|
Zilretta 32mg/5 mL inj - Zilretta Med Charge
|
Facility
|
OP
|
$1,321.00
|
|
|
Service Code
|
HCPCS J3304
|
| Hospital Charge Code |
6222269
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$17.54 |
| 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: Aetna Managed Medicare |
$17.54
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$858.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$660.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$634.08
|
| Rate for Payer: Anthem Medicare Advantage |
$17.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$700.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$17.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$17.54
|
| Rate for Payer: Cash Price |
$396.30
|
| Rate for Payer: Cash Price |
$396.30
|
| Rate for Payer: Cigna Commercial |
$1,215.32
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$17.54
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$23.14
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$17.54
|
| Rate for Payer: Health EOS Commercial |
$1,175.69
|
| Rate for Payer: HFN Commercial |
$1,215.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$65.25
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$17.54
|
| Rate for Payer: Independent Care Health Plan Medicare |
$17.54
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$17.54
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$17.54
|
| Rate for Payer: Multiplan Commercial |
$1,056.80
|
| Rate for Payer: NAPHCARE Commercial |
$26.31
|
| Rate for Payer: Preferred Network Access Commercial |
$1,215.32
|
| Rate for Payer: Quartz Beloit One Network |
$647.29
|
| Rate for Payer: Quartz Commercial |
$858.65
|
| Rate for Payer: Quartz Medicare Advantage |
$17.54
|
| Rate for Payer: The Alliance Commercial |
$70.16
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.54
|
| Rate for Payer: WEA Trust Commercial |
$726.55
|
| Rate for Payer: Wellcare Medicare |
$17.54
|
| Rate for Payer: WPS Commercial |
$43.73
|
|
|
Zilretta (triamcinalone) 32mg/5mL injt J3304
|
Professional
|
Both
|
$1,321.00
|
|
|
Service Code
|
HCPCS J3304
|
| Hospital Charge Code |
6230197
|
|
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 (triamcinalone) 32mg/5mL injt J3304
|
Facility
|
OP
|
$1,321.00
|
|
|
Service Code
|
HCPCS J3304
|
| Hospital Charge Code |
6230197
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$17.54 |
| 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: Aetna Managed Medicare |
$17.54
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$858.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$660.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$634.08
|
| Rate for Payer: Anthem Medicare Advantage |
$17.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$700.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$17.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$17.54
|
| Rate for Payer: Cash Price |
$396.30
|
| Rate for Payer: Cash Price |
$396.30
|
| Rate for Payer: Cigna Commercial |
$1,215.32
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$17.54
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$23.14
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$17.54
|
| Rate for Payer: Health EOS Commercial |
$1,175.69
|
| Rate for Payer: HFN Commercial |
$1,215.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$65.25
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$17.54
|
| Rate for Payer: Independent Care Health Plan Medicare |
$17.54
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$17.54
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$17.54
|
| Rate for Payer: Multiplan Commercial |
$1,056.80
|
| Rate for Payer: NAPHCARE Commercial |
$26.31
|
| Rate for Payer: Preferred Network Access Commercial |
$1,215.32
|
| Rate for Payer: Quartz Beloit One Network |
$647.29
|
| Rate for Payer: Quartz Commercial |
$858.65
|
| Rate for Payer: Quartz Medicare Advantage |
$17.54
|
| Rate for Payer: The Alliance Commercial |
$70.16
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.54
|
| Rate for Payer: WEA Trust Commercial |
$726.55
|
| Rate for Payer: Wellcare Medicare |
$17.54
|
| Rate for Payer: WPS Commercial |
$43.73
|
|
|
Zilretta (triamcinalone) 32mg/5mL injt J3304
|
Facility
|
IP
|
$1,321.00
|
|
|
Service Code
|
HCPCS J3304
|
| Hospital Charge Code |
6230197
|
|
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
|
|
|
Zinc Level
|
Facility
|
OP
|
$162.00
|
|
|
Service Code
|
CPT 84630
|
| Hospital Charge Code |
978099
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.39 |
| Max. Negotiated Rate |
$149.04 |
| Rate for Payer: Aetna Commercial |
$145.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$139.32
|
| Rate for Payer: Aetna Managed Medicare |
$11.39
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$42.71
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$19.93
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$18.91
|
| Rate for Payer: Anthem Medicaid |
$11.77
|
| Rate for Payer: Anthem Medicare Advantage |
$11.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$85.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$11.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$11.39
|
| Rate for Payer: Cash Price |
$48.60
|
| Rate for Payer: Cash Price |
$48.60
|
| Rate for Payer: Cigna Commercial |
$149.04
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$11.39
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$11.77
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$90.66
|
| Rate for Payer: Dean Health Medicaid |
$11.77
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$11.39
|
| Rate for Payer: Health EOS Commercial |
$144.18
|
| Rate for Payer: HFN Commercial |
$149.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$42.37
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$11.39
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$11.77
|
| Rate for Payer: Independent Care Health Plan Medicare |
$11.39
|
| Rate for Payer: Managed Health Services Medicaid |
$12.24
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$11.39
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$11.39
|
| Rate for Payer: Multiplan Commercial |
$129.60
|
| Rate for Payer: NAPHCARE Commercial |
$17.08
|
| Rate for Payer: Preferred Network Access Commercial |
$149.04
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$11.77
|
| Rate for Payer: Quartz Beloit One Network |
$79.38
|
| Rate for Payer: Quartz Commercial |
$105.30
|
| Rate for Payer: Quartz Medicare Advantage |
$11.39
|
| Rate for Payer: The Alliance Commercial |
$45.56
|
| Rate for Payer: United Healthcare Medicaid |
$11.77
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11.39
|
| Rate for Payer: United Healthcare PPO |
$121.50
|
| Rate for Payer: WEA Trust Commercial |
$89.10
|
| Rate for Payer: Wellcare Medicare |
$11.39
|
| Rate for Payer: WMAP Medicaid |
$11.77
|
| Rate for Payer: WPS Commercial |
$119.99
|
|
|
Zinc Level
|
Professional
|
Both
|
$162.00
|
|
|
Service Code
|
CPT 84630
|
| Hospital Charge Code |
978099
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$40.21 |
| Max. Negotiated Rate |
$153.90 |
| Rate for Payer: Aetna Commercial |
$153.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$139.32
|
| Rate for Payer: Cash Price |
$48.60
|
| Rate for Payer: Cash Price |
$48.60
|
| Rate for Payer: Cigna Commercial |
$153.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$81.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$97.20
|
| Rate for Payer: Health EOS Commercial |
$147.42
|
| Rate for Payer: HFN Commercial |
$153.90
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$40.21
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$40.21
|
| Rate for Payer: Multiplan Commercial |
$129.60
|
| Rate for Payer: Preferred Network Access Commercial |
$153.90
|
| Rate for Payer: Quartz Beloit One Network |
$71.28
|
| Rate for Payer: Quartz Commercial |
$92.34
|
| Rate for Payer: The Alliance Commercial |
$81.00
|
| Rate for Payer: WEA Trust Commercial |
$89.10
|
| Rate for Payer: WPS Commercial |
$119.99
|
|
|
Zinc Level
|
Facility
|
IP
|
$162.00
|
|
|
Service Code
|
CPT 84630
|
| Hospital Charge Code |
978099
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$79.38 |
| Max. Negotiated Rate |
$149.04 |
| Rate for Payer: Aetna Commercial |
$145.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$139.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$85.86
|
| Rate for Payer: Cash Price |
$48.60
|
| Rate for Payer: Cigna Commercial |
$149.04
|
| Rate for Payer: Health EOS Commercial |
$144.18
|
| Rate for Payer: HFN Commercial |
$149.04
|
| Rate for Payer: Multiplan Commercial |
$129.60
|
| Rate for Payer: NAPHCARE Commercial |
$97.20
|
| Rate for Payer: Preferred Network Access Commercial |
$149.04
|
| Rate for Payer: Quartz Beloit One Network |
$79.38
|
| Rate for Payer: Quartz Commercial |
$97.20
|
| Rate for Payer: WEA Trust Commercial |
$89.10
|
| Rate for Payer: WPS Commercial |
$119.99
|
|
|
Zinc Protoporphyrin
|
Professional
|
Both
|
$255.00
|
|
|
Service Code
|
CPT 84202
|
| Hospital Charge Code |
978100
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$50.66 |
| Max. Negotiated Rate |
$242.25 |
| Rate for Payer: Aetna Commercial |
$242.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$219.30
|
| Rate for Payer: Cash Price |
$76.50
|
| Rate for Payer: Cash Price |
$76.50
|
| Rate for Payer: Cigna Commercial |
$242.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$127.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$153.00
|
| Rate for Payer: Health EOS Commercial |
$232.05
|
| Rate for Payer: HFN Commercial |
$242.25
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$50.66
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$50.66
|
| Rate for Payer: Multiplan Commercial |
$204.00
|
| Rate for Payer: Preferred Network Access Commercial |
$242.25
|
| Rate for Payer: Quartz Beloit One Network |
$112.20
|
| Rate for Payer: Quartz Commercial |
$145.35
|
| Rate for Payer: The Alliance Commercial |
$127.50
|
| Rate for Payer: WEA Trust Commercial |
$140.25
|
| Rate for Payer: WPS Commercial |
$188.88
|
|
|
Zinc Protoporphyrin
|
Facility
|
OP
|
$255.00
|
|
|
Service Code
|
CPT 84202
|
| Hospital Charge Code |
978100
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.35 |
| Max. Negotiated Rate |
$234.60 |
| Rate for Payer: Anthem Medicare Advantage |
$14.35
|
| Rate for Payer: Aetna Commercial |
$229.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$219.30
|
| Rate for Payer: Aetna Managed Medicare |
$14.35
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$53.81
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$25.11
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$23.82
|
| Rate for Payer: Anthem Medicaid |
$14.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$135.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$14.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$14.35
|
| Rate for Payer: Cash Price |
$76.50
|
| Rate for Payer: Cash Price |
$76.50
|
| Rate for Payer: Cigna Commercial |
$234.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$14.35
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$14.83
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$142.70
|
| Rate for Payer: Dean Health Medicaid |
$14.83
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$14.35
|
| Rate for Payer: Health EOS Commercial |
$226.95
|
| Rate for Payer: HFN Commercial |
$234.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$53.38
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$14.35
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$14.83
|
| Rate for Payer: Independent Care Health Plan Medicare |
$14.35
|
| Rate for Payer: Managed Health Services Medicaid |
$15.42
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$14.35
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$14.35
|
| Rate for Payer: Multiplan Commercial |
$204.00
|
| Rate for Payer: NAPHCARE Commercial |
$21.52
|
| Rate for Payer: Preferred Network Access Commercial |
$234.60
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$14.83
|
| Rate for Payer: Quartz Beloit One Network |
$124.95
|
| Rate for Payer: Quartz Commercial |
$165.75
|
| Rate for Payer: Quartz Medicare Advantage |
$14.35
|
| Rate for Payer: The Alliance Commercial |
$57.40
|
| Rate for Payer: United Healthcare Medicaid |
$14.83
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14.35
|
| Rate for Payer: United Healthcare PPO |
$191.25
|
| Rate for Payer: WEA Trust Commercial |
$140.25
|
| Rate for Payer: Wellcare Medicare |
$14.35
|
| Rate for Payer: WMAP Medicaid |
$14.83
|
| Rate for Payer: WPS Commercial |
$188.88
|
|
|
Zinc Protoporphyrin
|
Facility
|
IP
|
$255.00
|
|
|
Service Code
|
CPT 84202
|
| Hospital Charge Code |
978100
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$124.95 |
| Max. Negotiated Rate |
$234.60 |
| Rate for Payer: Aetna Commercial |
$229.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$219.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$135.15
|
| Rate for Payer: Cash Price |
$76.50
|
| Rate for Payer: Cigna Commercial |
$234.60
|
| Rate for Payer: Health EOS Commercial |
$226.95
|
| Rate for Payer: HFN Commercial |
$234.60
|
| Rate for Payer: Multiplan Commercial |
$204.00
|
| Rate for Payer: NAPHCARE Commercial |
$153.00
|
| Rate for Payer: Preferred Network Access Commercial |
$234.60
|
| Rate for Payer: Quartz Beloit One Network |
$124.95
|
| Rate for Payer: Quartz Commercial |
$153.00
|
| Rate for Payer: WEA Trust Commercial |
$140.25
|
| Rate for Payer: WPS Commercial |
$188.88
|
|
|
Zinc, RBC
|
Professional
|
Both
|
$87.00
|
|
|
Service Code
|
CPT 84630
|
| Hospital Charge Code |
4048791
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$38.28 |
| 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 |
$43.50
|
| 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 |
$40.21
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$40.21
|
| 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: WEA Trust Commercial |
$47.85
|
| Rate for Payer: WPS Commercial |
$64.44
|
|
|
Zinc, RBC
|
Facility
|
OP
|
$87.00
|
|
|
Service Code
|
CPT 84630
|
| Hospital Charge Code |
4048791
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.39 |
| Max. Negotiated Rate |
$80.04 |
| Rate for Payer: Aetna Commercial |
$78.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$74.82
|
| Rate for Payer: Aetna Managed Medicare |
$11.39
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$42.71
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$19.93
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$18.91
|
| Rate for Payer: Anthem Medicaid |
$11.77
|
| Rate for Payer: Anthem Medicare Advantage |
$11.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$46.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$11.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$11.39
|
| Rate for Payer: Cash Price |
$26.10
|
| Rate for Payer: Cash Price |
$26.10
|
| Rate for Payer: Cigna Commercial |
$80.04
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$11.39
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$11.77
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$48.69
|
| Rate for Payer: Dean Health Medicaid |
$11.77
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$11.39
|
| Rate for Payer: Health EOS Commercial |
$77.43
|
| Rate for Payer: HFN Commercial |
$80.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$42.37
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$11.39
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$11.77
|
| Rate for Payer: Independent Care Health Plan Medicare |
$11.39
|
| Rate for Payer: Managed Health Services Medicaid |
$12.24
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$11.39
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$11.39
|
| Rate for Payer: Multiplan Commercial |
$69.60
|
| Rate for Payer: NAPHCARE Commercial |
$17.08
|
| Rate for Payer: Preferred Network Access Commercial |
$80.04
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$11.77
|
| Rate for Payer: Quartz Beloit One Network |
$42.63
|
| Rate for Payer: Quartz Commercial |
$56.55
|
| Rate for Payer: Quartz Medicare Advantage |
$11.39
|
| Rate for Payer: The Alliance Commercial |
$45.56
|
| Rate for Payer: United Healthcare Medicaid |
$11.77
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11.39
|
| Rate for Payer: United Healthcare PPO |
$65.25
|
| Rate for Payer: WEA Trust Commercial |
$47.85
|
| Rate for Payer: Wellcare Medicare |
$11.39
|
| Rate for Payer: WMAP Medicaid |
$11.77
|
| Rate for Payer: WPS Commercial |
$64.44
|
|
|
Zinc, RBC
|
Facility
|
IP
|
$87.00
|
|
|
Service Code
|
CPT 84630
|
| Hospital Charge Code |
4048791
|
|
Hospital Revenue Code
|
300
|
| 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
|
|
|
Zinc Transporter 8 Ab
|
Facility
|
IP
|
$84.45
|
|
|
Service Code
|
CPT 86341
|
| Hospital Charge Code |
6222161
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$41.38 |
| Max. Negotiated Rate |
$77.69 |
| Rate for Payer: Aetna Commercial |
$76.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$72.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$44.76
|
| Rate for Payer: Cash Price |
$25.34
|
| Rate for Payer: Cigna Commercial |
$77.69
|
| Rate for Payer: Health EOS Commercial |
$75.16
|
| Rate for Payer: HFN Commercial |
$77.69
|
| Rate for Payer: Multiplan Commercial |
$67.56
|
| Rate for Payer: NAPHCARE Commercial |
$50.67
|
| Rate for Payer: Preferred Network Access Commercial |
$77.69
|
| Rate for Payer: Quartz Beloit One Network |
$41.38
|
| Rate for Payer: Quartz Commercial |
$50.67
|
| Rate for Payer: WEA Trust Commercial |
$46.45
|
| Rate for Payer: WPS Commercial |
$62.55
|
|
|
Zinc Transporter 8 Ab
|
Facility
|
OP
|
$84.45
|
|
|
Service Code
|
CPT 86341
|
| Hospital Charge Code |
6222161
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$19.88 |
| Max. Negotiated Rate |
$94.28 |
| Rate for Payer: Aetna Commercial |
$76.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$72.63
|
| Rate for Payer: Aetna Managed Medicare |
$23.57
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$88.39
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$41.25
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$39.13
|
| Rate for Payer: Anthem Medicaid |
$19.88
|
| Rate for Payer: Anthem Medicare Advantage |
$23.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$44.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$23.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$23.57
|
| Rate for Payer: Cash Price |
$25.34
|
| Rate for Payer: Cash Price |
$25.34
|
| Rate for Payer: Cigna Commercial |
$77.69
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$23.57
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$19.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$47.26
|
| Rate for Payer: Dean Health Medicaid |
$19.88
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$23.57
|
| Rate for Payer: Health EOS Commercial |
$75.16
|
| Rate for Payer: HFN Commercial |
$77.69
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$87.68
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$23.57
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$19.88
|
| Rate for Payer: Independent Care Health Plan Medicare |
$23.57
|
| Rate for Payer: Managed Health Services Medicaid |
$20.68
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$23.57
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$23.57
|
| Rate for Payer: Multiplan Commercial |
$67.56
|
| Rate for Payer: NAPHCARE Commercial |
$35.36
|
| Rate for Payer: Preferred Network Access Commercial |
$77.69
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$19.88
|
| Rate for Payer: Quartz Beloit One Network |
$41.38
|
| Rate for Payer: Quartz Commercial |
$54.89
|
| Rate for Payer: Quartz Medicare Advantage |
$23.57
|
| Rate for Payer: The Alliance Commercial |
$94.28
|
| Rate for Payer: United Healthcare Medicaid |
$19.88
|
| Rate for Payer: United Healthcare Medicare Advantage |
$23.57
|
| Rate for Payer: United Healthcare PPO |
$63.34
|
| Rate for Payer: WEA Trust Commercial |
$46.45
|
| Rate for Payer: Wellcare Medicare |
$23.57
|
| Rate for Payer: WMAP Medicaid |
$19.88
|
| Rate for Payer: WPS Commercial |
$62.55
|
|
|
Zinc Transporter 8 Ab
|
Professional
|
Both
|
$84.45
|
|
|
Service Code
|
CPT 86341
|
| Hospital Charge Code |
6222161
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$37.16 |
| Max. Negotiated Rate |
$83.20 |
| Rate for Payer: Aetna Commercial |
$80.23
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$72.63
|
| Rate for Payer: Cash Price |
$25.34
|
| Rate for Payer: Cash Price |
$25.34
|
| Rate for Payer: Cigna Commercial |
$80.23
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$42.22
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$50.67
|
| Rate for Payer: Health EOS Commercial |
$76.85
|
| Rate for Payer: HFN Commercial |
$80.23
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$83.20
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$83.20
|
| Rate for Payer: Multiplan Commercial |
$67.56
|
| Rate for Payer: Preferred Network Access Commercial |
$80.23
|
| Rate for Payer: Quartz Beloit One Network |
$37.16
|
| Rate for Payer: Quartz Commercial |
$48.14
|
| Rate for Payer: The Alliance Commercial |
$42.22
|
| Rate for Payer: WEA Trust Commercial |
$46.45
|
| Rate for Payer: WPS Commercial |
$62.55
|
|
|
Ziprasidone JW Waste Charge per 10 mg
|
Professional
|
Both
|
$193.00
|
|
|
Service Code
|
HCPCS J3486 JW
|
| Hospital Charge Code |
5266680
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.76 |
| Max. Negotiated Rate |
$183.35 |
| Rate for Payer: Aetna Commercial |
$183.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$165.98
|
| Rate for Payer: Cash Price |
$57.90
|
| Rate for Payer: Cash Price |
$57.90
|
| Rate for Payer: Cigna Commercial |
$183.35
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$9.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$10.22
|
| Rate for Payer: Health EOS Commercial |
$175.63
|
| Rate for Payer: HFN Commercial |
$183.35
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$26.35
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$26.35
|
| Rate for Payer: Multiplan Commercial |
$154.40
|
| Rate for Payer: Preferred Network Access Commercial |
$183.35
|
| Rate for Payer: Quartz Beloit One Network |
$84.92
|
| Rate for Payer: Quartz Commercial |
$110.01
|
| Rate for Payer: The Alliance Commercial |
$96.50
|
| Rate for Payer: United Healthcare Medicaid |
$9.76
|
| Rate for Payer: WEA Trust Commercial |
$106.15
|
| Rate for Payer: WPS Commercial |
$25.55
|
|
|
Ziprasidone JW Waste Charge per 10 mg
|
Facility
|
IP
|
$193.00
|
|
|
Service Code
|
HCPCS J3486 JW
|
| Hospital Charge Code |
5266680
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$94.57 |
| Max. Negotiated Rate |
$177.56 |
| Rate for Payer: Aetna Commercial |
$173.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$165.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$102.29
|
| Rate for Payer: Cash Price |
$57.90
|
| Rate for Payer: Cigna Commercial |
$177.56
|
| Rate for Payer: Health EOS Commercial |
$171.77
|
| Rate for Payer: HFN Commercial |
$177.56
|
| Rate for Payer: Multiplan Commercial |
$154.40
|
| Rate for Payer: NAPHCARE Commercial |
$115.80
|
| Rate for Payer: Preferred Network Access Commercial |
$177.56
|
| Rate for Payer: Quartz Beloit One Network |
$94.57
|
| Rate for Payer: Quartz Commercial |
$115.80
|
| Rate for Payer: WEA Trust Commercial |
$106.15
|
| Rate for Payer: WPS Commercial |
$142.96
|
|
|
Ziprasidone JW Waste Charge per 10 mg
|
Facility
|
OP
|
$193.00
|
|
|
Service Code
|
HCPCS J3486 JW
|
| Hospital Charge Code |
5266680
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.52 |
| Max. Negotiated Rate |
$772.00 |
| Rate for Payer: Aetna Commercial |
$173.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$165.98
|
| Rate for Payer: Aetna Managed Medicare |
$54.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$125.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$96.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$92.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$102.29
|
| Rate for Payer: Cash Price |
$57.90
|
| Rate for Payer: Cash Price |
$57.90
|
| Rate for Payer: Cigna Commercial |
$177.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$13.52
|
| Rate for Payer: Health EOS Commercial |
$171.77
|
| Rate for Payer: HFN Commercial |
$177.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$144.75
|
| Rate for Payer: Multiplan Commercial |
$154.40
|
| Rate for Payer: NAPHCARE Commercial |
$115.80
|
| Rate for Payer: Preferred Network Access Commercial |
$177.56
|
| Rate for Payer: Quartz Beloit One Network |
$94.57
|
| Rate for Payer: Quartz Commercial |
$125.45
|
| Rate for Payer: Quartz Medicare Advantage |
$115.80
|
| Rate for Payer: The Alliance Commercial |
$772.00
|
| Rate for Payer: WEA Trust Commercial |
$106.15
|
| Rate for Payer: WPS Commercial |
$25.55
|
|
|
Ziprasidone Level
|
Professional
|
Both
|
$178.00
|
|
|
Service Code
|
CPT 80342
|
| Hospital Charge Code |
983443
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$78.32 |
| Max. Negotiated Rate |
$169.10 |
| Rate for Payer: Multiplan Commercial |
$142.40
|
| Rate for Payer: Aetna Commercial |
$169.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$153.08
|
| Rate for Payer: Cash Price |
$53.40
|
| Rate for Payer: Cash Price |
$53.40
|
| Rate for Payer: Cigna Commercial |
$169.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$89.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$106.80
|
| Rate for Payer: Health EOS Commercial |
$161.98
|
| Rate for Payer: HFN Commercial |
$169.10
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$80.06
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$80.06
|
| Rate for Payer: Preferred Network Access Commercial |
$169.10
|
| Rate for Payer: Quartz Beloit One Network |
$78.32
|
| Rate for Payer: Quartz Commercial |
$101.46
|
| Rate for Payer: The Alliance Commercial |
$89.00
|
| Rate for Payer: WEA Trust Commercial |
$97.90
|
| Rate for Payer: WPS Commercial |
$131.84
|
|
|
Ziprasidone Level
|
Facility
|
OP
|
$178.00
|
|
|
Service Code
|
CPT 80342
|
| Hospital Charge Code |
983443
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$49.84 |
| Max. Negotiated Rate |
$712.00 |
| Rate for Payer: Aetna Commercial |
$160.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$153.08
|
| Rate for Payer: Aetna Managed Medicare |
$49.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$115.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$89.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$85.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$94.34
|
| Rate for Payer: Cash Price |
$53.40
|
| Rate for Payer: Cigna Commercial |
$163.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$99.61
|
| Rate for Payer: Health EOS Commercial |
$158.42
|
| Rate for Payer: HFN Commercial |
$163.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$133.50
|
| Rate for Payer: Multiplan Commercial |
$142.40
|
| Rate for Payer: NAPHCARE Commercial |
$106.80
|
| Rate for Payer: Preferred Network Access Commercial |
$163.76
|
| Rate for Payer: Quartz Beloit One Network |
$87.22
|
| Rate for Payer: Quartz Commercial |
$115.70
|
| Rate for Payer: Quartz Medicare Advantage |
$106.80
|
| Rate for Payer: The Alliance Commercial |
$712.00
|
| Rate for Payer: United Healthcare PPO |
$133.50
|
| Rate for Payer: WEA Trust Commercial |
$97.90
|
| Rate for Payer: WPS Commercial |
$131.84
|
|
|
Ziprasidone Level
|
Facility
|
IP
|
$178.00
|
|
|
Service Code
|
CPT 80342
|
| Hospital Charge Code |
983443
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$87.22 |
| Max. Negotiated Rate |
$163.76 |
| Rate for Payer: Aetna Commercial |
$160.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$153.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$94.34
|
| Rate for Payer: Cash Price |
$53.40
|
| Rate for Payer: Cigna Commercial |
$163.76
|
| Rate for Payer: Health EOS Commercial |
$158.42
|
| Rate for Payer: HFN Commercial |
$163.76
|
| Rate for Payer: Multiplan Commercial |
$142.40
|
| Rate for Payer: NAPHCARE Commercial |
$106.80
|
| Rate for Payer: Preferred Network Access Commercial |
$163.76
|
| Rate for Payer: Quartz Beloit One Network |
$87.22
|
| Rate for Payer: Quartz Commercial |
$106.80
|
| Rate for Payer: WEA Trust Commercial |
$97.90
|
| Rate for Payer: WPS Commercial |
$131.84
|
|
|
ZIPWIRE .035 X 180CM STIFF ANGLED M00146308B0
|
Facility
|
IP
|
$1,012.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
2973301
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$495.88 |
| Max. Negotiated Rate |
$931.04 |
| Rate for Payer: Aetna Commercial |
$910.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$870.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$536.36
|
| Rate for Payer: Cash Price |
$303.60
|
| Rate for Payer: Cigna Commercial |
$931.04
|
| Rate for Payer: Health EOS Commercial |
$900.68
|
| Rate for Payer: HFN Commercial |
$931.04
|
| Rate for Payer: Multiplan Commercial |
$809.60
|
| Rate for Payer: NAPHCARE Commercial |
$607.20
|
| Rate for Payer: Preferred Network Access Commercial |
$931.04
|
| Rate for Payer: Quartz Beloit One Network |
$495.88
|
| Rate for Payer: Quartz Commercial |
$607.20
|
| Rate for Payer: WEA Trust Commercial |
$556.60
|
| Rate for Payer: WPS Commercial |
$749.59
|
|
|
ZIPWIRE .035 X 180CM STIFF ANGLED M00146308B0
|
Facility
|
OP
|
$1,012.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
2973301
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$283.36 |
| Max. Negotiated Rate |
$4,048.00 |
| Rate for Payer: Aetna Commercial |
$910.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$870.32
|
| Rate for Payer: Aetna Managed Medicare |
$283.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$657.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$506.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$485.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$536.36
|
| Rate for Payer: Cash Price |
$303.60
|
| Rate for Payer: Cigna Commercial |
$931.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$566.32
|
| Rate for Payer: Health EOS Commercial |
$900.68
|
| Rate for Payer: HFN Commercial |
$931.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$759.00
|
| Rate for Payer: Multiplan Commercial |
$809.60
|
| Rate for Payer: NAPHCARE Commercial |
$607.20
|
| Rate for Payer: Preferred Network Access Commercial |
$931.04
|
| Rate for Payer: Quartz Beloit One Network |
$495.88
|
| Rate for Payer: Quartz Commercial |
$657.80
|
| Rate for Payer: Quartz Medicare Advantage |
$607.20
|
| Rate for Payer: The Alliance Commercial |
$4,048.00
|
| Rate for Payer: WEA Trust Commercial |
$556.60
|
| Rate for Payer: WPS Commercial |
$749.59
|
|
|
ZIPWIRE ANGLED TIP 0.018 X 180CM M00146232B0
|
Facility
|
IP
|
$302.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
2973386
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$147.98 |
| Max. Negotiated Rate |
$277.84 |
| Rate for Payer: Aetna Commercial |
$271.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$259.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$160.06
|
| Rate for Payer: Cash Price |
$90.60
|
| Rate for Payer: Cigna Commercial |
$277.84
|
| Rate for Payer: Health EOS Commercial |
$268.78
|
| Rate for Payer: HFN Commercial |
$277.84
|
| Rate for Payer: Multiplan Commercial |
$241.60
|
| Rate for Payer: NAPHCARE Commercial |
$181.20
|
| Rate for Payer: Preferred Network Access Commercial |
$277.84
|
| Rate for Payer: Quartz Beloit One Network |
$147.98
|
| Rate for Payer: Quartz Commercial |
$181.20
|
| Rate for Payer: WEA Trust Commercial |
$166.10
|
| Rate for Payer: WPS Commercial |
$223.69
|
|
