|
Cinacalcet 90 mg per tablet
|
Facility
|
OP
|
$1.00
|
|
|
Service Code
|
HCPCS J0604 AX
|
| Hospital Charge Code |
5551799
|
|
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 90 mg per tablet
|
Facility
|
IP
|
$1.00
|
|
|
Service Code
|
HCPCS J0604 AX
|
| Hospital Charge Code |
5551799
|
|
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
|
|
|
Ciprodex Otic Suspension [Med]
|
Facility
|
IP
|
$578.00
|
|
| Hospital Charge Code |
2974921
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$294.55 |
| Max. Negotiated Rate |
$553.03 |
| Rate for Payer: Aetna Commercial |
$541.01
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$516.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$318.59
|
| Rate for Payer: Cash Price |
$173.40
|
| Rate for Payer: Cigna Commercial |
$553.03
|
| Rate for Payer: Health EOS Commercial |
$535.00
|
| Rate for Payer: HFN Commercial |
$553.03
|
| Rate for Payer: Multiplan Commercial |
$480.90
|
| Rate for Payer: Preferred Network Access Commercial |
$553.03
|
| Rate for Payer: Quartz Beloit One Network |
$294.55
|
| Rate for Payer: Quartz Commercial |
$360.67
|
| Rate for Payer: WEA Trust Commercial |
$330.62
|
| Rate for Payer: WPS Commercial |
$445.23
|
|
|
Ciprodex Otic Suspension [Med]
|
Facility
|
OP
|
$578.00
|
|
| Hospital Charge Code |
2974921
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$168.31 |
| Max. Negotiated Rate |
$553.03 |
| Rate for Payer: Aetna Commercial |
$541.01
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$516.96
|
| Rate for Payer: Aetna Managed Medicare |
$168.31
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$390.73
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$300.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$288.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$318.59
|
| Rate for Payer: Cash Price |
$173.40
|
| Rate for Payer: Cigna Commercial |
$553.03
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$336.40
|
| Rate for Payer: Health EOS Commercial |
$535.00
|
| Rate for Payer: HFN Commercial |
$553.03
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$450.84
|
| Rate for Payer: Multiplan Commercial |
$480.90
|
| Rate for Payer: NAPHCARE Commercial |
$360.67
|
| Rate for Payer: Preferred Network Access Commercial |
$553.03
|
| Rate for Payer: Quartz Beloit One Network |
$294.55
|
| Rate for Payer: Quartz Commercial |
$390.73
|
| Rate for Payer: Quartz Medicare Advantage |
$360.67
|
| Rate for Payer: The Alliance Commercial |
$300.56
|
| Rate for Payer: WEA Trust Commercial |
$330.62
|
| Rate for Payer: WPS Commercial |
$445.23
|
|
|
Ciprofloxacin 0.3% Ophth Ointment 3.5 gm [Med]
|
Facility
|
IP
|
$589.00
|
|
| Hospital Charge Code |
2974922
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$300.15 |
| Max. Negotiated Rate |
$563.56 |
| Rate for Payer: Aetna Commercial |
$551.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$526.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$324.66
|
| Rate for Payer: Cash Price |
$176.70
|
| Rate for Payer: Cigna Commercial |
$563.56
|
| Rate for Payer: Health EOS Commercial |
$545.18
|
| Rate for Payer: HFN Commercial |
$563.56
|
| Rate for Payer: Multiplan Commercial |
$490.05
|
| Rate for Payer: Preferred Network Access Commercial |
$563.56
|
| Rate for Payer: Quartz Beloit One Network |
$300.15
|
| Rate for Payer: Quartz Commercial |
$367.54
|
| Rate for Payer: WEA Trust Commercial |
$336.91
|
| Rate for Payer: WPS Commercial |
$453.71
|
|
|
Ciprofloxacin 0.3% Ophth Ointment 3.5 gm [Med]
|
Facility
|
OP
|
$589.00
|
|
| Hospital Charge Code |
2974922
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$171.52 |
| Max. Negotiated Rate |
$563.56 |
| Rate for Payer: Aetna Commercial |
$551.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$526.80
|
| Rate for Payer: Aetna Managed Medicare |
$171.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$398.16
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$306.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$294.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$324.66
|
| Rate for Payer: Cash Price |
$176.70
|
| Rate for Payer: Cigna Commercial |
$563.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$342.80
|
| Rate for Payer: Health EOS Commercial |
$545.18
|
| Rate for Payer: HFN Commercial |
$563.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$459.42
|
| Rate for Payer: Multiplan Commercial |
$490.05
|
| Rate for Payer: NAPHCARE Commercial |
$367.54
|
| Rate for Payer: Preferred Network Access Commercial |
$563.56
|
| Rate for Payer: Quartz Beloit One Network |
$300.15
|
| Rate for Payer: Quartz Commercial |
$398.16
|
| Rate for Payer: Quartz Medicare Advantage |
$367.54
|
| Rate for Payer: The Alliance Commercial |
$306.28
|
| Rate for Payer: WEA Trust Commercial |
$336.91
|
| Rate for Payer: WPS Commercial |
$453.71
|
|
|
Ciprofloxacin 0.3% Ophth solution 5ml [Med]
|
Facility
|
IP
|
$20.00
|
|
| Hospital Charge Code |
2974923
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.19 |
| Max. Negotiated Rate |
$19.14 |
| Rate for Payer: Aetna Commercial |
$18.72
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$17.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$11.02
|
| Rate for Payer: Cash Price |
$6.00
|
| Rate for Payer: Cigna Commercial |
$19.14
|
| Rate for Payer: Health EOS Commercial |
$18.51
|
| Rate for Payer: HFN Commercial |
$19.14
|
| Rate for Payer: Multiplan Commercial |
$16.64
|
| Rate for Payer: Preferred Network Access Commercial |
$19.14
|
| Rate for Payer: Quartz Beloit One Network |
$10.19
|
| Rate for Payer: Quartz Commercial |
$12.48
|
| Rate for Payer: WEA Trust Commercial |
$11.44
|
| Rate for Payer: WPS Commercial |
$15.41
|
|
|
Ciprofloxacin 0.3% Ophth solution 5ml [Med]
|
Facility
|
OP
|
$20.00
|
|
| Hospital Charge Code |
2974923
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.82 |
| Max. Negotiated Rate |
$19.14 |
| Rate for Payer: Aetna Commercial |
$18.72
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$17.89
|
| Rate for Payer: Aetna Managed Medicare |
$5.82
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$13.52
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$10.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$9.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$11.02
|
| Rate for Payer: Cash Price |
$6.00
|
| Rate for Payer: Cigna Commercial |
$19.14
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$11.64
|
| Rate for Payer: Health EOS Commercial |
$18.51
|
| Rate for Payer: HFN Commercial |
$19.14
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$15.60
|
| Rate for Payer: Multiplan Commercial |
$16.64
|
| Rate for Payer: NAPHCARE Commercial |
$12.48
|
| Rate for Payer: Preferred Network Access Commercial |
$19.14
|
| Rate for Payer: Quartz Beloit One Network |
$10.19
|
| Rate for Payer: Quartz Commercial |
$13.52
|
| Rate for Payer: Quartz Medicare Advantage |
$12.48
|
| Rate for Payer: The Alliance Commercial |
$10.40
|
| Rate for Payer: WEA Trust Commercial |
$11.44
|
| Rate for Payer: WPS Commercial |
$15.41
|
|
|
Ciprofloxacin Hydrochloride Ophth 0.3% Ointment [Med]
|
Facility
|
OP
|
$589.00
|
|
| Hospital Charge Code |
2974924
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$171.52 |
| Max. Negotiated Rate |
$563.56 |
| Rate for Payer: Aetna Commercial |
$551.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$526.80
|
| Rate for Payer: Aetna Managed Medicare |
$171.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$398.16
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$306.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$294.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$324.66
|
| Rate for Payer: Cash Price |
$176.70
|
| Rate for Payer: Cigna Commercial |
$563.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$342.80
|
| Rate for Payer: Health EOS Commercial |
$545.18
|
| Rate for Payer: HFN Commercial |
$563.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$459.42
|
| Rate for Payer: Multiplan Commercial |
$490.05
|
| Rate for Payer: NAPHCARE Commercial |
$367.54
|
| Rate for Payer: Preferred Network Access Commercial |
$563.56
|
| Rate for Payer: Quartz Beloit One Network |
$300.15
|
| Rate for Payer: Quartz Commercial |
$398.16
|
| Rate for Payer: Quartz Medicare Advantage |
$367.54
|
| Rate for Payer: The Alliance Commercial |
$306.28
|
| Rate for Payer: WEA Trust Commercial |
$336.91
|
| Rate for Payer: WPS Commercial |
$453.71
|
|
|
Ciprofloxacin Hydrochloride Ophth 0.3% Ointment [Med]
|
Facility
|
IP
|
$589.00
|
|
| Hospital Charge Code |
2974924
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$300.15 |
| Max. Negotiated Rate |
$563.56 |
| Rate for Payer: Aetna Commercial |
$551.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$526.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$324.66
|
| Rate for Payer: Cash Price |
$176.70
|
| Rate for Payer: Cigna Commercial |
$563.56
|
| Rate for Payer: Health EOS Commercial |
$545.18
|
| Rate for Payer: HFN Commercial |
$563.56
|
| Rate for Payer: Multiplan Commercial |
$490.05
|
| Rate for Payer: Preferred Network Access Commercial |
$563.56
|
| Rate for Payer: Quartz Beloit One Network |
$300.15
|
| Rate for Payer: Quartz Commercial |
$367.54
|
| Rate for Payer: WEA Trust Commercial |
$336.91
|
| Rate for Payer: WPS Commercial |
$453.71
|
|
|
CIRCUIT MRI 3 METER VENT
|
Facility
|
OP
|
$514.00
|
|
| Hospital Charge Code |
2971345
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$149.68 |
| Max. Negotiated Rate |
$491.80 |
| Rate for Payer: Aetna Commercial |
$481.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$459.72
|
| Rate for Payer: Aetna Managed Medicare |
$149.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$347.46
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$267.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$256.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$283.32
|
| Rate for Payer: Cash Price |
$154.20
|
| Rate for Payer: Cigna Commercial |
$491.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$299.15
|
| Rate for Payer: Health EOS Commercial |
$475.76
|
| Rate for Payer: HFN Commercial |
$491.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$400.92
|
| Rate for Payer: Multiplan Commercial |
$427.65
|
| Rate for Payer: NAPHCARE Commercial |
$320.74
|
| Rate for Payer: Preferred Network Access Commercial |
$491.80
|
| Rate for Payer: Quartz Beloit One Network |
$261.93
|
| Rate for Payer: Quartz Commercial |
$347.46
|
| Rate for Payer: Quartz Medicare Advantage |
$320.74
|
| Rate for Payer: The Alliance Commercial |
$267.28
|
| Rate for Payer: WEA Trust Commercial |
$294.01
|
| Rate for Payer: WPS Commercial |
$395.93
|
|
|
CIRCUIT MRI 3 METER VENT
|
Facility
|
IP
|
$514.00
|
|
| Hospital Charge Code |
2971345
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$261.93 |
| Max. Negotiated Rate |
$491.80 |
| Rate for Payer: Aetna Commercial |
$481.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$459.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$283.32
|
| Rate for Payer: Cash Price |
$154.20
|
| Rate for Payer: Cigna Commercial |
$491.80
|
| Rate for Payer: Health EOS Commercial |
$475.76
|
| Rate for Payer: HFN Commercial |
$491.80
|
| Rate for Payer: Multiplan Commercial |
$427.65
|
| Rate for Payer: Preferred Network Access Commercial |
$491.80
|
| Rate for Payer: Quartz Beloit One Network |
$261.93
|
| Rate for Payer: Quartz Commercial |
$320.74
|
| Rate for Payer: WEA Trust Commercial |
$294.01
|
| Rate for Payer: WPS Commercial |
$395.93
|
|
|
CIRCUIT PT HIGH FLOW PRECISION
|
Facility
|
OP
|
$1,757.00
|
|
| Hospital Charge Code |
2972442
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$511.64 |
| Max. Negotiated Rate |
$1,681.10 |
| Rate for Payer: Aetna Commercial |
$1,644.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,571.46
|
| Rate for Payer: Aetna Managed Medicare |
$511.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,187.73
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$913.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$877.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$968.46
|
| Rate for Payer: Cash Price |
$527.10
|
| Rate for Payer: Cigna Commercial |
$1,681.10
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,022.57
|
| Rate for Payer: Health EOS Commercial |
$1,626.28
|
| Rate for Payer: HFN Commercial |
$1,681.10
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,370.46
|
| Rate for Payer: Multiplan Commercial |
$1,461.82
|
| Rate for Payer: NAPHCARE Commercial |
$1,096.37
|
| Rate for Payer: Preferred Network Access Commercial |
$1,681.10
|
| Rate for Payer: Quartz Beloit One Network |
$895.37
|
| Rate for Payer: Quartz Commercial |
$1,187.73
|
| Rate for Payer: Quartz Medicare Advantage |
$1,096.37
|
| Rate for Payer: The Alliance Commercial |
$913.64
|
| Rate for Payer: WEA Trust Commercial |
$1,005.00
|
| Rate for Payer: WPS Commercial |
$1,353.42
|
|
|
CIRCUIT PT HIGH FLOW PRECISION
|
Facility
|
IP
|
$1,757.00
|
|
| Hospital Charge Code |
2972442
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$895.37 |
| Max. Negotiated Rate |
$1,681.10 |
| Rate for Payer: Aetna Commercial |
$1,644.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,571.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$968.46
|
| Rate for Payer: Cash Price |
$527.10
|
| Rate for Payer: Cigna Commercial |
$1,681.10
|
| Rate for Payer: Health EOS Commercial |
$1,626.28
|
| Rate for Payer: HFN Commercial |
$1,681.10
|
| Rate for Payer: Multiplan Commercial |
$1,461.82
|
| Rate for Payer: Preferred Network Access Commercial |
$1,681.10
|
| Rate for Payer: Quartz Beloit One Network |
$895.37
|
| Rate for Payer: Quartz Commercial |
$1,096.37
|
| Rate for Payer: WEA Trust Commercial |
$1,005.00
|
| Rate for Payer: WPS Commercial |
$1,353.42
|
|
|
CIRCUIT PT LOW FLOW PRECISION FP-DPC-LOW
|
Facility
|
IP
|
$1,757.00
|
|
| Hospital Charge Code |
2972443
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$895.37 |
| Max. Negotiated Rate |
$1,681.10 |
| Rate for Payer: Aetna Commercial |
$1,644.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,571.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$968.46
|
| Rate for Payer: Cash Price |
$527.10
|
| Rate for Payer: Cigna Commercial |
$1,681.10
|
| Rate for Payer: Health EOS Commercial |
$1,626.28
|
| Rate for Payer: HFN Commercial |
$1,681.10
|
| Rate for Payer: Multiplan Commercial |
$1,461.82
|
| Rate for Payer: Preferred Network Access Commercial |
$1,681.10
|
| Rate for Payer: Quartz Beloit One Network |
$895.37
|
| Rate for Payer: Quartz Commercial |
$1,096.37
|
| Rate for Payer: WEA Trust Commercial |
$1,005.00
|
| Rate for Payer: WPS Commercial |
$1,353.42
|
|
|
CIRCUIT PT LOW FLOW PRECISION FP-DPC-LOW
|
Facility
|
OP
|
$1,757.00
|
|
| Hospital Charge Code |
2972443
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$511.64 |
| Max. Negotiated Rate |
$1,681.10 |
| Rate for Payer: Aetna Commercial |
$1,644.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,571.46
|
| Rate for Payer: Aetna Managed Medicare |
$511.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,187.73
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$913.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$877.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$968.46
|
| Rate for Payer: Cash Price |
$527.10
|
| Rate for Payer: Cigna Commercial |
$1,681.10
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,022.57
|
| Rate for Payer: Health EOS Commercial |
$1,626.28
|
| Rate for Payer: HFN Commercial |
$1,681.10
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,370.46
|
| Rate for Payer: Multiplan Commercial |
$1,461.82
|
| Rate for Payer: NAPHCARE Commercial |
$1,096.37
|
| Rate for Payer: Preferred Network Access Commercial |
$1,681.10
|
| Rate for Payer: Quartz Beloit One Network |
$895.37
|
| Rate for Payer: Quartz Commercial |
$1,187.73
|
| Rate for Payer: Quartz Medicare Advantage |
$1,096.37
|
| Rate for Payer: The Alliance Commercial |
$913.64
|
| Rate for Payer: WEA Trust Commercial |
$1,005.00
|
| Rate for Payer: WPS Commercial |
$1,353.42
|
|
|
CIRCULATORY DISORDERS EXCEPT AMI, WITH CARDIAC CATHETERIZATION WITH MCC
|
Facility
|
IP
|
$59,934.16
|
|
|
Service Code
|
MSDRG 286
|
| Min. Negotiated Rate |
$17,452.84 |
| Max. Negotiated Rate |
$59,934.16 |
| Rate for Payer: Aetna Managed Medicare |
$17,452.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$48,281.53
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$37,007.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$35,159.44
|
| Rate for Payer: Anthem Medicare Advantage |
$17,452.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$17,452.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$17,452.84
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$17,452.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$39,030.21
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$17,452.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$43,715.57
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$17,452.84
|
| Rate for Payer: Independent Care Health Plan Medicare |
$17,452.84
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$17,452.84
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$17,452.84
|
| Rate for Payer: NAPHCARE Commercial |
$26,179.26
|
| Rate for Payer: Quartz Medicare Advantage |
$17,452.84
|
| Rate for Payer: The Alliance Commercial |
$59,934.16
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17,452.84
|
| Rate for Payer: United Healthcare PPO |
$34,033.13
|
| Rate for Payer: Wellcare Medicare |
$17,452.84
|
|
|
CIRCULATORY DISORDERS EXCEPT AMI, WITH CARDIAC CATHETERIZATION WITHOUT MCC
|
Facility
|
IP
|
$30,239.04
|
|
|
Service Code
|
MSDRG 287
|
| Min. Negotiated Rate |
$8,701.80 |
| Max. Negotiated Rate |
$30,239.04 |
| Rate for Payer: Aetna Managed Medicare |
$8,701.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$23,348.73
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$17,896.61
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$17,002.95
|
| Rate for Payer: Anthem Medicare Advantage |
$8,701.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$8,701.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$8,701.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$8,701.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$18,874.83
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$8,701.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$21,934.85
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$8,701.80
|
| Rate for Payer: Independent Care Health Plan Medicare |
$8,701.80
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$8,701.80
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$8,701.80
|
| Rate for Payer: NAPHCARE Commercial |
$13,052.71
|
| Rate for Payer: Quartz Medicare Advantage |
$8,701.80
|
| Rate for Payer: The Alliance Commercial |
$30,239.04
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8,701.80
|
| Rate for Payer: United Healthcare PPO |
$17,076.56
|
| Rate for Payer: Wellcare Medicare |
$8,701.80
|
|
|
CIRCUMCISION
|
Facility
|
OP
|
$1,084.00
|
|
| Hospital Charge Code |
2959931
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$315.66 |
| Max. Negotiated Rate |
$1,037.17 |
| Rate for Payer: Aetna Commercial |
$1,014.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$969.53
|
| Rate for Payer: Aetna Managed Medicare |
$315.66
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$732.78
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$563.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$541.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$597.50
|
| Rate for Payer: Cash Price |
$325.20
|
| Rate for Payer: Cigna Commercial |
$1,037.17
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$630.89
|
| Rate for Payer: Health EOS Commercial |
$1,003.35
|
| Rate for Payer: HFN Commercial |
$1,037.17
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$845.52
|
| Rate for Payer: Multiplan Commercial |
$901.89
|
| Rate for Payer: NAPHCARE Commercial |
$676.42
|
| Rate for Payer: Preferred Network Access Commercial |
$1,037.17
|
| Rate for Payer: Quartz Beloit One Network |
$552.41
|
| Rate for Payer: Quartz Commercial |
$732.78
|
| Rate for Payer: Quartz Medicare Advantage |
$676.42
|
| Rate for Payer: The Alliance Commercial |
$563.68
|
| Rate for Payer: WEA Trust Commercial |
$620.05
|
| Rate for Payer: WPS Commercial |
$835.01
|
|
|
CIRCUMCISION
|
Facility
|
IP
|
$1,084.00
|
|
| Hospital Charge Code |
2959931
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$552.41 |
| Max. Negotiated Rate |
$1,037.17 |
| Rate for Payer: Aetna Commercial |
$1,014.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$969.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$597.50
|
| Rate for Payer: Cash Price |
$325.20
|
| Rate for Payer: Cigna Commercial |
$1,037.17
|
| Rate for Payer: Health EOS Commercial |
$1,003.35
|
| Rate for Payer: HFN Commercial |
$1,037.17
|
| Rate for Payer: Multiplan Commercial |
$901.89
|
| Rate for Payer: Preferred Network Access Commercial |
$1,037.17
|
| Rate for Payer: Quartz Beloit One Network |
$552.41
|
| Rate for Payer: Quartz Commercial |
$676.42
|
| Rate for Payer: WEA Trust Commercial |
$620.05
|
| Rate for Payer: WPS Commercial |
$835.01
|
|
|
Circumcision - Family Care Center
|
Facility
|
IP
|
$709.00
|
|
|
Service Code
|
CPT 54150
|
| Hospital Charge Code |
3732197
|
|
Hospital Revenue Code
|
723
|
| Min. Negotiated Rate |
$361.31 |
| Max. Negotiated Rate |
$678.37 |
| Rate for Payer: Aetna Commercial |
$663.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$634.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$390.80
|
| Rate for Payer: Cash Price |
$212.70
|
| Rate for Payer: Cigna Commercial |
$678.37
|
| Rate for Payer: Health EOS Commercial |
$656.25
|
| Rate for Payer: HFN Commercial |
$678.37
|
| Rate for Payer: Multiplan Commercial |
$589.89
|
| Rate for Payer: Preferred Network Access Commercial |
$678.37
|
| Rate for Payer: Quartz Beloit One Network |
$361.31
|
| Rate for Payer: Quartz Commercial |
$442.42
|
| Rate for Payer: WEA Trust Commercial |
$405.55
|
| Rate for Payer: WPS Commercial |
$546.14
|
|
|
Circumcision - Family Care Center
|
Facility
|
OP
|
$709.00
|
|
|
Service Code
|
CPT 54150
|
| Hospital Charge Code |
3732197
|
|
Hospital Revenue Code
|
723
|
| Min. Negotiated Rate |
$353.93 |
| Max. Negotiated Rate |
$8,799.61 |
| Rate for Payer: Aetna Commercial |
$663.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$634.13
|
| Rate for Payer: Aetna Managed Medicare |
$2,199.90
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$479.28
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$368.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$353.93
|
| Rate for Payer: Anthem Medicare Advantage |
$2,199.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$390.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$2,199.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$2,199.90
|
| Rate for Payer: Cash Price |
$212.70
|
| Rate for Payer: Cash Price |
$212.70
|
| Rate for Payer: Cigna Commercial |
$678.37
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$2,199.90
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$2,199.90
|
| Rate for Payer: Health EOS Commercial |
$656.25
|
| Rate for Payer: HFN Commercial |
$678.37
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$8,183.63
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$2,199.90
|
| Rate for Payer: Independent Care Health Plan Medicare |
$2,199.90
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$2,199.90
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$2,199.90
|
| Rate for Payer: Multiplan Commercial |
$589.89
|
| Rate for Payer: NAPHCARE Commercial |
$3,299.85
|
| Rate for Payer: Preferred Network Access Commercial |
$678.37
|
| Rate for Payer: Quartz Beloit One Network |
$361.31
|
| Rate for Payer: Quartz Commercial |
$479.28
|
| Rate for Payer: Quartz Medicare Advantage |
$2,199.90
|
| Rate for Payer: The Alliance Commercial |
$8,799.61
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,199.90
|
| Rate for Payer: WEA Trust Commercial |
$405.55
|
| Rate for Payer: Wellcare Medicare |
$2,199.90
|
| Rate for Payer: WPS Commercial |
$546.14
|
|
|
CIRCUMCISION, SURGICAL EXCISION OTHER THAN CLAMP, DEVICE, OR DORSAL SLIT; OLDER THAN 28 DAYS OF AGE
|
Facility
|
OP
|
$8,799.61
|
|
|
Service Code
|
CPT 54161
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,199.90 |
| Max. Negotiated Rate |
$8,799.61 |
| Rate for Payer: Aetna Managed Medicare |
$2,199.90
|
| 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 |
$2,199.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$2,199.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$2,199.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$2,199.90
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,947.89
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$2,199.90
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$8,183.63
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$2,199.90
|
| Rate for Payer: Independent Care Health Plan Medicare |
$2,199.90
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$2,199.90
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$2,199.90
|
| Rate for Payer: NAPHCARE Commercial |
$3,299.85
|
| Rate for Payer: Quartz Medicare Advantage |
$2,199.90
|
| Rate for Payer: The Alliance Commercial |
$8,799.61
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,199.90
|
| Rate for Payer: United Healthcare PPO |
$3,726.32
|
| Rate for Payer: Wellcare Medicare |
$2,199.90
|
|
|
CIRCUMCISION W/REGIONL BLOCK 54150
|
Professional
|
Both
|
$794.00
|
|
|
Service Code
|
CPT 54150
|
| Hospital Charge Code |
3015023
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$63.06 |
| Max. Negotiated Rate |
$784.47 |
| Rate for Payer: Aetna Commercial |
$784.47
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$710.15
|
| Rate for Payer: Aetna Managed Medicare |
$81.14
|
| Rate for Payer: Anthem Medicare Advantage |
$81.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$81.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$81.14
|
| Rate for Payer: Cash Price |
$238.20
|
| Rate for Payer: Cash Price |
$238.20
|
| Rate for Payer: Cash Price |
$238.20
|
| Rate for Payer: Cigna Commercial |
$784.47
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$63.06
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$81.14
|
| Rate for Payer: Health EOS Commercial |
$751.44
|
| Rate for Payer: HFN Commercial |
$784.47
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$336.14
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$336.14
|
| Rate for Payer: Independent Care Health Plan Medicare |
$81.14
|
| Rate for Payer: Multiplan Commercial |
$660.61
|
| Rate for Payer: NAPHCARE Commercial |
$121.71
|
| Rate for Payer: Preferred Network Access Commercial |
$784.47
|
| Rate for Payer: Quartz Beloit One Network |
$363.33
|
| Rate for Payer: Quartz Commercial |
$470.68
|
| Rate for Payer: Quartz Medicare Advantage |
$81.14
|
| Rate for Payer: The Alliance Commercial |
$344.85
|
| Rate for Payer: United Healthcare Medicaid |
$63.06
|
| Rate for Payer: United Healthcare Medicare Advantage |
$81.14
|
| Rate for Payer: WEA Trust Commercial |
$454.17
|
| Rate for Payer: WPS Commercial |
$365.13
|
|
|
CIRRHOSIS AND ALCOHOLIC HEPATITIS WITH CC
|
Facility
|
IP
|
$28,840.24
|
|
|
Service Code
|
MSDRG 433
|
| Min. Negotiated Rate |
$8,869.05 |
| Max. Negotiated Rate |
$28,840.24 |
| Rate for Payer: Aetna Managed Medicare |
$8,869.05
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$23,045.44
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$17,664.14
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$16,782.09
|
| Rate for Payer: Anthem Medicare Advantage |
$8,869.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$8,869.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$8,869.05
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$8,869.05
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$18,629.66
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$8,869.05
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$20,908.68
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$8,869.05
|
| Rate for Payer: Independent Care Health Plan Medicare |
$8,869.05
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$8,869.05
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$8,869.05
|
| Rate for Payer: NAPHCARE Commercial |
$13,303.57
|
| Rate for Payer: Quartz Medicare Advantage |
$8,869.05
|
| Rate for Payer: The Alliance Commercial |
$28,840.24
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8,869.05
|
| Rate for Payer: United Healthcare PPO |
$16,277.67
|
| Rate for Payer: Wellcare Medicare |
$8,869.05
|
|
