.41
|
| Rate for Payer: NAPHCARE Commercial |
$39.83
|
| Rate for Payer: Preferred Network Access Commercial |
$315.17
|
| Rate for Payer: Quartz Beloit One Network |
$145.97
|
| Rate for Payer: Quartz Commercial |
$189.10
|
| Rate for Payer: Quartz Medicare Advantage |
$26.55
|
| Rate for Payer: The Alliance Commercial |
$104.88
|
| Rate for Payer: United Healthcare Medicare Advantage |
$26.55
|
| Rate for Payer: WEA Trust Commercial |
$182.47
|
| Rate for Payer: WPS Commercial |
$116.83
|
|
|
Self-Mgmt Educ & Train 1 Pt
|
Facility
|
IP
|
$172.00
|
|
|
Service Code
|
CPT 98960
|
| Hospital Charge Code |
4668607
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$87.65 |
| Max. Negotiated Rate |
$164.57 |
| Rate for Payer: Aetna Commercial |
$160.99
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$153.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$94.81
|
| Rate for Payer: Cash Price |
$51.60
|
| Rate for Payer: Cigna Commercial |
$164.57
|
| Rate for Payer: Health EOS Commercial |
$159.20
|
| Rate for Payer: HFN Commercial |
$164.57
|
| Rate for Payer: Multiplan Commercial |
$143.10
|
| Rate for Payer: Preferred Network Access Commercial |
$164.57
|
| Rate for Payer: Quartz Beloit One Network |
$87.65
|
| Rate for Payer: Quartz Commercial |
$107.33
|
| Rate for Payer: WEA Trust Commercial |
$98.38
|
| Rate for Payer: WPS Commercial |
$132.49
|
|
|
Self-Mgmt Educ & Train 1 Pt
|
Facility
|
OP
|
$172.00
|
|
|
Service Code
|
CPT 98960
|
| Hospital Charge Code |
4668607
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$50.09 |
| Max. Negotiated Rate |
$164.57 |
| Rate for Payer: Aetna Commercial |
$160.99
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$153.84
|
| Rate for Payer: Aetna Managed Medicare |
$50.09
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$116.27
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$89.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$85.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$94.81
|
| Rate for Payer: Cash Price |
$51.60
|
| Rate for Payer: Cigna Commercial |
$164.57
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$100.10
|
| Rate for Payer: Health EOS Commercial |
$159.20
|
| Rate for Payer: HFN Commercial |
$164.57
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$134.16
|
| Rate for Payer: Multiplan Commercial |
$143.10
|
| Rate for Payer: NAPHCARE Commercial |
$107.33
|
| Rate for Payer: Preferred Network Access Commercial |
$164.57
|
| Rate for Payer: Quartz Beloit One Network |
$87.65
|
| Rate for Payer: Quartz Commercial |
$116.27
|
| Rate for Payer: Quartz Medicare Advantage |
$107.33
|
| Rate for Payer: The Alliance Commercial |
$89.44
|
| Rate for Payer: United Healthcare PPO |
$134.16
|
| Rate for Payer: WEA Trust Commercial |
$98.38
|
| Rate for Payer: WPS Commercial |
$132.49
|
|
|
Semen Analysis Complete
|
Facility
|
OP
|
$242.00
|
|
|
Service Code
|
CPT 89320
|
| Hospital Charge Code |
633831
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.80 |
| Max. Negotiated Rate |
$231.55 |
| Rate for Payer: Aetna Commercial |
$226.51
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$216.44
|
| Rate for Payer: Aetna Managed Medicare |
$12.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$48.01
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$22.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$21.25
|
| Rate for Payer: Anthem Medicare Advantage |
$12.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$133.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12.80
|
| Rate for Payer: Cash Price |
$72.60
|
| Rate for Payer: Cash Price |
$72.60
|
| Rate for Payer: Cigna Commercial |
$231.55
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$12.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$140.84
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$12.80
|
| Rate for Payer: Health EOS Commercial |
$224.00
|
| Rate for Payer: HFN Commercial |
$231.55
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$47.62
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$12.80
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12.80
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$12.80
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$12.80
|
| Rate for Payer: Multiplan Commercial |
$201.34
|
| Rate for Payer: NAPHCARE Commercial |
$19.20
|
| Rate for Payer: Preferred Network Access Commercial |
$231.55
|
| Rate for Payer: Quartz Beloit One Network |
$123.32
|
| Rate for Payer: Quartz Commercial |
$163.59
|
| Rate for Payer: Quartz Medicare Advantage |
$12.80
|
| Rate for Payer: The Alliance Commercial |
$51.21
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.80
|
| Rate for Payer: United Healthcare PPO |
$188.76
|
| Rate for Payer: WEA Trust Commercial |
$138.42
|
| Rate for Payer: Wellcare Medicare |
$12.80
|
| Rate for Payer: WPS Commercial |
$186.41
|
|
|
Semen Analysis Complete
|
Facility
|
IP
|
$242.00
|
|
|
Service Code
|
CPT 89320
|
| Hospital Charge Code |
633831
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$123.32 |
| Max. Negotiated Rate |
$231.55 |
| Rate for Payer: Aetna Commercial |
$226.51
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$216.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$133.39
|
| Rate for Payer: Cash Price |
$72.60
|
| Rate for Payer: Cigna Commercial |
$231.55
|
| Rate for Payer: Health EOS Commercial |
$224.00
|
| Rate for Payer: HFN Commercial |
$231.55
|
| Rate for Payer: Multiplan Commercial |
$201.34
|
| Rate for Payer: Preferred Network Access Commercial |
$231.55
|
| Rate for Payer: Quartz Beloit One Network |
$123.32
|
| Rate for Payer: Quartz Commercial |
$151.01
|
| Rate for Payer: WEA Trust Commercial |
$138.42
|
| Rate for Payer: WPS Commercial |
$186.41
|
|
|
Semen Analysis Complete
|
Professional
|
Both
|
$242.00
|
|
|
Service Code
|
CPT 89320
|
| Hospital Charge Code |
633831
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.80 |
| Max. Negotiated Rate |
$239.10 |
| Rate for Payer: Aetna Commercial |
$239.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$216.44
|
| Rate for Payer: Aetna Managed Medicare |
$12.80
|
| Rate for Payer: Anthem Medicare Advantage |
$12.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12.80
|
| Rate for Payer: Cash Price |
$72.60
|
| Rate for Payer: Cash Price |
$72.60
|
| Rate for Payer: Cigna Commercial |
$239.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$125.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12.80
|
| Rate for Payer: Health EOS Commercial |
$229.03
|
| Rate for Payer: HFN Commercial |
$239.10
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$45.19
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$45.19
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12.80
|
| Rate for Payer: Multiplan Commercial |
$201.34
|
| Rate for Payer: NAPHCARE Commercial |
$19.20
|
| Rate for Payer: Preferred Network Access Commercial |
$239.10
|
| Rate for Payer: Quartz Beloit One Network |
$110.74
|
| Rate for Payer: Quartz Commercial |
$143.46
|
| Rate for Payer: Quartz Medicare Advantage |
$12.80
|
| Rate for Payer: The Alliance Commercial |
$50.57
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.80
|
| Rate for Payer: WEA Trust Commercial |
$138.42
|
| Rate for Payer: WPS Commercial |
$56.33
|
|
|
Sensipar 30 mg per dose
|
Facility
|
OP
|
$2.00
|
|
|
Service Code
|
HCPCS J0604
|
| Hospital Charge Code |
5412996
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.58 |
| Max. Negotiated Rate |
$1.91 |
| Rate for Payer: Aetna Commercial |
$1.87
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1.79
|
| Rate for Payer: Aetna Managed Medicare |
$0.58
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1.10
|
| Rate for Payer: Cash Price |
$0.60
|
| Rate for Payer: Cigna Commercial |
$1.91
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1.16
|
| Rate for Payer: Health EOS Commercial |
$1.85
|
| Rate for Payer: HFN Commercial |
$1.91
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1.56
|
| Rate for Payer: Multiplan Commercial |
$1.66
|
| Rate for Payer: NAPHCARE Commercial |
$1.25
|
| Rate for Payer: Preferred Network Access Commercial |
$1.91
|
| Rate for Payer: Quartz Beloit One Network |
$1.02
|
| Rate for Payer: Quartz Commercial |
$1.35
|
| Rate for Payer: Quartz Medicare Advantage |
$1.25
|
| Rate for Payer: The Alliance Commercial |
$1.04
|
| Rate for Payer: WEA Trust Commercial |
$1.14
|
| Rate for Payer: WPS Commercial |
$1.54
|
|
|
Sensipar 30 mg per dose
|
Facility
|
IP
|
$2.00
|
|
|
Service Code
|
HCPCS J0604
|
| Hospital Charge Code |
5412996
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.02 |
| Max. Negotiated Rate |
$1.91 |
| Rate for Payer: Aetna Commercial |
$1.87
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1.79
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1.10
|
| Rate for Payer: Cash Price |
$0.60
|
| Rate for Payer: Cigna Commercial |
$1.91
|
| Rate for Payer: Health EOS Commercial |
$1.85
|
| Rate for Payer: HFN Commercial |
$1.91
|
| Rate for Payer: Multiplan Commercial |
$1.66
|
| Rate for Payer: Preferred Network Access Commercial |
$1.91
|
| Rate for Payer: Quartz Beloit One Network |
$1.02
|
| Rate for Payer: Quartz Commercial |
$1.25
|
| Rate for Payer: WEA Trust Commercial |
$1.14
|
| Rate for Payer: WPS Commercial |
$1.54
|
|
|
Sensipar 30 mg per tablet
|
Facility
|
OP
|
$2.00
|
|
|
Service Code
|
HCPCS J0604 AX
|
| Hospital Charge Code |
5412993
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.58 |
| Max. Negotiated Rate |
$1.91 |
| Rate for Payer: Aetna Commercial |
$1.87
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1.79
|
| Rate for Payer: Aetna Managed Medicare |
$0.58
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1.10
|
| Rate for Payer: Cash Price |
$0.60
|
| Rate for Payer: Cigna Commercial |
$1.91
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1.16
|
| Rate for Payer: Health EOS Commercial |
$1.85
|
| Rate for Payer: HFN Commercial |
$1.91
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1.56
|
| Rate for Payer: Multiplan Commercial |
$1.66
|
| Rate for Payer: NAPHCARE Commercial |
$1.25
|
| Rate for Payer: Preferred Network Access Commercial |
$1.91
|
| Rate for Payer: Quartz Beloit One Network |
$1.02
|
| Rate for Payer: Quartz Commercial |
$1.35
|
| Rate for Payer: Quartz Medicare Advantage |
$1.25
|
| Rate for Payer: The Alliance Commercial |
$1.04
|
| Rate for Payer: WEA Trust Commercial |
$1.14
|
| Rate for Payer: WPS Commercial |
$1.54
|
|
|
Sensipar 30 mg per tablet
|
Facility
|
IP
|
$2.00
|
|
|
Service Code
|
HCPCS J0604 AX
|
| Hospital Charge Code |
5412993
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.02 |
| Max. Negotiated Rate |
$1.91 |
| Rate for Payer: Aetna Commercial |
$1.87
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1.79
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1.10
|
| Rate for Payer: Cash Price |
$0.60
|
| Rate for Payer: Cigna Commercial |
$1.91
|
| Rate for Payer: Health EOS Commercial |
$1.85
|
| Rate for Payer: HFN Commercial |
$1.91
|
| Rate for Payer: Multiplan Commercial |
$1.66
|
| Rate for Payer: Preferred Network Access Commercial |
$1.91
|
| Rate for Payer: Quartz Beloit One Network |
$1.02
|
| Rate for Payer: Quartz Commercial |
$1.25
|
| Rate for Payer: WEA Trust Commercial |
$1.14
|
| Rate for Payer: WPS Commercial |
$1.54
|
|
|
Sensipar 60 mg per dose
|
Facility
|
OP
|
$2.00
|
|
|
Service Code
|
HCPCS J0604
|
| Hospital Charge Code |
5412997
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.58 |
| Max. Negotiated Rate |
$1.91 |
| Rate for Payer: Aetna Commercial |
$1.87
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1.79
|
| Rate for Payer: Aetna Managed Medicare |
$0.58
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1.10
|
| Rate for Payer: Cash Price |
$0.60
|
| Rate for Payer: Cigna Commercial |
$1.91
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1.16
|
| Rate for Payer: Health EOS Commercial |
$1.85
|
| Rate for Payer: HFN Commercial |
$1.91
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1.56
|
| Rate for Payer: Multiplan Commercial |
$1.66
|
| Rate for Payer: NAPHCARE Commercial |
$1.25
|
| Rate for Payer: Preferred Network Access Commercial |
$1.91
|
| Rate for Payer: Quartz Beloit One Network |
$1.02
|
| Rate for Payer: Quartz Commercial |
$1.35
|
| Rate for Payer: Quartz Medicare Advantage |
$1.25
|
| Rate for Payer: The Alliance Commercial |
$1.04
|
| Rate for Payer: WEA Trust Commercial |
$1.14
|
| Rate for Payer: WPS Commercial |
$1.54
|
|
|
Sensipar 60 mg per dose
|
Facility
|
IP
|
$2.00
|
|
|
Service Code
|
HCPCS J0604
|
| Hospital Charge Code |
5412997
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.02 |
| Max. Negotiated Rate |
$1.91 |
| Rate for Payer: Aetna Commercial |
$1.87
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1.79
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1.10
|
| Rate for Payer: Cash Price |
$0.60
|
| Rate for Payer: Cigna Commercial |
$1.91
|
| Rate for Payer: Health EOS Commercial |
$1.85
|
| Rate for Payer: HFN Commercial |
$1.91
|
| Rate for Payer: Multiplan Commercial |
$1.66
|
| Rate for Payer: Preferred Network Access Commercial |
$1.91
|
| Rate for Payer: Quartz Beloit One Network |
$1.02
|
| Rate for Payer: Quartz Commercial |
$1.25
|
| Rate for Payer: WEA Trust Commercial |
$1.14
|
| Rate for Payer: WPS Commercial |
$1.54
|
|
|
Sensipar 60 mg per tablet
|
Facility
|
OP
|
$2.00
|
|
|
Service Code
|
HCPCS J0604 AX
|
| Hospital Charge Code |
5412994
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.58 |
| Max. Negotiated Rate |
$1.91 |
| Rate for Payer: Aetna Commercial |
$1.87
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1.79
|
| Rate for Payer: Aetna Managed Medicare |
$0.58
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1.10
|
| Rate for Payer: Cash Price |
$0.60
|
| Rate for Payer: Cigna Commercial |
$1.91
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1.16
|
| Rate for Payer: Health EOS Commercial |
$1.85
|
| Rate for Payer: HFN Commercial |
$1.91
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1.56
|
| Rate for Payer: Multiplan Commercial |
$1.66
|
| Rate for Payer: NAPHCARE Commercial |
$1.25
|
| Rate for Payer: Preferred Network Access Commercial |
$1.91
|
| Rate for Payer: Quartz Beloit One Network |
$1.02
|
| Rate for Payer: Quartz Commercial |
$1.35
|
| Rate for Payer: Quartz Medicare Advantage |
$1.25
|
| Rate for Payer: The Alliance Commercial |
$1.04
|
| Rate for Payer: WEA Trust Commercial |
$1.14
|
| Rate for Payer: WPS Commercial |
$1.54
|
|
|
Sensipar 60 mg per tablet
|
Facility
|
IP
|
$2.00
|
|
|
Service Code
|
HCPCS J0604 AX
|
| Hospital Charge Code |
5412994
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.02 |
| Max. Negotiated Rate |
$1.91 |
| Rate for Payer: Aetna Commercial |
$1.87
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1.79
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1.10
|
| Rate for Payer: Cash Price |
$0.60
|
| Rate for Payer: Cigna Commercial |
$1.91
|
| Rate for Payer: Health EOS Commercial |
$1.85
|
| Rate for Payer: HFN Commercial |
$1.91
|
| Rate for Payer: Multiplan Commercial |
$1.66
|
| Rate for Payer: Preferred Network Access Commercial |
$1.91
|
| Rate for Payer: Quartz Beloit One Network |
$1.02
|
| Rate for Payer: Quartz Commercial |
$1.25
|
| Rate for Payer: WEA Trust Commercial |
$1.14
|
| Rate for Payer: WPS Commercial |
$1.54
|
|
|
Sensipar 90 mg per dose
|
Facility
|
IP
|
$2.00
|
|
|
Service Code
|
HCPCS J0604
|
| Hospital Charge Code |
5412998
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.02 |
| Max. Negotiated Rate |
$1.91 |
| Rate for Payer: Aetna Commercial |
$1.87
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1.79
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1.10
|
| Rate for Payer: Cash Price |
$0.60
|
| Rate for Payer: Cigna Commercial |
$1.91
|
| Rate for Payer: Health EOS Commercial |
$1.85
|
| Rate for Payer: HFN Commercial |
$1.91
|
| Rate for Payer: Multiplan Commercial |
$1.66
|
| Rate for Payer: Preferred Network Access Commercial |
$1.91
|
| Rate for Payer: Quartz Beloit One Network |
$1.02
|
| Rate for Payer: Quartz Commercial |
$1.25
|
| Rate for Payer: WEA Trust Commercial |
$1.14
|
| Rate for Payer: WPS Commercial |
$1.54
|
|
|
Sensipar 90 mg per dose
|
Facility
|
OP
|
$2.00
|
|
|
Service Code
|
HCPCS J0604
|
| Hospital Charge Code |
5412998
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.58 |
| Max. Negotiated Rate |
$1.91 |
| Rate for Payer: Aetna Commercial |
$1.87
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1.79
|
| Rate for Payer: Aetna Managed Medicare |
$0.58
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1.10
|
| Rate for Payer: Cash Price |
$0.60
|
| Rate for Payer: Cigna Commercial |
$1.91
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1.16
|
| Rate for Payer: Health EOS Commercial |
$1.85
|
| Rate for Payer: HFN Commercial |
$1.91
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1.56
|
| Rate for Payer: Multiplan Commercial |
$1.66
|
| Rate for Payer: NAPHCARE Commercial |
$1.25
|
| Rate for Payer: Preferred Network Access Commercial |
$1.91
|
| Rate for Payer: Quartz Beloit One Network |
$1.02
|
| Rate for Payer: Quartz Commercial |
$1.35
|
| Rate for Payer: Quartz Medicare Advantage |
$1.25
|
| Rate for Payer: The Alliance Commercial |
$1.04
|
| Rate for Payer: WEA Trust Commercial |
$1.14
|
| Rate for Payer: WPS Commercial |
$1.54
|
|
|
Sensipar 90 mg per tablet
|
Facility
|
IP
|
$2.00
|
|
|
Service Code
|
HCPCS J0604 AX
|
| Hospital Charge Code |
5412995
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.02 |
| Max. Negotiated Rate |
$1.91 |
| Rate for Payer: Aetna Commercial |
$1.87
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1.79
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1.10
|
| Rate for Payer: Cash Price |
$0.60
|
| Rate for Payer: Cigna Commercial |
$1.91
|
| Rate for Payer: Health EOS Commercial |
$1.85
|
| Rate for Payer: HFN Commercial |
$1.91
|
| Rate for Payer: Multiplan Commercial |
$1.66
|
| Rate for Payer: Preferred Network Access Commercial |
$1.91
|
| Rate for Payer: Quartz Beloit One Network |
$1.02
|
| Rate for Payer: Quartz Commercial |
$1.25
|
| Rate for Payer: WEA Trust Commercial |
$1.14
|
| Rate for Payer: WPS Commercial |
$1.54
|
|
|
Sensipar 90 mg per tablet
|
Facility
|
OP
|
$2.00
|
|
|
Service Code
|
HCPCS J0604 AX
|
| Hospital Charge Code |
5412995
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.58 |
| Max. Negotiated Rate |
$1.91 |
| Rate for Payer: Aetna Commercial |
$1.87
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1.79
|
| Rate for Payer: Aetna Managed Medicare |
$0.58
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1.10
|
| Rate for Payer: Cash Price |
$0.60
|
| Rate for Payer: Cigna Commercial |
$1.91
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1.16
|
| Rate for Payer: Health EOS Commercial |
$1.85
|
| Rate for Payer: HFN Commercial |
$1.91
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1.56
|
| Rate for Payer: Multiplan Commercial |
$1.66
|
| Rate for Payer: NAPHCARE Commercial |
$1.25
|
| Rate for Payer: Preferred Network Access Commercial |
$1.91
|
| Rate for Payer: Quartz Beloit One Network |
$1.02
|
| Rate for Payer: Quartz Commercial |
$1.35
|
| Rate for Payer: Quartz Medicare Advantage |
$1.25
|
| Rate for Payer: The Alliance Commercial |
$1.04
|
| Rate for Payer: WEA Trust Commercial |
$1.14
|
| Rate for Payer: WPS Commercial |
$1.54
|
|
|
SENSOR ADLT DISPOSABLE NELLCOR
|
Facility
|
OP
|
$346.00
|
|
| Hospital Charge Code |
2969074
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$100.76 |
| Max. Negotiated Rate |
$331.05 |
| Rate for Payer: Aetna Commercial |
$323.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$309.46
|
| Rate for Payer: Aetna Managed Medicare |
$100.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$233.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$179.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$172.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$190.72
|
| Rate for Payer: Cash Price |
$103.80
|
| Rate for Payer: Cigna Commercial |
$331.05
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$201.37
|
| Rate for Payer: Health EOS Commercial |
$320.26
|
| Rate for Payer: HFN Commercial |
$331.05
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$269.88
|
| Rate for Payer: Multiplan Commercial |
$287.87
|
| Rate for Payer: NAPHCARE Commercial |
$215.90
|
| Rate for Payer: Preferred Network Access Commercial |
$331.05
|
| Rate for Payer: Quartz Beloit One Network |
$176.32
|
| Rate for Payer: Quartz Commercial |
$233.90
|
| Rate for Payer: Quartz Medicare Advantage |
$215.90
|
| Rate for Payer: The Alliance Commercial |
$179.92
|
| Rate for Payer: WEA Trust Commercial |
$197.91
|
| Rate for Payer: WPS Commercial |
$266.52
|
|
