|
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: 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
|
Professional
|
$193.00
|
|
|
Service Code
|
HCPCS J3486 JW
|
| Hospital Charge Code |
5266680
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$84.92 |
| 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: Cigna Commercial |
$183.35
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$96.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$115.80
|
| Rate for Payer: Health EOS Commercial |
$175.63
|
| 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: WEA Trust Commercial |
$106.15
|
| Rate for Payer: WPS Commercial |
$142.96
|
|
|
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 |
$163.76 |
| 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: 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: 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: United Healthcare PPO |
$133.50
|
| Rate for Payer: WEA Trust Commercial |
$97.90
|
| Rate for Payer: WPS Commercial |
$131.84
|
|
|
Ziprasidone Level
|
Professional
|
$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: 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: Humana Commercial/EPO/HMO/POS/PPO |
$80.06
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$80.06
|
| Rate for Payer: Multiplan Commercial |
$142.40
|
| 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
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: 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: 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 |
$931.04 |
| 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: WEA Trust Commercial |
$556.60
|
| Rate for Payer: WPS Commercial |
$749.59
|
|
|
ZIPWIRE ANGLED TIP 0.018 X 180CM M00146232B0
|
Facility
OP
|
$302.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
2973386
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$84.56 |
| Max. Negotiated Rate |
$277.84 |
| Rate for Payer: Aetna Commercial |
$271.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$259.72
|
| Rate for Payer: Aetna Managed Medicare |
$84.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$196.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$151.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$144.96
|
| 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: Dean Health DHI/DHP/ASO |
$169.00
|
| Rate for Payer: Health EOS Commercial |
$268.78
|
| Rate for Payer: HFN Commercial |
$277.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$226.50
|
| 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 |
$196.30
|
| Rate for Payer: Quartz Medicare Advantage |
$181.20
|
| Rate for Payer: WEA Trust Commercial |
$166.10
|
| Rate for Payer: WPS Commercial |
$223.69
|
|
|
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: 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
|
|
|
ZIPWIRE ANGLED TIP 035 X 150 STIFF SHAFT M006630206B0/M0066802060
|
Facility
IP
|
$781.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
5179401
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$382.69 |
| Max. Negotiated Rate |
$718.52 |
| Rate for Payer: Aetna Commercial |
$702.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$413.93
|
| Rate for Payer: Cash Price |
$234.30
|
| Rate for Payer: Cigna Commercial |
$718.52
|
| Rate for Payer: Health EOS Commercial |
$695.09
|
| Rate for Payer: HFN Commercial |
$718.52
|
| Rate for Payer: Multiplan Commercial |
$624.80
|
| Rate for Payer: NAPHCARE Commercial |
$468.60
|
| Rate for Payer: Preferred Network Access Commercial |
$718.52
|
| Rate for Payer: Quartz Beloit One Network |
$382.69
|
| Rate for Payer: Quartz Commercial |
$468.60
|
| Rate for Payer: WEA Trust Commercial |
$429.55
|
| Rate for Payer: WPS Commercial |
$578.49
|
|
|
ZIPWIRE ANGLED TIP 035 X 150 STIFF SHAFT M006630206B0/M0066802060
|
Facility
OP
|
$781.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
5179401
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$218.68 |
| Max. Negotiated Rate |
$718.52 |
| Rate for Payer: Aetna Commercial |
$702.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$671.66
|
| Rate for Payer: Aetna Managed Medicare |
$218.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$507.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$390.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$374.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$413.93
|
| Rate for Payer: Cash Price |
$234.30
|
| Rate for Payer: Cigna Commercial |
$718.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$437.05
|
| Rate for Payer: Health EOS Commercial |
$695.09
|
| Rate for Payer: HFN Commercial |
$718.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$585.75
|
| Rate for Payer: Multiplan Commercial |
$624.80
|
| Rate for Payer: NAPHCARE Commercial |
$468.60
|
| Rate for Payer: Preferred Network Access Commercial |
$718.52
|
| Rate for Payer: Quartz Beloit One Network |
$382.69
|
| Rate for Payer: Quartz Commercial |
$507.65
|
| Rate for Payer: Quartz Medicare Advantage |
$468.60
|
| Rate for Payer: WEA Trust Commercial |
$429.55
|
| Rate for Payer: WPS Commercial |
$578.49
|
|
|
ZIPWIRE STRAIGHT TIP .025 X 150 STIFF SHAFT M006630216B0/M0066802160
|
Facility
IP
|
$901.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
4519969
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$441.49 |
| Max. Negotiated Rate |
$828.92 |
| Rate for Payer: Aetna Commercial |
$810.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$477.53
|
| Rate for Payer: Cash Price |
$270.30
|
| Rate for Payer: Cigna Commercial |
$828.92
|
| Rate for Payer: Health EOS Commercial |
$801.89
|
| Rate for Payer: HFN Commercial |
$828.92
|
| Rate for Payer: Multiplan Commercial |
$720.80
|
| Rate for Payer: NAPHCARE Commercial |
$540.60
|
| Rate for Payer: Preferred Network Access Commercial |
$828.92
|
| Rate for Payer: Quartz Beloit One Network |
$441.49
|
| Rate for Payer: Quartz Commercial |
$540.60
|
| Rate for Payer: WEA Trust Commercial |
$495.55
|
| Rate for Payer: WPS Commercial |
$667.37
|
|
|
ZIPWIRE STRAIGHT TIP .025 X 150 STIFF SHAFT M006630216B0/M0066802160
|
Facility
OP
|
$901.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
4519969
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$252.28 |
| Max. Negotiated Rate |
$828.92 |
| Rate for Payer: Aetna Commercial |
$810.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$774.86
|
| Rate for Payer: Aetna Managed Medicare |
$252.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$585.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$450.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$432.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$477.53
|
| Rate for Payer: Cash Price |
$270.30
|
| Rate for Payer: Cigna Commercial |
$828.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$504.20
|
| Rate for Payer: Health EOS Commercial |
$801.89
|
| Rate for Payer: HFN Commercial |
$828.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$675.75
|
| Rate for Payer: Multiplan Commercial |
$720.80
|
| Rate for Payer: NAPHCARE Commercial |
$540.60
|
| Rate for Payer: Preferred Network Access Commercial |
$828.92
|
| Rate for Payer: Quartz Beloit One Network |
$441.49
|
| Rate for Payer: Quartz Commercial |
$585.65
|
| Rate for Payer: Quartz Medicare Advantage |
$540.60
|
| Rate for Payer: WEA Trust Commercial |
$495.55
|
| Rate for Payer: WPS Commercial |
$667.37
|
|
|
ZIPWIRE STRAIGHT TIP .035 X 150 STIFF SHAFT M0066802220
|
Facility
OP
|
$901.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
4519134
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$252.28 |
| Max. Negotiated Rate |
$828.92 |
| Rate for Payer: Aetna Commercial |
$810.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$774.86
|
| Rate for Payer: Aetna Managed Medicare |
$252.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$585.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$450.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$432.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$477.53
|
| Rate for Payer: Cash Price |
$270.30
|
| Rate for Payer: Cigna Commercial |
$828.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$504.20
|
| Rate for Payer: Health EOS Commercial |
$801.89
|
| Rate for Payer: HFN Commercial |
$828.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$675.75
|
| Rate for Payer: Multiplan Commercial |
$720.80
|
| Rate for Payer: NAPHCARE Commercial |
$540.60
|
| Rate for Payer: Preferred Network Access Commercial |
$828.92
|
| Rate for Payer: Quartz Beloit One Network |
$441.49
|
| Rate for Payer: Quartz Commercial |
$585.65
|
| Rate for Payer: Quartz Medicare Advantage |
$540.60
|
| Rate for Payer: WEA Trust Commercial |
$495.55
|
| Rate for Payer: WPS Commercial |
$667.37
|
|
|
ZIPWIRE STRAIGHT TIP .035 X 150 STIFF SHAFT M0066802220
|
Facility
IP
|
$901.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
4519134
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$441.49 |
| Max. Negotiated Rate |
$828.92 |
| Rate for Payer: Aetna Commercial |
$810.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$477.53
|
| Rate for Payer: Cash Price |
$270.30
|
| Rate for Payer: Cigna Commercial |
$828.92
|
| Rate for Payer: Health EOS Commercial |
$801.89
|
| Rate for Payer: HFN Commercial |
$828.92
|
| Rate for Payer: Multiplan Commercial |
$720.80
|
| Rate for Payer: NAPHCARE Commercial |
$540.60
|
| Rate for Payer: Preferred Network Access Commercial |
$828.92
|
| Rate for Payer: Quartz Beloit One Network |
$441.49
|
| Rate for Payer: Quartz Commercial |
$540.60
|
| Rate for Payer: WEA Trust Commercial |
$495.55
|
| Rate for Payer: WPS Commercial |
$667.37
|
|
|
ZIPWIRE STRAIGHT TIP .038 X 150 STIFF SHAFT M0066802250
|
Facility
IP
|
$974.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
4519970
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$477.26 |
| Max. Negotiated Rate |
$896.08 |
| Rate for Payer: Aetna Commercial |
$876.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$516.22
|
| Rate for Payer: Cash Price |
$292.20
|
| Rate for Payer: Cigna Commercial |
$896.08
|
| Rate for Payer: Health EOS Commercial |
$866.86
|
| Rate for Payer: HFN Commercial |
$896.08
|
| Rate for Payer: Multiplan Commercial |
$779.20
|
| Rate for Payer: NAPHCARE Commercial |
$584.40
|
| Rate for Payer: Preferred Network Access Commercial |
$896.08
|
| Rate for Payer: Quartz Beloit One Network |
$477.26
|
| Rate for Payer: Quartz Commercial |
$584.40
|
| Rate for Payer: WEA Trust Commercial |
$535.70
|
| Rate for Payer: WPS Commercial |
$721.44
|
|
|
ZIPWIRE STRAIGHT TIP .038 X 150 STIFF SHAFT M0066802250
|
Facility
OP
|
$974.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
4519970
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$272.72 |
| Max. Negotiated Rate |
$896.08 |
| Rate for Payer: Aetna Commercial |
$876.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$837.64
|
| Rate for Payer: Aetna Managed Medicare |
$272.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$633.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$487.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$467.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$516.22
|
| Rate for Payer: Cash Price |
$292.20
|
| Rate for Payer: Cigna Commercial |
$896.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$545.05
|
| Rate for Payer: Health EOS Commercial |
$866.86
|
| Rate for Payer: HFN Commercial |
$896.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$730.50
|
| Rate for Payer: Multiplan Commercial |
$779.20
|
| Rate for Payer: NAPHCARE Commercial |
$584.40
|
| Rate for Payer: Preferred Network Access Commercial |
$896.08
|
| Rate for Payer: Quartz Beloit One Network |
$477.26
|
| Rate for Payer: Quartz Commercial |
$633.10
|
| Rate for Payer: Quartz Medicare Advantage |
$584.40
|
| Rate for Payer: WEA Trust Commercial |
$535.70
|
| Rate for Payer: WPS Commercial |
$721.44
|
|
|
Zonisamide (Zonegran)
|
Facility
IP
|
$235.00
|
|
|
Service Code
|
CPT 80203
|
| Hospital Charge Code |
983444
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$115.15 |
| Max. Negotiated Rate |
$216.20 |
| Rate for Payer: Aetna Commercial |
$211.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$124.55
|
| Rate for Payer: Cash Price |
$70.50
|
| Rate for Payer: Cigna Commercial |
$216.20
|
| Rate for Payer: Health EOS Commercial |
$209.15
|
| Rate for Payer: HFN Commercial |
$216.20
|
| Rate for Payer: Multiplan Commercial |
$188.00
|
| Rate for Payer: NAPHCARE Commercial |
$141.00
|
| Rate for Payer: Preferred Network Access Commercial |
$216.20
|
| Rate for Payer: Quartz Beloit One Network |
$115.15
|
| Rate for Payer: Quartz Commercial |
$141.00
|
| Rate for Payer: WEA Trust Commercial |
$129.25
|
| Rate for Payer: WPS Commercial |
$174.06
|
|
|
Zonisamide (Zonegran)
|
Professional
|
$235.00
|
|
|
Service Code
|
CPT 80203
|
| Hospital Charge Code |
983444
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.25 |
| Max. Negotiated Rate |
$223.25 |
| Rate for Payer: Aetna Commercial |
$223.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$202.10
|
| Rate for Payer: Aetna Managed Medicare |
$13.25
|
| Rate for Payer: Anthem Medicare Advantage |
$13.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13.25
|
| Rate for Payer: Cash Price |
$70.50
|
| Rate for Payer: Cash Price |
$70.50
|
| Rate for Payer: Cigna Commercial |
$223.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$117.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$13.25
|
| Rate for Payer: Health EOS Commercial |
$213.85
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$46.77
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$46.77
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13.25
|
| Rate for Payer: Multiplan Commercial |
$188.00
|
| Rate for Payer: Preferred Network Access Commercial |
$223.25
|
| Rate for Payer: Quartz Beloit One Network |
$103.40
|
| Rate for Payer: Quartz Commercial |
$133.95
|
| Rate for Payer: Quartz Medicare Advantage |
$13.25
|
| Rate for Payer: The Alliance Commercial |
$52.34
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.25
|
| Rate for Payer: WEA Trust Commercial |
$129.25
|
| Rate for Payer: WPS Commercial |
$58.30
|
|
|
Zonisamide (Zonegran)
|
Facility
OP
|
$235.00
|
|
|
Service Code
|
CPT 80203
|
| Hospital Charge Code |
983444
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.25 |
| Max. Negotiated Rate |
$940.00 |
| Rate for Payer: Aetna Commercial |
$211.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$202.10
|
| Rate for Payer: Aetna Managed Medicare |
$13.25
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$49.69
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$23.19
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$22.00
|
| Rate for Payer: Anthem Medicaid |
$13.69
|
| Rate for Payer: Anthem Medicare Advantage |
$13.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$124.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13.25
|
| Rate for Payer: Cash Price |
$70.50
|
| Rate for Payer: Cash Price |
$70.50
|
| Rate for Payer: Cigna Commercial |
$216.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$13.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$13.69
|
| Rate for Payer: Dean Health Medicaid |
$13.69
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$13.25
|
| Rate for Payer: Health EOS Commercial |
$209.15
|
| Rate for Payer: HFN Commercial |
$216.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$49.29
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$13.25
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$13.69
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13.25
|
| Rate for Payer: Managed Health Services Medicaid |
$14.24
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$13.25
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$13.25
|
| Rate for Payer: Multiplan Commercial |
$188.00
|
| Rate for Payer: NAPHCARE Commercial |
$19.88
|
| Rate for Payer: Preferred Network Access Commercial |
$216.20
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$13.69
|
| Rate for Payer: Quartz Beloit One Network |
$115.15
|
| Rate for Payer: Quartz Commercial |
$152.75
|
| Rate for Payer: Quartz Medicare Advantage |
$13.25
|
| Rate for Payer: The Alliance Commercial |
$940.00
|
| Rate for Payer: United Healthcare Medicaid |
$13.69
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.25
|
| Rate for Payer: United Healthcare PPO |
$176.25
|
| Rate for Payer: WEA Trust Commercial |
$129.25
|
| Rate for Payer: Wellcare Medicare |
$13.25
|
| Rate for Payer: WMAP Medicaid |
$13.69
|
| Rate for Payer: WPS Commercial |
$174.06
|
|
|
Zoster Vacc, SC 90736 man
|
Facility
IP
|
$484.00
|
|
|
Service Code
|
CPT 90736
|
| Hospital Charge Code |
3369597
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$237.16 |
| Max. Negotiated Rate |
$445.28 |
| Rate for Payer: Aetna Commercial |
$435.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$256.52
|
| Rate for Payer: Cash Price |
$145.20
|
| Rate for Payer: Cigna Commercial |
$445.28
|
| Rate for Payer: Health EOS Commercial |
$430.76
|
| Rate for Payer: HFN Commercial |
$445.28
|
| Rate for Payer: Multiplan Commercial |
$387.20
|
| Rate for Payer: NAPHCARE Commercial |
$290.40
|
| Rate for Payer: Preferred Network Access Commercial |
$445.28
|
| Rate for Payer: Quartz Beloit One Network |
$237.16
|
| Rate for Payer: Quartz Commercial |
$290.40
|
| Rate for Payer: WEA Trust Commercial |
$266.20
|
| Rate for Payer: WPS Commercial |
$358.50
|
|
|
Zoster Vacc, SC 90736 man
|
Professional
|
$484.00
|
|
|
Service Code
|
CPT 90736
|
| Hospital Charge Code |
3369597
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$180.69 |
| Max. Negotiated Rate |
$459.80 |
| Rate for Payer: Aetna Commercial |
$459.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$416.24
|
| Rate for Payer: Cash Price |
$145.20
|
| Rate for Payer: Cash Price |
$145.20
|
| Rate for Payer: Cigna Commercial |
$459.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$242.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$290.40
|
| Rate for Payer: Health EOS Commercial |
$440.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$353.96
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$353.96
|
| Rate for Payer: Multiplan Commercial |
$387.20
|
| Rate for Payer: Preferred Network Access Commercial |
$459.80
|
| Rate for Payer: Quartz Beloit One Network |
$212.96
|
| Rate for Payer: Quartz Commercial |
$275.88
|
| Rate for Payer: The Alliance Commercial |
$242.00
|
| Rate for Payer: United Healthcare Medicaid |
$180.69
|
| Rate for Payer: WEA Trust Commercial |
$266.20
|
| Rate for Payer: WPS Commercial |
$358.50
|
|
|
Zoster Vacc, SC 90736 man
|
Facility
OP
|
$484.00
|
|
|
Service Code
|
CPT 90736
|
| Hospital Charge Code |
3369597
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$135.52 |
| Max. Negotiated Rate |
$1,936.00 |
| Rate for Payer: Aetna Commercial |
$435.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$416.24
|
| Rate for Payer: Aetna Managed Medicare |
$135.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$314.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$242.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$232.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$256.52
|
| Rate for Payer: Cash Price |
$145.20
|
| Rate for Payer: Cigna Commercial |
$445.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$270.85
|
| Rate for Payer: Health EOS Commercial |
$430.76
|
| Rate for Payer: HFN Commercial |
$445.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$363.00
|
| Rate for Payer: Multiplan Commercial |
$387.20
|
| Rate for Payer: NAPHCARE Commercial |
$290.40
|
| Rate for Payer: Preferred Network Access Commercial |
$445.28
|
| Rate for Payer: Quartz Beloit One Network |
$237.16
|
| Rate for Payer: Quartz Commercial |
$314.60
|
| Rate for Payer: Quartz Medicare Advantage |
$290.40
|
| Rate for Payer: The Alliance Commercial |
$1,936.00
|
| Rate for Payer: WEA Trust Commercial |
$266.20
|
| Rate for Payer: WPS Commercial |
$358.50
|
|
|
Z-PLASTY WOUND REVISION
|
Facility
IP
|
$1,006.00
|
|
| Hospital Charge Code |
2960515
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$492.94 |
| Max. Negotiated Rate |
$925.52 |
| Rate for Payer: Aetna Commercial |
$905.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$533.18
|
| Rate for Payer: Cash Price |
$301.80
|
| Rate for Payer: Cigna Commercial |
$925.52
|
| Rate for Payer: Health EOS Commercial |
$895.34
|
| Rate for Payer: HFN Commercial |
$925.52
|
| Rate for Payer: Multiplan Commercial |
$804.80
|
| Rate for Payer: NAPHCARE Commercial |
$603.60
|
| Rate for Payer: Preferred Network Access Commercial |
$925.52
|
| Rate for Payer: Quartz Beloit One Network |
$492.94
|
| Rate for Payer: Quartz Commercial |
$603.60
|
| Rate for Payer: WEA Trust Commercial |
$553.30
|
| Rate for Payer: WPS Commercial |
$745.14
|
|
|
Z-PLASTY WOUND REVISION
|
Facility
OP
|
$1,006.00
|
|
| Hospital Charge Code |
2960515
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$281.68 |
| Max. Negotiated Rate |
$4,024.00 |
| Rate for Payer: Aetna Commercial |
$905.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$865.16
|
| Rate for Payer: Aetna Managed Medicare |
$281.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$653.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$503.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$482.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$533.18
|
| Rate for Payer: Cash Price |
$301.80
|
| Rate for Payer: Cigna Commercial |
$925.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$562.96
|
| Rate for Payer: Health EOS Commercial |
$895.34
|
| Rate for Payer: HFN Commercial |
$925.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$754.50
|
| Rate for Payer: Multiplan Commercial |
$804.80
|
| Rate for Payer: NAPHCARE Commercial |
$603.60
|
| Rate for Payer: Preferred Network Access Commercial |
$925.52
|
| Rate for Payer: Quartz Beloit One Network |
$492.94
|
| Rate for Payer: Quartz Commercial |
$653.90
|
| Rate for Payer: Quartz Medicare Advantage |
$603.60
|
| Rate for Payer: The Alliance Commercial |
$4,024.00
|
| Rate for Payer: WEA Trust Commercial |
$553.30
|
| Rate for Payer: WPS Commercial |
$745.14
|
|
