|
CHRONIC OBSTRUCTIVE PULMONARY DISEASE
|
Facility
|
IP
|
$5,787.08
|
|
|
Service Code
|
APR-DRG 1402
|
| Min. Negotiated Rate |
$5,140.45 |
| Max. Negotiated Rate |
$5,787.08 |
| Rate for Payer: Anthem Medicaid |
$5,541.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$5,541.45
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$5,541.45
|
| Rate for Payer: Dean Health Medicaid |
$5,541.45
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$5,140.45
|
| Rate for Payer: Managed Health Services Medicaid |
$5,787.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,541.45
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$5,541.45
|
| Rate for Payer: United Healthcare Medicaid |
$5,541.45
|
|
|
CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITH CC
|
Facility
|
IP
|
$23,807.68
|
|
|
Service Code
|
MSDRG 191
|
| Min. Negotiated Rate |
$6,962.63 |
| Max. Negotiated Rate |
$23,807.68 |
| Rate for Payer: Aetna Managed Medicare |
$6,962.63
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$18,393.59
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$14,098.53
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$13,394.53
|
| Rate for Payer: Anthem Medicare Advantage |
$6,962.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$6,962.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$6,962.63
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$6,962.63
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$14,869.15
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$6,962.63
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$17,217.72
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$6,962.63
|
| Rate for Payer: Independent Care Health Plan Medicare |
$6,962.63
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$6,962.63
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$6,962.63
|
| Rate for Payer: NAPHCARE Commercial |
$10,443.95
|
| Rate for Payer: Quartz Medicare Advantage |
$6,962.63
|
| Rate for Payer: The Alliance Commercial |
$23,807.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,962.63
|
| Rate for Payer: United Healthcare PPO |
$13,404.22
|
| Rate for Payer: Wellcare Medicare |
$6,962.63
|
|
|
CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITH MCC
|
Facility
|
IP
|
$30,802.72
|
|
|
Service Code
|
MSDRG 190
|
| Min. Negotiated Rate |
$8,989.76 |
| Max. Negotiated Rate |
$30,802.72 |
| Rate for Payer: Aetna Managed Medicare |
$8,989.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$24,169.13
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$18,525.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$17,600.38
|
| Rate for Payer: Anthem Medicare Advantage |
$8,989.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$8,989.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$8,989.76
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$8,989.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$19,538.03
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$8,989.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$22,348.56
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$8,989.76
|
| Rate for Payer: Independent Care Health Plan Medicare |
$8,989.76
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$8,989.76
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$8,989.76
|
| Rate for Payer: NAPHCARE Commercial |
$13,484.64
|
| Rate for Payer: Quartz Medicare Advantage |
$8,989.76
|
| Rate for Payer: The Alliance Commercial |
$30,802.72
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8,989.76
|
| Rate for Payer: United Healthcare PPO |
$17,398.64
|
| Rate for Payer: Wellcare Medicare |
$8,989.76
|
|
|
CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITHOUT CC/MCC
|
Facility
|
IP
|
$18,078.32
|
|
|
Service Code
|
MSDRG 192
|
| Min. Negotiated Rate |
$5,423.35 |
| Max. Negotiated Rate |
$18,078.32 |
| Rate for Payer: Aetna Managed Medicare |
$5,423.35
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$14,007.93
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$10,736.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$10,200.82
|
| Rate for Payer: Anthem Medicare Advantage |
$5,423.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5,423.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5,423.35
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$5,423.35
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$11,323.84
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$5,423.35
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$13,015.70
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$5,423.35
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5,423.35
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$5,423.35
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$5,423.35
|
| Rate for Payer: NAPHCARE Commercial |
$8,135.03
|
| Rate for Payer: Quartz Medicare Advantage |
$5,423.35
|
| Rate for Payer: The Alliance Commercial |
$18,078.32
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5,423.35
|
| Rate for Payer: United Healthcare PPO |
$10,132.90
|
| Rate for Payer: Wellcare Medicare |
$5,423.35
|
|
|
CHRONOS PHOSPHATE GRANULES 710.019.97S
|
Facility
|
IP
|
$6,765.00
|
|
| Hospital Charge Code |
2966161
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,447.44 |
| Max. Negotiated Rate |
$6,472.75 |
| Rate for Payer: Aetna Commercial |
$6,332.04
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,050.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,728.87
|
| Rate for Payer: Cash Price |
$2,029.50
|
| Rate for Payer: Cigna Commercial |
$6,472.75
|
| Rate for Payer: Health EOS Commercial |
$6,261.68
|
| Rate for Payer: HFN Commercial |
$6,472.75
|
| Rate for Payer: Multiplan Commercial |
$5,628.48
|
| Rate for Payer: Preferred Network Access Commercial |
$6,472.75
|
| Rate for Payer: Quartz Beloit One Network |
$3,447.44
|
| Rate for Payer: Quartz Commercial |
$4,221.36
|
| Rate for Payer: WEA Trust Commercial |
$3,869.58
|
| Rate for Payer: WPS Commercial |
$5,211.08
|
|
|
CHRONOS PHOSPHATE GRANULES 710.019.97S
|
Facility
|
OP
|
$6,765.00
|
|
| Hospital Charge Code |
2966161
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,969.97 |
| Max. Negotiated Rate |
$6,472.75 |
| Rate for Payer: Aetna Commercial |
$6,332.04
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,050.62
|
| Rate for Payer: Aetna Managed Medicare |
$1,969.97
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,573.14
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,517.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,377.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,728.87
|
| Rate for Payer: Cash Price |
$2,029.50
|
| Rate for Payer: Cigna Commercial |
$6,472.75
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,937.23
|
| Rate for Payer: Health EOS Commercial |
$6,261.68
|
| Rate for Payer: HFN Commercial |
$6,472.75
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,276.70
|
| Rate for Payer: Multiplan Commercial |
$5,628.48
|
| Rate for Payer: NAPHCARE Commercial |
$4,221.36
|
| Rate for Payer: Preferred Network Access Commercial |
$6,472.75
|
| Rate for Payer: Quartz Beloit One Network |
$3,447.44
|
| Rate for Payer: Quartz Commercial |
$4,573.14
|
| Rate for Payer: Quartz Medicare Advantage |
$4,221.36
|
| Rate for Payer: The Alliance Commercial |
$3,517.80
|
| Rate for Payer: WEA Trust Commercial |
$3,869.58
|
| Rate for Payer: WPS Commercial |
$5,211.08
|
|
|
Chux
|
Facility
|
OP
|
$1.00
|
|
| Hospital Charge Code |
3040325
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$0.29 |
| Max. Negotiated Rate |
$0.96 |
| Rate for Payer: Aetna Commercial |
$0.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$0.89
|
| Rate for Payer: Aetna Managed Medicare |
$0.29
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$0.68
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$0.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$0.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$0.55
|
| Rate for Payer: Cash Price |
$0.30
|
| Rate for Payer: Cigna Commercial |
$0.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$0.58
|
| Rate for Payer: Health EOS Commercial |
$0.93
|
| Rate for Payer: HFN Commercial |
$0.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$0.78
|
| Rate for Payer: Multiplan Commercial |
$0.83
|
| Rate for Payer: NAPHCARE Commercial |
$0.62
|
| Rate for Payer: Preferred Network Access Commercial |
$0.96
|
| Rate for Payer: Quartz Beloit One Network |
$0.51
|
| Rate for Payer: Quartz Commercial |
$0.68
|
| Rate for Payer: Quartz Medicare Advantage |
$0.62
|
| Rate for Payer: The Alliance Commercial |
$0.52
|
| Rate for Payer: WEA Trust Commercial |
$0.57
|
| Rate for Payer: WPS Commercial |
$0.77
|
|
|
Chux
|
Facility
|
IP
|
$1.00
|
|
| Hospital Charge Code |
3040325
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$0.51 |
| Max. Negotiated Rate |
$0.96 |
| Rate for Payer: Aetna Commercial |
$0.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$0.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$0.55
|
| Rate for Payer: Cash Price |
$0.30
|
| Rate for Payer: Cigna Commercial |
$0.96
|
| Rate for Payer: Health EOS Commercial |
$0.93
|
| Rate for Payer: HFN Commercial |
$0.96
|
| Rate for Payer: Multiplan Commercial |
$0.83
|
| Rate for Payer: Preferred Network Access Commercial |
$0.96
|
| Rate for Payer: Quartz Beloit One Network |
$0.51
|
| Rate for Payer: Quartz Commercial |
$0.62
|
| Rate for Payer: WEA Trust Commercial |
$0.57
|
| Rate for Payer: WPS Commercial |
$0.77
|
|
|
Chymotrypsin Spectrophotometry
|
Professional
|
Both
|
$118.00
|
|
|
Service Code
|
CPT 84311
|
| Hospital Charge Code |
2794800
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.42 |
| Max. Negotiated Rate |
$116.58 |
| Rate for Payer: Aetna Commercial |
$116.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$105.54
|
| Rate for Payer: Aetna Managed Medicare |
$8.42
|
| Rate for Payer: Anthem Medicare Advantage |
$8.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$8.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$8.42
|
| Rate for Payer: Cash Price |
$35.40
|
| Rate for Payer: Cash Price |
$35.40
|
| Rate for Payer: Cigna Commercial |
$116.58
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$61.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$8.42
|
| Rate for Payer: Health EOS Commercial |
$111.68
|
| Rate for Payer: HFN Commercial |
$116.58
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$29.73
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$29.73
|
| Rate for Payer: Independent Care Health Plan Medicare |
$8.42
|
| Rate for Payer: Multiplan Commercial |
$98.18
|
| Rate for Payer: NAPHCARE Commercial |
$12.64
|
| Rate for Payer: Preferred Network Access Commercial |
$116.58
|
| Rate for Payer: Quartz Beloit One Network |
$54.00
|
| Rate for Payer: Quartz Commercial |
$69.95
|
| Rate for Payer: Quartz Medicare Advantage |
$8.42
|
| Rate for Payer: The Alliance Commercial |
$33.27
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8.42
|
| Rate for Payer: WEA Trust Commercial |
$67.50
|
| Rate for Payer: WPS Commercial |
$37.07
|
|
|
Chymotrypsin Spectrophotometry
|
Facility
|
OP
|
$118.00
|
|
|
Service Code
|
CPT 84311
|
| Hospital Charge Code |
2794800
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.42 |
| Max. Negotiated Rate |
$112.90 |
| Rate for Payer: Aetna Commercial |
$110.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$105.54
|
| Rate for Payer: Aetna Managed Medicare |
$8.42
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$31.59
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$14.74
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$13.98
|
| Rate for Payer: Anthem Medicare Advantage |
$8.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$65.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$8.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$8.42
|
| Rate for Payer: Cash Price |
$35.40
|
| Rate for Payer: Cash Price |
$35.40
|
| Rate for Payer: Cigna Commercial |
$112.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$8.42
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$68.68
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$8.42
|
| Rate for Payer: Health EOS Commercial |
$109.22
|
| Rate for Payer: HFN Commercial |
$112.90
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$31.34
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$8.42
|
| Rate for Payer: Independent Care Health Plan Medicare |
$8.42
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$8.42
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$8.42
|
| Rate for Payer: Multiplan Commercial |
$98.18
|
| Rate for Payer: NAPHCARE Commercial |
$12.64
|
| Rate for Payer: Preferred Network Access Commercial |
$112.90
|
| Rate for Payer: Quartz Beloit One Network |
$60.13
|
| Rate for Payer: Quartz Commercial |
$79.77
|
| Rate for Payer: Quartz Medicare Advantage |
$8.42
|
| Rate for Payer: The Alliance Commercial |
$33.70
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8.42
|
| Rate for Payer: United Healthcare PPO |
$92.04
|
| Rate for Payer: WEA Trust Commercial |
$67.50
|
| Rate for Payer: Wellcare Medicare |
$8.42
|
| Rate for Payer: WPS Commercial |
$90.90
|
|
|
Chymotrypsin Spectrophotometry
|
Facility
|
IP
|
$118.00
|
|
|
Service Code
|
CPT 84311
|
| Hospital Charge Code |
2794800
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$60.13 |
| Max. Negotiated Rate |
$112.90 |
| Rate for Payer: Aetna Commercial |
$110.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$105.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$65.04
|
| Rate for Payer: Cash Price |
$35.40
|
| Rate for Payer: Cigna Commercial |
$112.90
|
| Rate for Payer: Health EOS Commercial |
$109.22
|
| Rate for Payer: HFN Commercial |
$112.90
|
| Rate for Payer: Multiplan Commercial |
$98.18
|
| Rate for Payer: Preferred Network Access Commercial |
$112.90
|
| Rate for Payer: Quartz Beloit One Network |
$60.13
|
| Rate for Payer: Quartz Commercial |
$73.63
|
| Rate for Payer: WEA Trust Commercial |
$67.50
|
| Rate for Payer: WPS Commercial |
$90.90
|
|
|
CILIARY BODY DESTRUCTION; CYCLOPHOTOCOAGULATION, TRANSSCLERAL
|
Facility
|
OP
|
$10,008.17
|
|
|
Service Code
|
CPT 66710
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,502.04 |
| Max. Negotiated Rate |
$10,008.17 |
| Rate for Payer: Aetna Managed Medicare |
$2,502.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,635.84
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,985.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,835.04
|
| Rate for Payer: Anthem Medicare Advantage |
$2,502.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$2,502.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$2,502.04
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$2,502.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,947.89
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$2,502.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$9,307.60
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$2,502.04
|
| Rate for Payer: Independent Care Health Plan Medicare |
$2,502.04
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$2,502.04
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$2,502.04
|
| Rate for Payer: NAPHCARE Commercial |
$3,753.06
|
| Rate for Payer: Quartz Medicare Advantage |
$2,502.04
|
| Rate for Payer: The Alliance Commercial |
$10,008.17
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,502.04
|
| Rate for Payer: United Healthcare PPO |
$3,726.32
|
| Rate for Payer: Wellcare Medicare |
$2,502.04
|
|
|
CILIARY BODY DSTRJ CYCLOPHOTOCOAG TRANSSCERAL, LASER 66710
|
Professional
|
Both
|
$4,997.00
|
|
|
Service Code
|
CPT 66710
|
| Hospital Charge Code |
6178388
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$332.38 |
| Max. Negotiated Rate |
$4,937.04 |
| Rate for Payer: Aetna Commercial |
$4,937.04
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,469.32
|
| Rate for Payer: Aetna Managed Medicare |
$332.38
|
| Rate for Payer: Anthem Medicare Advantage |
$332.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$332.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$332.38
|
| Rate for Payer: Cash Price |
$1,499.10
|
| Rate for Payer: Cash Price |
$1,499.10
|
| Rate for Payer: Cash Price |
$1,499.10
|
| Rate for Payer: Cigna Commercial |
$4,937.04
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$511.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$332.38
|
| Rate for Payer: Health EOS Commercial |
$4,729.16
|
| Rate for Payer: HFN Commercial |
$4,937.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,368.30
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,368.30
|
| Rate for Payer: Independent Care Health Plan Medicare |
$332.38
|
| Rate for Payer: Multiplan Commercial |
$4,157.50
|
| Rate for Payer: NAPHCARE Commercial |
$498.58
|
| Rate for Payer: Preferred Network Access Commercial |
$4,937.04
|
| Rate for Payer: Quartz Beloit One Network |
$2,286.63
|
| Rate for Payer: Quartz Commercial |
$2,962.22
|
| Rate for Payer: Quartz Medicare Advantage |
$332.38
|
| Rate for Payer: The Alliance Commercial |
$1,412.63
|
| Rate for Payer: United Healthcare Medicaid |
$511.92
|
| Rate for Payer: United Healthcare Medicare Advantage |
$332.38
|
| Rate for Payer: WEA Trust Commercial |
$2,858.28
|
| Rate for Payer: WPS Commercial |
$1,495.73
|
|
|
CIMINO SHUNT CREATION
|
Facility
|
OP
|
$12,095.00
|
|
| Hospital Charge Code |
2959930
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,522.06 |
| Max. Negotiated Rate |
$11,572.50 |
| Rate for Payer: Aetna Commercial |
$11,320.92
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,817.77
|
| Rate for Payer: Aetna Managed Medicare |
$3,522.06
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$8,176.22
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$6,289.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$6,037.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,666.76
|
| Rate for Payer: Cash Price |
$3,628.50
|
| Rate for Payer: Cigna Commercial |
$11,572.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$7,039.29
|
| Rate for Payer: Health EOS Commercial |
$11,195.13
|
| Rate for Payer: HFN Commercial |
$11,572.50
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$9,434.10
|
| Rate for Payer: Multiplan Commercial |
$10,063.04
|
| Rate for Payer: NAPHCARE Commercial |
$7,547.28
|
| Rate for Payer: Preferred Network Access Commercial |
$11,572.50
|
| Rate for Payer: Quartz Beloit One Network |
$6,163.61
|
| Rate for Payer: Quartz Commercial |
$8,176.22
|
| Rate for Payer: Quartz Medicare Advantage |
$7,547.28
|
| Rate for Payer: The Alliance Commercial |
$6,289.40
|
| Rate for Payer: WEA Trust Commercial |
$6,918.34
|
| Rate for Payer: WPS Commercial |
$9,316.78
|
|
|
CIMINO SHUNT CREATION
|
Facility
|
IP
|
$12,095.00
|
|
| Hospital Charge Code |
2959930
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$6,163.61 |
| Max. Negotiated Rate |
$11,572.50 |
| Rate for Payer: Aetna Commercial |
$11,320.92
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,817.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,666.76
|
| Rate for Payer: Cash Price |
$3,628.50
|
| Rate for Payer: Cigna Commercial |
$11,572.50
|
| Rate for Payer: Health EOS Commercial |
$11,195.13
|
| Rate for Payer: HFN Commercial |
$11,572.50
|
| Rate for Payer: Multiplan Commercial |
$10,063.04
|
| Rate for Payer: Preferred Network Access Commercial |
$11,572.50
|
| Rate for Payer: Quartz Beloit One Network |
$6,163.61
|
| Rate for Payer: Quartz Commercial |
$7,547.28
|
| Rate for Payer: WEA Trust Commercial |
$6,918.34
|
| Rate for Payer: WPS Commercial |
$9,316.78
|
|
|
Cinacalcet 30 mg per dose
|
Facility
|
IP
|
$1.00
|
|
|
Service Code
|
HCPCS J0604
|
| Hospital Charge Code |
5551800
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.51 |
| Max. Negotiated Rate |
$0.96 |
| Rate for Payer: Aetna Commercial |
$0.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$0.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$0.55
|
| Rate for Payer: Cash Price |
$0.30
|
| Rate for Payer: Cigna Commercial |
$0.96
|
| Rate for Payer: Health EOS Commercial |
$0.93
|
| Rate for Payer: HFN Commercial |
$0.96
|
| Rate for Payer: Multiplan Commercial |
$0.83
|
| Rate for Payer: Preferred Network Access Commercial |
$0.96
|
| Rate for Payer: Quartz Beloit One Network |
$0.51
|
| Rate for Payer: Quartz Commercial |
$0.62
|
| Rate for Payer: WEA Trust Commercial |
$0.57
|
| Rate for Payer: WPS Commercial |
$0.77
|
|
|
Cinacalcet 30 mg per dose
|
Facility
|
OP
|
$1.00
|
|
|
Service Code
|
HCPCS J0604
|
| Hospital Charge Code |
5551800
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.29 |
| Max. Negotiated Rate |
$0.96 |
| Rate for Payer: Aetna Commercial |
$0.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$0.89
|
| Rate for Payer: Aetna Managed Medicare |
$0.29
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$0.68
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$0.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$0.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$0.55
|
| Rate for Payer: Cash Price |
$0.30
|
| Rate for Payer: Cigna Commercial |
$0.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$0.58
|
| Rate for Payer: Health EOS Commercial |
$0.93
|
| Rate for Payer: HFN Commercial |
$0.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$0.78
|
| Rate for Payer: Multiplan Commercial |
$0.83
|
| Rate for Payer: NAPHCARE Commercial |
$0.62
|
| Rate for Payer: Preferred Network Access Commercial |
$0.96
|
| Rate for Payer: Quartz Beloit One Network |
$0.51
|
| Rate for Payer: Quartz Commercial |
$0.68
|
| Rate for Payer: Quartz Medicare Advantage |
$0.62
|
| Rate for Payer: The Alliance Commercial |
$0.52
|
| Rate for Payer: WEA Trust Commercial |
$0.57
|
| Rate for Payer: WPS Commercial |
$0.77
|
|
|
Cinacalcet 30 mg per tablet
|
Facility
|
IP
|
$1.00
|
|
|
Service Code
|
HCPCS J0604 AX
|
| Hospital Charge Code |
5551797
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.51 |
| Max. Negotiated Rate |
$0.96 |
| Rate for Payer: Aetna Commercial |
$0.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$0.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$0.55
|
| Rate for Payer: Cash Price |
$0.30
|
| Rate for Payer: Cigna Commercial |
$0.96
|
| Rate for Payer: Health EOS Commercial |
$0.93
|
| Rate for Payer: HFN Commercial |
$0.96
|
| Rate for Payer: Multiplan Commercial |
$0.83
|
| Rate for Payer: Preferred Network Access Commercial |
$0.96
|
| Rate for Payer: Quartz Beloit One Network |
$0.51
|
| Rate for Payer: Quartz Commercial |
$0.62
|
| Rate for Payer: WEA Trust Commercial |
$0.57
|
| Rate for Payer: WPS Commercial |
$0.77
|
|
|
Cinacalcet 30 mg per tablet
|
Facility
|
OP
|
$1.00
|
|
|
Service Code
|
HCPCS J0604 AX
|
| Hospital Charge Code |
5551797
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.29 |
| Max. Negotiated Rate |
$0.96 |
| Rate for Payer: Aetna Commercial |
$0.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$0.89
|
| Rate for Payer: Aetna Managed Medicare |
$0.29
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$0.68
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$0.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$0.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$0.55
|
| Rate for Payer: Cash Price |
$0.30
|
| Rate for Payer: Cigna Commercial |
$0.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$0.58
|
| Rate for Payer: Health EOS Commercial |
$0.93
|
| Rate for Payer: HFN Commercial |
$0.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$0.78
|
| Rate for Payer: Multiplan Commercial |
$0.83
|
| Rate for Payer: NAPHCARE Commercial |
$0.62
|
| Rate for Payer: Preferred Network Access Commercial |
$0.96
|
| Rate for Payer: Quartz Beloit One Network |
$0.51
|
| Rate for Payer: Quartz Commercial |
$0.68
|
| Rate for Payer: Quartz Medicare Advantage |
$0.62
|
| Rate for Payer: The Alliance Commercial |
$0.52
|
| Rate for Payer: WEA Trust Commercial |
$0.57
|
| Rate for Payer: WPS Commercial |
$0.77
|
|
|
Cinacalcet 60 mg per dose
|
Facility
|
IP
|
$1.00
|
|
|
Service Code
|
HCPCS J0604
|
| Hospital Charge Code |
5551801
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.51 |
| Max. Negotiated Rate |
$0.96 |
| Rate for Payer: Aetna Commercial |
$0.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$0.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$0.55
|
| Rate for Payer: Cash Price |
$0.30
|
| Rate for Payer: Cigna Commercial |
$0.96
|
| Rate for Payer: Health EOS Commercial |
$0.93
|
| Rate for Payer: HFN Commercial |
$0.96
|
| Rate for Payer: Multiplan Commercial |
$0.83
|
| Rate for Payer: Preferred Network Access Commercial |
$0.96
|
| Rate for Payer: Quartz Beloit One Network |
$0.51
|
| Rate for Payer: Quartz Commercial |
$0.62
|
| Rate for Payer: WEA Trust Commercial |
$0.57
|
| Rate for Payer: WPS Commercial |
$0.77
|
|
|
Cinacalcet 60 mg per dose
|
Facility
|
OP
|
$1.00
|
|
|
Service Code
|
HCPCS J0604
|
| Hospital Charge Code |
5551801
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.29 |
| Max. Negotiated Rate |
$0.96 |
| Rate for Payer: Aetna Commercial |
$0.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$0.89
|
| Rate for Payer: Aetna Managed Medicare |
$0.29
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$0.68
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$0.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$0.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$0.55
|
| Rate for Payer: Cash Price |
$0.30
|
| Rate for Payer: Cigna Commercial |
$0.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$0.58
|
| Rate for Payer: Health EOS Commercial |
$0.93
|
| Rate for Payer: HFN Commercial |
$0.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$0.78
|
| Rate for Payer: Multiplan Commercial |
$0.83
|
| Rate for Payer: NAPHCARE Commercial |
$0.62
|
| Rate for Payer: Preferred Network Access Commercial |
$0.96
|
| Rate for Payer: Quartz Beloit One Network |
$0.51
|
| Rate for Payer: Quartz Commercial |
$0.68
|
| Rate for Payer: Quartz Medicare Advantage |
$0.62
|
| Rate for Payer: The Alliance Commercial |
$0.52
|
| Rate for Payer: WEA Trust Commercial |
$0.57
|
| Rate for Payer: WPS Commercial |
$0.77
|
|
|
Cinacalcet 60 mg per tablet
|
Facility
|
OP
|
$1.00
|
|
|
Service Code
|
HCPCS J0604 AX
|
| Hospital Charge Code |
5551798
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.29 |
| Max. Negotiated Rate |
$0.96 |
| Rate for Payer: Aetna Commercial |
$0.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$0.89
|
| Rate for Payer: Aetna Managed Medicare |
$0.29
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$0.68
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$0.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$0.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$0.55
|
| Rate for Payer: Cash Price |
$0.30
|
| Rate for Payer: Cigna Commercial |
$0.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$0.58
|
| Rate for Payer: Health EOS Commercial |
$0.93
|
| Rate for Payer: HFN Commercial |
$0.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$0.78
|
| Rate for Payer: Multiplan Commercial |
$0.83
|
| Rate for Payer: NAPHCARE Commercial |
$0.62
|
| Rate for Payer: Preferred Network Access Commercial |
$0.96
|
| Rate for Payer: Quartz Beloit One Network |
$0.51
|
| Rate for Payer: Quartz Commercial |
$0.68
|
| Rate for Payer: Quartz Medicare Advantage |
$0.62
|
| Rate for Payer: The Alliance Commercial |
$0.52
|
| Rate for Payer: WEA Trust Commercial |
$0.57
|
| Rate for Payer: WPS Commercial |
$0.77
|
|
|
Cinacalcet 60 mg per tablet
|
Facility
|
IP
|
$1.00
|
|
|
Service Code
|
HCPCS J0604 AX
|
| Hospital Charge Code |
5551798
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.51 |
| Max. Negotiated Rate |
$0.96 |
| Rate for Payer: Aetna Commercial |
$0.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$0.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$0.55
|
| Rate for Payer: Cash Price |
$0.30
|
| Rate for Payer: Cigna Commercial |
$0.96
|
| Rate for Payer: Health EOS Commercial |
$0.93
|
| Rate for Payer: HFN Commercial |
$0.96
|
| Rate for Payer: Multiplan Commercial |
$0.83
|
| Rate for Payer: Preferred Network Access Commercial |
$0.96
|
| Rate for Payer: Quartz Beloit One Network |
$0.51
|
| Rate for Payer: Quartz Commercial |
$0.62
|
| Rate for Payer: WEA Trust Commercial |
$0.57
|
| Rate for Payer: WPS Commercial |
$0.77
|
|
|
Cinacalcet 90 mg per dose
|
Facility
|
IP
|
$1.00
|
|
|
Service Code
|
HCPCS J0604
|
| Hospital Charge Code |
5551802
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.51 |
| Max. Negotiated Rate |
$0.96 |
| Rate for Payer: Aetna Commercial |
$0.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$0.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$0.55
|
| Rate for Payer: Cash Price |
$0.30
|
| Rate for Payer: Cigna Commercial |
$0.96
|
| Rate for Payer: Health EOS Commercial |
$0.93
|
| Rate for Payer: HFN Commercial |
$0.96
|
| Rate for Payer: Multiplan Commercial |
$0.83
|
| Rate for Payer: Preferred Network Access Commercial |
$0.96
|
| Rate for Payer: Quartz Beloit One Network |
$0.51
|
| Rate for Payer: Quartz Commercial |
$0.62
|
| Rate for Payer: WEA Trust Commercial |
$0.57
|
| Rate for Payer: WPS Commercial |
$0.77
|
|
|
Cinacalcet 90 mg per dose
|
Facility
|
OP
|
$1.00
|
|
|
Service Code
|
HCPCS J0604
|
| Hospital Charge Code |
5551802
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.29 |
| Max. Negotiated Rate |
$0.96 |
| Rate for Payer: Aetna Commercial |
$0.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$0.89
|
| Rate for Payer: Aetna Managed Medicare |
$0.29
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$0.68
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$0.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$0.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$0.55
|
| Rate for Payer: Cash Price |
$0.30
|
| Rate for Payer: Cigna Commercial |
$0.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$0.58
|
| Rate for Payer: Health EOS Commercial |
$0.93
|
| Rate for Payer: HFN Commercial |
$0.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$0.78
|
| Rate for Payer: Multiplan Commercial |
$0.83
|
| Rate for Payer: NAPHCARE Commercial |
$0.62
|
| Rate for Payer: Preferred Network Access Commercial |
$0.96
|
| Rate for Payer: Quartz Beloit One Network |
$0.51
|
| Rate for Payer: Quartz Commercial |
$0.68
|
| Rate for Payer: Quartz Medicare Advantage |
$0.62
|
| Rate for Payer: The Alliance Commercial |
$0.52
|
| Rate for Payer: WEA Trust Commercial |
$0.57
|
| Rate for Payer: WPS Commercial |
$0.77
|
|
