|
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
|
|
|
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: Quartz Medicare Advantage |
$7,547.28
|
| 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: 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
|
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 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 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 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 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 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 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
|
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
|
|
|
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 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
|
|
|
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
|
|
|
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
|
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 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 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 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 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
|
|
