|
Y-PLATE 2.0 3HEAD 7HL 247.350
|
Facility
|
OP
|
$3,944.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5767802
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,104.32 |
| Max. Negotiated Rate |
$15,776.00 |
| Rate for Payer: Aetna Commercial |
$3,549.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,391.84
|
| Rate for Payer: Aetna Managed Medicare |
$1,104.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,563.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,972.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,893.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,090.32
|
| Rate for Payer: Cash Price |
$1,183.20
|
| Rate for Payer: Cigna Commercial |
$3,628.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,207.06
|
| Rate for Payer: Health EOS Commercial |
$3,510.16
|
| Rate for Payer: HFN Commercial |
$3,628.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,958.00
|
| Rate for Payer: Multiplan Commercial |
$3,155.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,366.40
|
| Rate for Payer: Preferred Network Access Commercial |
$3,628.48
|
| Rate for Payer: Quartz Beloit One Network |
$1,932.56
|
| Rate for Payer: Quartz Commercial |
$2,563.60
|
| Rate for Payer: Quartz Medicare Advantage |
$2,366.40
|
| Rate for Payer: The Alliance Commercial |
$15,776.00
|
| Rate for Payer: WEA Trust Commercial |
$2,169.20
|
| Rate for Payer: WPS Commercial |
$2,921.32
|
|
|
Y-PLATE 2.0MM 3H HEAD/ 8H SHAFT 247.612
|
Facility
|
OP
|
$4,330.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4508690
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,212.40 |
| Max. Negotiated Rate |
$17,320.00 |
| Rate for Payer: Aetna Commercial |
$3,897.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,723.80
|
| Rate for Payer: Aetna Managed Medicare |
$1,212.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,814.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,165.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,078.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,294.90
|
| Rate for Payer: Cash Price |
$1,299.00
|
| Rate for Payer: Cigna Commercial |
$3,983.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,423.07
|
| Rate for Payer: Health EOS Commercial |
$3,853.70
|
| Rate for Payer: HFN Commercial |
$3,983.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,247.50
|
| Rate for Payer: Multiplan Commercial |
$3,464.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,598.00
|
| Rate for Payer: Preferred Network Access Commercial |
$3,983.60
|
| Rate for Payer: Quartz Beloit One Network |
$2,121.70
|
| Rate for Payer: Quartz Commercial |
$2,814.50
|
| Rate for Payer: Quartz Medicare Advantage |
$2,598.00
|
| Rate for Payer: The Alliance Commercial |
$17,320.00
|
| Rate for Payer: WEA Trust Commercial |
$2,381.50
|
| Rate for Payer: WPS Commercial |
$3,207.23
|
|
|
Y-PLATE 2.0MM 3H HEAD/ 8H SHAFT 247.612
|
Facility
|
IP
|
$4,330.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4508690
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,121.70 |
| Max. Negotiated Rate |
$3,983.60 |
| Rate for Payer: Aetna Commercial |
$3,897.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,723.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,294.90
|
| Rate for Payer: Cash Price |
$1,299.00
|
| Rate for Payer: Cigna Commercial |
$3,983.60
|
| Rate for Payer: Health EOS Commercial |
$3,853.70
|
| Rate for Payer: HFN Commercial |
$3,983.60
|
| Rate for Payer: Multiplan Commercial |
$3,464.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,598.00
|
| Rate for Payer: Preferred Network Access Commercial |
$3,983.60
|
| Rate for Payer: Quartz Beloit One Network |
$2,121.70
|
| Rate for Payer: Quartz Commercial |
$2,598.00
|
| Rate for Payer: WEA Trust Commercial |
$2,381.50
|
| Rate for Payer: WPS Commercial |
$3,207.23
|
|
|
Y-PLATE 2.4MM 3HL HEAD/8HL SHAFT 249.915
|
Facility
|
OP
|
$4,597.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4508775
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,287.16 |
| Max. Negotiated Rate |
$18,388.00 |
| Rate for Payer: Aetna Commercial |
$4,137.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,953.42
|
| Rate for Payer: Aetna Managed Medicare |
$1,287.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,988.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,298.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,206.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,436.41
|
| Rate for Payer: Cash Price |
$1,379.10
|
| Rate for Payer: Cigna Commercial |
$4,229.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,572.48
|
| Rate for Payer: Health EOS Commercial |
$4,091.33
|
| Rate for Payer: HFN Commercial |
$4,229.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,447.75
|
| Rate for Payer: Multiplan Commercial |
$3,677.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,758.20
|
| Rate for Payer: Preferred Network Access Commercial |
$4,229.24
|
| Rate for Payer: Quartz Beloit One Network |
$2,252.53
|
| Rate for Payer: Quartz Commercial |
$2,988.05
|
| Rate for Payer: Quartz Medicare Advantage |
$2,758.20
|
| Rate for Payer: The Alliance Commercial |
$18,388.00
|
| Rate for Payer: WEA Trust Commercial |
$2,528.35
|
| Rate for Payer: WPS Commercial |
$3,405.00
|
|
|
Y-PLATE 2.4MM 3HL HEAD/8HL SHAFT 249.915
|
Facility
|
IP
|
$4,597.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4508775
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,252.53 |
| Max. Negotiated Rate |
$4,229.24 |
| Rate for Payer: Aetna Commercial |
$4,137.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,953.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,436.41
|
| Rate for Payer: Cash Price |
$1,379.10
|
| Rate for Payer: Cigna Commercial |
$4,229.24
|
| Rate for Payer: Health EOS Commercial |
$4,091.33
|
| Rate for Payer: HFN Commercial |
$4,229.24
|
| Rate for Payer: Multiplan Commercial |
$3,677.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,758.20
|
| Rate for Payer: Preferred Network Access Commercial |
$4,229.24
|
| Rate for Payer: Quartz Beloit One Network |
$2,252.53
|
| Rate for Payer: Quartz Commercial |
$2,758.20
|
| Rate for Payer: WEA Trust Commercial |
$2,528.35
|
| Rate for Payer: WPS Commercial |
$3,405.00
|
|
|
Y-PLATE 3Di CROSSCHECK 5820YPX1
|
Facility
|
OP
|
$11,517.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6185022
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,224.76 |
| Max. Negotiated Rate |
$46,068.00 |
| Rate for Payer: Aetna Commercial |
$10,365.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,904.62
|
| Rate for Payer: Aetna Managed Medicare |
$3,224.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$7,486.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,758.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,528.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,104.01
|
| Rate for Payer: Cash Price |
$3,455.10
|
| Rate for Payer: Cigna Commercial |
$10,595.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,444.91
|
| Rate for Payer: Health EOS Commercial |
$10,250.13
|
| Rate for Payer: HFN Commercial |
$10,595.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$8,637.75
|
| Rate for Payer: Multiplan Commercial |
$9,213.60
|
| Rate for Payer: NAPHCARE Commercial |
$6,910.20
|
| Rate for Payer: Preferred Network Access Commercial |
$10,595.64
|
| Rate for Payer: Quartz Beloit One Network |
$5,643.33
|
| Rate for Payer: Quartz Commercial |
$7,486.05
|
| Rate for Payer: Quartz Medicare Advantage |
$6,910.20
|
| Rate for Payer: The Alliance Commercial |
$46,068.00
|
| Rate for Payer: WEA Trust Commercial |
$6,334.35
|
| Rate for Payer: WPS Commercial |
$8,530.64
|
|
|
Y-PLATE 3Di CROSSCHECK 5820YPX1
|
Facility
|
IP
|
$11,517.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6185022
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,643.33 |
| Max. Negotiated Rate |
$10,595.64 |
| Rate for Payer: Aetna Commercial |
$10,365.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,904.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,104.01
|
| Rate for Payer: Cash Price |
$3,455.10
|
| Rate for Payer: Cigna Commercial |
$10,595.64
|
| Rate for Payer: Health EOS Commercial |
$10,250.13
|
| Rate for Payer: HFN Commercial |
$10,595.64
|
| Rate for Payer: Multiplan Commercial |
$9,213.60
|
| Rate for Payer: NAPHCARE Commercial |
$6,910.20
|
| Rate for Payer: Preferred Network Access Commercial |
$10,595.64
|
| Rate for Payer: Quartz Beloit One Network |
$5,643.33
|
| Rate for Payer: Quartz Commercial |
$6,910.20
|
| Rate for Payer: WEA Trust Commercial |
$6,334.35
|
| Rate for Payer: WPS Commercial |
$8,530.64
|
|
|
Y-PLATE 5TH METATARSAL RT 5202500R
|
Facility
|
OP
|
$6,953.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6172201
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,946.84 |
| Max. Negotiated Rate |
$27,812.00 |
| Rate for Payer: Aetna Commercial |
$6,257.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,979.58
|
| Rate for Payer: Aetna Managed Medicare |
$1,946.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,519.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,476.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,337.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,685.09
|
| Rate for Payer: Cash Price |
$2,085.90
|
| Rate for Payer: Cigna Commercial |
$6,396.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,890.90
|
| Rate for Payer: Health EOS Commercial |
$6,188.17
|
| Rate for Payer: HFN Commercial |
$6,396.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,214.75
|
| Rate for Payer: Multiplan Commercial |
$5,562.40
|
| Rate for Payer: NAPHCARE Commercial |
$4,171.80
|
| Rate for Payer: Preferred Network Access Commercial |
$6,396.76
|
| Rate for Payer: Quartz Beloit One Network |
$3,406.97
|
| Rate for Payer: Quartz Commercial |
$4,519.45
|
| Rate for Payer: Quartz Medicare Advantage |
$4,171.80
|
| Rate for Payer: The Alliance Commercial |
$27,812.00
|
| Rate for Payer: WEA Trust Commercial |
$3,824.15
|
| Rate for Payer: WPS Commercial |
$5,150.09
|
|
|
Y-PLATE 5TH METATARSAL RT 5202500R
|
Facility
|
IP
|
$6,953.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6172201
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,406.97 |
| Max. Negotiated Rate |
$6,396.76 |
| Rate for Payer: Aetna Commercial |
$6,257.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,979.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,685.09
|
| Rate for Payer: Cash Price |
$2,085.90
|
| Rate for Payer: Cigna Commercial |
$6,396.76
|
| Rate for Payer: Health EOS Commercial |
$6,188.17
|
| Rate for Payer: HFN Commercial |
$6,396.76
|
| Rate for Payer: Multiplan Commercial |
$5,562.40
|
| Rate for Payer: NAPHCARE Commercial |
$4,171.80
|
| Rate for Payer: Preferred Network Access Commercial |
$6,396.76
|
| Rate for Payer: Quartz Beloit One Network |
$3,406.97
|
| Rate for Payer: Quartz Commercial |
$4,171.80
|
| Rate for Payer: WEA Trust Commercial |
$3,824.15
|
| Rate for Payer: WPS Commercial |
$5,150.09
|
|
|
Y-PLATE MATRIX MIDFACE 1.0 X 3HL 0.7MM THICK TI 04.503.377
|
Facility
|
IP
|
$2,524.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5349172
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,236.76 |
| Max. Negotiated Rate |
$2,322.08 |
| Rate for Payer: Aetna Commercial |
$2,271.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,170.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,337.72
|
| Rate for Payer: Cash Price |
$757.20
|
| Rate for Payer: Cigna Commercial |
$2,322.08
|
| Rate for Payer: Health EOS Commercial |
$2,246.36
|
| Rate for Payer: HFN Commercial |
$2,322.08
|
| Rate for Payer: Multiplan Commercial |
$2,019.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,514.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,322.08
|
| Rate for Payer: Quartz Beloit One Network |
$1,236.76
|
| Rate for Payer: Quartz Commercial |
$1,514.40
|
| Rate for Payer: WEA Trust Commercial |
$1,388.20
|
| Rate for Payer: WPS Commercial |
$1,869.53
|
|
|
Y-PLATE MATRIX MIDFACE 1.0 X 3HL 0.7MM THICK TI 04.503.377
|
Facility
|
OP
|
$2,524.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5349172
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$706.72 |
| Max. Negotiated Rate |
$10,096.00 |
| Rate for Payer: Aetna Commercial |
$2,271.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,170.64
|
| Rate for Payer: Aetna Managed Medicare |
$706.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,640.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,262.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,211.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,337.72
|
| Rate for Payer: Cash Price |
$757.20
|
| Rate for Payer: Cigna Commercial |
$2,322.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,412.43
|
| Rate for Payer: Health EOS Commercial |
$2,246.36
|
| Rate for Payer: HFN Commercial |
$2,322.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,893.00
|
| Rate for Payer: Multiplan Commercial |
$2,019.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,514.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,322.08
|
| Rate for Payer: Quartz Beloit One Network |
$1,236.76
|
| Rate for Payer: Quartz Commercial |
$1,640.60
|
| Rate for Payer: Quartz Medicare Advantage |
$1,514.40
|
| Rate for Payer: The Alliance Commercial |
$10,096.00
|
| Rate for Payer: WEA Trust Commercial |
$1,388.20
|
| Rate for Payer: WPS Commercial |
$1,869.53
|
|
|
Zantac 25 mg Charge
|
Facility
|
OP
|
$87.00
|
|
|
Service Code
|
HCPCS J2780
|
| Hospital Charge Code |
2958939
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$24.36 |
| Max. Negotiated Rate |
$348.00 |
| Rate for Payer: Aetna Commercial |
$78.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$74.82
|
| Rate for Payer: Aetna Managed Medicare |
$24.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$56.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$43.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$41.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$46.11
|
| Rate for Payer: Cash Price |
$26.10
|
| Rate for Payer: Cigna Commercial |
$80.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$48.69
|
| Rate for Payer: Health EOS Commercial |
$77.43
|
| Rate for Payer: HFN Commercial |
$80.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$65.25
|
| Rate for Payer: Multiplan Commercial |
$69.60
|
| Rate for Payer: NAPHCARE Commercial |
$52.20
|
| Rate for Payer: Preferred Network Access Commercial |
$80.04
|
| Rate for Payer: Quartz Beloit One Network |
$42.63
|
| Rate for Payer: Quartz Commercial |
$56.55
|
| Rate for Payer: Quartz Medicare Advantage |
$52.20
|
| Rate for Payer: The Alliance Commercial |
$348.00
|
| Rate for Payer: WEA Trust Commercial |
$47.85
|
| Rate for Payer: WPS Commercial |
$64.44
|
|
|
Zantac 25 mg Charge
|
Professional
|
Both
|
$87.00
|
|
|
Service Code
|
HCPCS J2780
|
| Hospital Charge Code |
2958939
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.12 |
| Max. Negotiated Rate |
$82.65 |
| Rate for Payer: Aetna Commercial |
$82.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$74.82
|
| Rate for Payer: Cash Price |
$26.10
|
| Rate for Payer: Cash Price |
$26.10
|
| Rate for Payer: Cigna Commercial |
$82.65
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$6.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$52.20
|
| Rate for Payer: Health EOS Commercial |
$79.17
|
| Rate for Payer: HFN Commercial |
$82.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$8.94
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$8.94
|
| Rate for Payer: Multiplan Commercial |
$69.60
|
| Rate for Payer: Preferred Network Access Commercial |
$82.65
|
| Rate for Payer: Quartz Beloit One Network |
$38.28
|
| Rate for Payer: Quartz Commercial |
$49.59
|
| Rate for Payer: The Alliance Commercial |
$43.50
|
| Rate for Payer: United Healthcare Medicaid |
$6.12
|
| Rate for Payer: WEA Trust Commercial |
$47.85
|
| Rate for Payer: WPS Commercial |
$64.44
|
|
|
Zantac 25 mg Charge
|
Facility
|
IP
|
$87.00
|
|
|
Service Code
|
HCPCS J2780
|
| Hospital Charge Code |
2958939
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$42.63 |
| Max. Negotiated Rate |
$80.04 |
| Rate for Payer: Aetna Commercial |
$78.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$74.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$46.11
|
| Rate for Payer: Cash Price |
$26.10
|
| Rate for Payer: Cigna Commercial |
$80.04
|
| Rate for Payer: Health EOS Commercial |
$77.43
|
| Rate for Payer: HFN Commercial |
$80.04
|
| Rate for Payer: Multiplan Commercial |
$69.60
|
| Rate for Payer: NAPHCARE Commercial |
$52.20
|
| Rate for Payer: Preferred Network Access Commercial |
$80.04
|
| Rate for Payer: Quartz Beloit One Network |
$42.63
|
| Rate for Payer: Quartz Commercial |
$52.20
|
| Rate for Payer: WEA Trust Commercial |
$47.85
|
| Rate for Payer: WPS Commercial |
$64.44
|
|
|
Zemplar Supplies
|
Facility
|
OP
|
$5.00
|
|
| Hospital Charge Code |
3005576
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1.40 |
| Max. Negotiated Rate |
$20.00 |
| Rate for Payer: Aetna Commercial |
$4.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4.30
|
| Rate for Payer: Aetna Managed Medicare |
$1.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2.65
|
| Rate for Payer: Cash Price |
$1.50
|
| Rate for Payer: Cigna Commercial |
$4.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2.80
|
| Rate for Payer: Health EOS Commercial |
$4.45
|
| Rate for Payer: HFN Commercial |
$4.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3.75
|
| Rate for Payer: Multiplan Commercial |
$4.00
|
| Rate for Payer: NAPHCARE Commercial |
$3.00
|
| Rate for Payer: Preferred Network Access Commercial |
$4.60
|
| Rate for Payer: Quartz Beloit One Network |
$2.45
|
| Rate for Payer: Quartz Commercial |
$3.25
|
| Rate for Payer: Quartz Medicare Advantage |
$3.00
|
| Rate for Payer: The Alliance Commercial |
$20.00
|
| Rate for Payer: WEA Trust Commercial |
$2.75
|
| Rate for Payer: WPS Commercial |
$3.70
|
|
|
Zemplar Supplies
|
Facility
|
IP
|
$5.00
|
|
| Hospital Charge Code |
3005576
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$2.45 |
| Max. Negotiated Rate |
$4.60 |
| Rate for Payer: Aetna Commercial |
$4.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2.65
|
| Rate for Payer: Cash Price |
$1.50
|
| Rate for Payer: Cigna Commercial |
$4.60
|
| Rate for Payer: Health EOS Commercial |
$4.45
|
| Rate for Payer: HFN Commercial |
$4.60
|
| Rate for Payer: Multiplan Commercial |
$4.00
|
| Rate for Payer: NAPHCARE Commercial |
$3.00
|
| Rate for Payer: Preferred Network Access Commercial |
$4.60
|
| Rate for Payer: Quartz Beloit One Network |
$2.45
|
| Rate for Payer: Quartz Commercial |
$3.00
|
| Rate for Payer: WEA Trust Commercial |
$2.75
|
| Rate for Payer: WPS Commercial |
$3.70
|
|
|
ZENKERS DIVERTICULECTOMY
|
Facility
|
IP
|
$4,460.00
|
|
| Hospital Charge Code |
2960514
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,185.40 |
| Max. Negotiated Rate |
$4,103.20 |
| Rate for Payer: Aetna Commercial |
$4,014.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,835.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,363.80
|
| Rate for Payer: Cash Price |
$1,338.00
|
| Rate for Payer: Cigna Commercial |
$4,103.20
|
| Rate for Payer: Health EOS Commercial |
$3,969.40
|
| Rate for Payer: HFN Commercial |
$4,103.20
|
| Rate for Payer: Multiplan Commercial |
$3,568.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,676.00
|
| Rate for Payer: Preferred Network Access Commercial |
$4,103.20
|
| Rate for Payer: Quartz Beloit One Network |
$2,185.40
|
| Rate for Payer: Quartz Commercial |
$2,676.00
|
| Rate for Payer: WEA Trust Commercial |
$2,453.00
|
| Rate for Payer: WPS Commercial |
$3,303.52
|
|
|
ZENKERS DIVERTICULECTOMY
|
Facility
|
OP
|
$4,460.00
|
|
| Hospital Charge Code |
2960514
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,248.80 |
| Max. Negotiated Rate |
$17,840.00 |
| Rate for Payer: Aetna Commercial |
$4,014.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,835.60
|
| Rate for Payer: Aetna Managed Medicare |
$1,248.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,899.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,230.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,140.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,363.80
|
| Rate for Payer: Cash Price |
$1,338.00
|
| Rate for Payer: Cigna Commercial |
$4,103.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,495.82
|
| Rate for Payer: Health EOS Commercial |
$3,969.40
|
| Rate for Payer: HFN Commercial |
$4,103.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,345.00
|
| Rate for Payer: Multiplan Commercial |
$3,568.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,676.00
|
| Rate for Payer: Preferred Network Access Commercial |
$4,103.20
|
| Rate for Payer: Quartz Beloit One Network |
$2,185.40
|
| Rate for Payer: Quartz Commercial |
$2,899.00
|
| Rate for Payer: Quartz Medicare Advantage |
$2,676.00
|
| Rate for Payer: The Alliance Commercial |
$17,840.00
|
| Rate for Payer: WEA Trust Commercial |
$2,453.00
|
| Rate for Payer: WPS Commercial |
$3,303.52
|
|
|
Z-Flo Specialty Pillow - CCC Z-Flo Specialty Pillow
|
Facility
|
OP
|
$988.00
|
|
| Hospital Charge Code |
5804416
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$276.64 |
| Max. Negotiated Rate |
$3,952.00 |
| Rate for Payer: Aetna Commercial |
$889.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$849.68
|
| Rate for Payer: Aetna Managed Medicare |
$276.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$642.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$494.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$474.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$523.64
|
| Rate for Payer: Cash Price |
$296.40
|
| Rate for Payer: Cigna Commercial |
$908.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$552.88
|
| Rate for Payer: Health EOS Commercial |
$879.32
|
| Rate for Payer: HFN Commercial |
$908.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$741.00
|
| Rate for Payer: Multiplan Commercial |
$790.40
|
| Rate for Payer: NAPHCARE Commercial |
$592.80
|
| Rate for Payer: Preferred Network Access Commercial |
$908.96
|
| Rate for Payer: Quartz Beloit One Network |
$484.12
|
| Rate for Payer: Quartz Commercial |
$642.20
|
| Rate for Payer: Quartz Medicare Advantage |
$592.80
|
| Rate for Payer: The Alliance Commercial |
$3,952.00
|
| Rate for Payer: WEA Trust Commercial |
$543.40
|
| Rate for Payer: WPS Commercial |
$731.81
|
|
|
Z-Flo Specialty Pillow - CCC Z-Flo Specialty Pillow
|
Facility
|
IP
|
$988.00
|
|
| Hospital Charge Code |
5804416
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$484.12 |
| Max. Negotiated Rate |
$908.96 |
| Rate for Payer: Aetna Commercial |
$889.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$849.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$523.64
|
| Rate for Payer: Cash Price |
$296.40
|
| Rate for Payer: Cigna Commercial |
$908.96
|
| Rate for Payer: Health EOS Commercial |
$879.32
|
| Rate for Payer: HFN Commercial |
$908.96
|
| Rate for Payer: Multiplan Commercial |
$790.40
|
| Rate for Payer: NAPHCARE Commercial |
$592.80
|
| Rate for Payer: Preferred Network Access Commercial |
$908.96
|
| Rate for Payer: Quartz Beloit One Network |
$484.12
|
| Rate for Payer: Quartz Commercial |
$592.80
|
| Rate for Payer: WEA Trust Commercial |
$543.40
|
| Rate for Payer: WPS Commercial |
$731.81
|
|
|
Zika Virus RNA, Qualitative PCR
|
Facility
|
IP
|
$783.00
|
|
|
Service Code
|
CPT 87662
|
| Hospital Charge Code |
4638630
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$383.67 |
| Max. Negotiated Rate |
$720.36 |
| Rate for Payer: Aetna Commercial |
$704.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$673.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$414.99
|
| Rate for Payer: Cash Price |
$234.90
|
| Rate for Payer: Cigna Commercial |
$720.36
|
| Rate for Payer: Health EOS Commercial |
$696.87
|
| Rate for Payer: HFN Commercial |
$720.36
|
| Rate for Payer: Multiplan Commercial |
$626.40
|
| Rate for Payer: NAPHCARE Commercial |
$469.80
|
| Rate for Payer: Preferred Network Access Commercial |
$720.36
|
| Rate for Payer: Quartz Beloit One Network |
$383.67
|
| Rate for Payer: Quartz Commercial |
$469.80
|
| Rate for Payer: WEA Trust Commercial |
$430.65
|
| Rate for Payer: WPS Commercial |
$579.97
|
|
|
Zika Virus RNA, Qualitative PCR
|
Professional
|
Both
|
$783.00
|
|
|
Service Code
|
CPT 87662
|
| Hospital Charge Code |
4638630
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$181.12 |
| Max. Negotiated Rate |
$743.85 |
| Rate for Payer: Aetna Commercial |
$743.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$673.38
|
| Rate for Payer: Cash Price |
$234.90
|
| Rate for Payer: Cash Price |
$234.90
|
| Rate for Payer: Cigna Commercial |
$743.85
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$391.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$469.80
|
| Rate for Payer: Health EOS Commercial |
$712.53
|
| Rate for Payer: HFN Commercial |
$743.85
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$181.12
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$181.12
|
| Rate for Payer: Multiplan Commercial |
$626.40
|
| Rate for Payer: Preferred Network Access Commercial |
$743.85
|
| Rate for Payer: Quartz Beloit One Network |
$344.52
|
| Rate for Payer: Quartz Commercial |
$446.31
|
| Rate for Payer: The Alliance Commercial |
$391.50
|
| Rate for Payer: WEA Trust Commercial |
$430.65
|
| Rate for Payer: WPS Commercial |
$579.97
|
|
|
Zika Virus RNA, Qualitative PCR
|
Facility
|
OP
|
$783.00
|
|
|
Service Code
|
CPT 87662
|
| Hospital Charge Code |
4638630
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$50.68 |
| Max. Negotiated Rate |
$720.36 |
| Rate for Payer: Aetna Commercial |
$704.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$673.38
|
| Rate for Payer: Aetna Managed Medicare |
$51.31
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$192.41
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$89.79
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$85.17
|
| Rate for Payer: Anthem Medicaid |
$50.68
|
| Rate for Payer: Anthem Medicare Advantage |
$51.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$414.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$51.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$51.31
|
| Rate for Payer: Cash Price |
$234.90
|
| Rate for Payer: Cash Price |
$234.90
|
| Rate for Payer: Cigna Commercial |
$720.36
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$51.31
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$50.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$438.17
|
| Rate for Payer: Dean Health Medicaid |
$50.68
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$51.31
|
| Rate for Payer: Health EOS Commercial |
$696.87
|
| Rate for Payer: HFN Commercial |
$720.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$190.87
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$51.31
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$50.68
|
| Rate for Payer: Independent Care Health Plan Medicare |
$51.31
|
| Rate for Payer: Managed Health Services Medicaid |
$52.71
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$51.31
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$51.31
|
| Rate for Payer: Multiplan Commercial |
$626.40
|
| Rate for Payer: NAPHCARE Commercial |
$76.96
|
| Rate for Payer: Preferred Network Access Commercial |
$720.36
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$50.68
|
| Rate for Payer: Quartz Beloit One Network |
$383.67
|
| Rate for Payer: Quartz Commercial |
$508.95
|
| Rate for Payer: Quartz Medicare Advantage |
$51.31
|
| Rate for Payer: The Alliance Commercial |
$205.24
|
| Rate for Payer: United Healthcare Medicaid |
$50.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$51.31
|
| Rate for Payer: United Healthcare PPO |
$587.25
|
| Rate for Payer: WEA Trust Commercial |
$430.65
|
| Rate for Payer: Wellcare Medicare |
$51.31
|
| Rate for Payer: WMAP Medicaid |
$50.68
|
| Rate for Payer: WPS Commercial |
$579.97
|
|
|
Zilretta 32mg/5 mL inj - Zilretta Med Charge
|
Professional
|
Both
|
$1,321.00
|
|
|
Service Code
|
HCPCS J3304
|
| Hospital Charge Code |
6222269
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$17.49 |
| Max. Negotiated Rate |
$1,254.95 |
| Rate for Payer: Aetna Commercial |
$1,254.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,136.06
|
| Rate for Payer: Cash Price |
$396.30
|
| Rate for Payer: Cash Price |
$396.30
|
| Rate for Payer: Cigna Commercial |
$1,254.95
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$17.49
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$17.49
|
| Rate for Payer: Health EOS Commercial |
$1,202.11
|
| Rate for Payer: HFN Commercial |
$1,254.95
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$26.12
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$26.12
|
| Rate for Payer: Multiplan Commercial |
$1,056.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,254.95
|
| Rate for Payer: Quartz Beloit One Network |
$581.24
|
| Rate for Payer: Quartz Commercial |
$752.97
|
| Rate for Payer: The Alliance Commercial |
$660.50
|
| Rate for Payer: United Healthcare Medicaid |
$17.49
|
| Rate for Payer: WEA Trust Commercial |
$726.55
|
| Rate for Payer: WPS Commercial |
$43.73
|
|
|
Zilretta 32mg/5 mL inj - Zilretta Med Charge
|
Facility
|
IP
|
$1,321.00
|
|
|
Service Code
|
HCPCS J3304
|
| Hospital Charge Code |
6222269
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$647.29 |
| Max. Negotiated Rate |
$1,215.32 |
| Rate for Payer: Aetna Commercial |
$1,188.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,136.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$700.13
|
| Rate for Payer: Cash Price |
$396.30
|
| Rate for Payer: Cigna Commercial |
$1,215.32
|
| Rate for Payer: Health EOS Commercial |
$1,175.69
|
| Rate for Payer: HFN Commercial |
$1,215.32
|
| Rate for Payer: Multiplan Commercial |
$1,056.80
|
| Rate for Payer: NAPHCARE Commercial |
$792.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,215.32
|
| Rate for Payer: Quartz Beloit One Network |
$647.29
|
| Rate for Payer: Quartz Commercial |
$792.60
|
| Rate for Payer: WEA Trust Commercial |
$726.55
|
| Rate for Payer: WPS Commercial |
$978.46
|
|
