|
Zemplar Supplies
|
Facility
|
OP
|
$5.00
|
|
| Hospital Charge Code |
3005576
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1.46 |
| Max. Negotiated Rate |
$4.78 |
| Rate for Payer: Aetna Commercial |
$4.68
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4.47
|
| Rate for Payer: Aetna Managed Medicare |
$1.46
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3.38
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2.76
|
| Rate for Payer: Cash Price |
$1.50
|
| Rate for Payer: Cigna Commercial |
$4.78
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2.91
|
| Rate for Payer: Health EOS Commercial |
$4.63
|
| Rate for Payer: HFN Commercial |
$4.78
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3.90
|
| Rate for Payer: Multiplan Commercial |
$4.16
|
| Rate for Payer: NAPHCARE Commercial |
$3.12
|
| Rate for Payer: Preferred Network Access Commercial |
$4.78
|
| Rate for Payer: Quartz Beloit One Network |
$2.55
|
| Rate for Payer: Quartz Commercial |
$3.38
|
| Rate for Payer: Quartz Medicare Advantage |
$3.12
|
| Rate for Payer: The Alliance Commercial |
$2.60
|
| Rate for Payer: WEA Trust Commercial |
$2.86
|
| Rate for Payer: WPS Commercial |
$3.85
|
|
|
ZENKERS DIVERTICULECTOMY
|
Facility
|
OP
|
$4,460.00
|
|
| Hospital Charge Code |
2960514
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,298.75 |
| Max. Negotiated Rate |
$4,267.33 |
| Rate for Payer: Aetna Commercial |
$4,174.56
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,989.02
|
| Rate for Payer: Aetna Managed Medicare |
$1,298.75
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,014.96
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,319.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,226.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,458.35
|
| Rate for Payer: Cash Price |
$1,338.00
|
| Rate for Payer: Cigna Commercial |
$4,267.33
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,595.72
|
| Rate for Payer: Health EOS Commercial |
$4,128.18
|
| Rate for Payer: HFN Commercial |
$4,267.33
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,478.80
|
| Rate for Payer: Multiplan Commercial |
$3,710.72
|
| Rate for Payer: NAPHCARE Commercial |
$2,783.04
|
| Rate for Payer: Preferred Network Access Commercial |
$4,267.33
|
| Rate for Payer: Quartz Beloit One Network |
$2,272.82
|
| Rate for Payer: Quartz Commercial |
$3,014.96
|
| Rate for Payer: Quartz Medicare Advantage |
$2,783.04
|
| Rate for Payer: The Alliance Commercial |
$2,319.20
|
| Rate for Payer: WEA Trust Commercial |
$2,551.12
|
| Rate for Payer: WPS Commercial |
$3,435.54
|
|
|
ZENKERS DIVERTICULECTOMY
|
Facility
|
IP
|
$4,460.00
|
|
| Hospital Charge Code |
2960514
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,272.82 |
| Max. Negotiated Rate |
$4,267.33 |
| Rate for Payer: Aetna Commercial |
$4,174.56
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,989.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,458.35
|
| Rate for Payer: Cash Price |
$1,338.00
|
| Rate for Payer: Cigna Commercial |
$4,267.33
|
| Rate for Payer: Health EOS Commercial |
$4,128.18
|
| Rate for Payer: HFN Commercial |
$4,267.33
|
| Rate for Payer: Multiplan Commercial |
$3,710.72
|
| Rate for Payer: Preferred Network Access Commercial |
$4,267.33
|
| Rate for Payer: Quartz Beloit One Network |
$2,272.82
|
| Rate for Payer: Quartz Commercial |
$2,783.04
|
| Rate for Payer: WEA Trust Commercial |
$2,551.12
|
| Rate for Payer: WPS Commercial |
$3,435.54
|
|
|
Z-Flo Specialty Pillow - CCC Z-Flo Specialty Pillow
|
Facility
|
IP
|
$988.00
|
|
| Hospital Charge Code |
5804416
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$503.48 |
| Max. Negotiated Rate |
$945.32 |
| Rate for Payer: Aetna Commercial |
$924.77
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$883.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$544.59
|
| Rate for Payer: Cash Price |
$296.40
|
| Rate for Payer: Cigna Commercial |
$945.32
|
| Rate for Payer: Health EOS Commercial |
$914.49
|
| Rate for Payer: HFN Commercial |
$945.32
|
| Rate for Payer: Multiplan Commercial |
$822.02
|
| Rate for Payer: Preferred Network Access Commercial |
$945.32
|
| Rate for Payer: Quartz Beloit One Network |
$503.48
|
| Rate for Payer: Quartz Commercial |
$616.51
|
| Rate for Payer: WEA Trust Commercial |
$565.14
|
| Rate for Payer: WPS Commercial |
$761.06
|
|
|
Z-Flo Specialty Pillow - CCC Z-Flo Specialty Pillow
|
Facility
|
OP
|
$988.00
|
|
| Hospital Charge Code |
5804416
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$287.71 |
| Max. Negotiated Rate |
$945.32 |
| Rate for Payer: Aetna Commercial |
$924.77
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$883.67
|
| Rate for Payer: Aetna Managed Medicare |
$287.71
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$667.89
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$513.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$493.21
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$544.59
|
| Rate for Payer: Cash Price |
$296.40
|
| Rate for Payer: Cigna Commercial |
$945.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$575.02
|
| Rate for Payer: Health EOS Commercial |
$914.49
|
| Rate for Payer: HFN Commercial |
$945.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$770.64
|
| Rate for Payer: Multiplan Commercial |
$822.02
|
| Rate for Payer: NAPHCARE Commercial |
$616.51
|
| Rate for Payer: Preferred Network Access Commercial |
$945.32
|
| Rate for Payer: Quartz Beloit One Network |
$503.48
|
| Rate for Payer: Quartz Commercial |
$667.89
|
| Rate for Payer: Quartz Medicare Advantage |
$616.51
|
| Rate for Payer: The Alliance Commercial |
$513.76
|
| Rate for Payer: WEA Trust Commercial |
$565.14
|
| Rate for Payer: WPS Commercial |
$761.06
|
|
|
Zika Virus RNA, Qualitative PCR
|
Professional
|
Both
|
$783.00
|
|
|
Service Code
|
CPT 87662
|
| Hospital Charge Code |
4638630
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$53.36 |
| Max. Negotiated Rate |
$773.60 |
| Rate for Payer: Aetna Commercial |
$773.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$700.32
|
| Rate for Payer: Aetna Managed Medicare |
$53.36
|
| Rate for Payer: Anthem Medicare Advantage |
$53.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$53.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$53.36
|
| Rate for Payer: Cash Price |
$234.90
|
| Rate for Payer: Cash Price |
$234.90
|
| Rate for Payer: Cigna Commercial |
$773.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$407.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$53.36
|
| Rate for Payer: Health EOS Commercial |
$741.03
|
| Rate for Payer: HFN Commercial |
$773.60
|
| Rate for Payer: Independent Care Health Plan Medicare |
$53.36
|
| Rate for Payer: Multiplan Commercial |
$651.46
|
| Rate for Payer: NAPHCARE Commercial |
$80.04
|
| Rate for Payer: Preferred Network Access Commercial |
$773.60
|
| Rate for Payer: Quartz Beloit One Network |
$358.30
|
| Rate for Payer: Quartz Commercial |
$464.16
|
| Rate for Payer: Quartz Medicare Advantage |
$53.36
|
| Rate for Payer: The Alliance Commercial |
$210.78
|
| Rate for Payer: United Healthcare Medicare Advantage |
$53.36
|
| Rate for Payer: WEA Trust Commercial |
$447.88
|
| Rate for Payer: WPS Commercial |
$234.79
|
|
|
Zika Virus RNA, Qualitative PCR
|
Facility
|
OP
|
$783.00
|
|
|
Service Code
|
CPT 87662
|
| Hospital Charge Code |
4638630
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$53.36 |
| Max. Negotiated Rate |
$749.17 |
| Rate for Payer: Aetna Commercial |
$732.89
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$700.32
|
| Rate for Payer: Aetna Managed Medicare |
$53.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$200.11
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$93.38
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$88.58
|
| Rate for Payer: Anthem Medicare Advantage |
$53.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$431.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$53.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$53.36
|
| Rate for Payer: Cash Price |
$234.90
|
| Rate for Payer: Cash Price |
$234.90
|
| Rate for Payer: Cigna Commercial |
$749.17
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$53.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$455.71
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$53.36
|
| Rate for Payer: Health EOS Commercial |
$724.74
|
| Rate for Payer: HFN Commercial |
$749.17
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$198.51
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$53.36
|
| Rate for Payer: Independent Care Health Plan Medicare |
$53.36
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$53.36
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$53.36
|
| Rate for Payer: Multiplan Commercial |
$651.46
|
| Rate for Payer: NAPHCARE Commercial |
$80.04
|
| Rate for Payer: Preferred Network Access Commercial |
$749.17
|
| Rate for Payer: Quartz Beloit One Network |
$399.02
|
| Rate for Payer: Quartz Commercial |
$529.31
|
| Rate for Payer: Quartz Medicare Advantage |
$53.36
|
| Rate for Payer: The Alliance Commercial |
$213.45
|
| Rate for Payer: United Healthcare Medicare Advantage |
$53.36
|
| Rate for Payer: United Healthcare PPO |
$610.74
|
| Rate for Payer: WEA Trust Commercial |
$447.88
|
| Rate for Payer: Wellcare Medicare |
$53.36
|
| Rate for Payer: WPS Commercial |
$603.14
|
|
|
Zika Virus RNA, Qualitative PCR
|
Facility
|
IP
|
$783.00
|
|
|
Service Code
|
CPT 87662
|
| Hospital Charge Code |
4638630
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$399.02 |
| Max. Negotiated Rate |
$749.17 |
| Rate for Payer: Aetna Commercial |
$732.89
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$700.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$431.59
|
| Rate for Payer: Cash Price |
$234.90
|
| Rate for Payer: Cigna Commercial |
$749.17
|
| Rate for Payer: Health EOS Commercial |
$724.74
|
| Rate for Payer: HFN Commercial |
$749.17
|
| Rate for Payer: Multiplan Commercial |
$651.46
|
| Rate for Payer: Preferred Network Access Commercial |
$749.17
|
| Rate for Payer: Quartz Beloit One Network |
$399.02
|
| Rate for Payer: Quartz Commercial |
$488.59
|
| Rate for Payer: WEA Trust Commercial |
$447.88
|
| Rate for Payer: WPS Commercial |
$603.14
|
|
|
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 |
$673.18 |
| Max. Negotiated Rate |
$1,263.93 |
| Rate for Payer: Aetna Commercial |
$1,236.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,181.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$728.14
|
| Rate for Payer: Cash Price |
$396.30
|
| Rate for Payer: Cigna Commercial |
$1,263.93
|
| Rate for Payer: Health EOS Commercial |
$1,222.72
|
| Rate for Payer: HFN Commercial |
$1,263.93
|
| Rate for Payer: Multiplan Commercial |
$1,099.07
|
| Rate for Payer: Preferred Network Access Commercial |
$1,263.93
|
| Rate for Payer: Quartz Beloit One Network |
$673.18
|
| Rate for Payer: Quartz Commercial |
$824.30
|
| Rate for Payer: WEA Trust Commercial |
$755.61
|
| Rate for Payer: WPS Commercial |
$1,017.57
|
|
|
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 |
$19.32 |
| Max. Negotiated Rate |
$1,305.15 |
| Rate for Payer: Aetna Commercial |
$1,305.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,181.50
|
| Rate for Payer: Aetna Managed Medicare |
$19.32
|
| Rate for Payer: Anthem Medicare Advantage |
$19.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$19.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$19.32
|
| Rate for Payer: Cash Price |
$396.30
|
| Rate for Payer: Cash Price |
$396.30
|
| Rate for Payer: Cigna Commercial |
$1,305.15
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$686.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$19.32
|
| Rate for Payer: Health EOS Commercial |
$1,250.19
|
| Rate for Payer: HFN Commercial |
$1,305.15
|
| Rate for Payer: Independent Care Health Plan Medicare |
$19.32
|
| Rate for Payer: Multiplan Commercial |
$1,099.07
|
| Rate for Payer: NAPHCARE Commercial |
$28.98
|
| Rate for Payer: Preferred Network Access Commercial |
$1,305.15
|
| Rate for Payer: Quartz Beloit One Network |
$604.49
|
| Rate for Payer: Quartz Commercial |
$783.09
|
| Rate for Payer: Quartz Medicare Advantage |
$19.32
|
| Rate for Payer: The Alliance Commercial |
$53.14
|
| Rate for Payer: United Healthcare Medicaid |
$19.32
|
| Rate for Payer: United Healthcare Medicare Advantage |
$19.32
|
| Rate for Payer: WEA Trust Commercial |
$755.61
|
| Rate for Payer: WPS Commercial |
$33.82
|
|
|
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 |
$19.32 |
| Max. Negotiated Rate |
$1,263.93 |
| Rate for Payer: Aetna Commercial |
$1,236.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,181.50
|
| Rate for Payer: Aetna Managed Medicare |
$19.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$893.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$686.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$659.44
|
| Rate for Payer: Anthem Medicare Advantage |
$19.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$728.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$19.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$19.32
|
| Rate for Payer: Cash Price |
$396.30
|
| Rate for Payer: Cash Price |
$396.30
|
| Rate for Payer: Cigna Commercial |
$1,263.93
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$19.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$768.82
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$19.32
|
| Rate for Payer: Health EOS Commercial |
$1,222.72
|
| Rate for Payer: HFN Commercial |
$1,263.93
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$71.88
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$19.32
|
| Rate for Payer: Independent Care Health Plan Medicare |
$19.32
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$19.32
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$19.32
|
| Rate for Payer: Multiplan Commercial |
$1,099.07
|
| Rate for Payer: NAPHCARE Commercial |
$28.98
|
| Rate for Payer: Preferred Network Access Commercial |
$1,263.93
|
| Rate for Payer: Quartz Beloit One Network |
$673.18
|
| Rate for Payer: Quartz Commercial |
$893.00
|
| Rate for Payer: Quartz Medicare Advantage |
$19.32
|
| Rate for Payer: The Alliance Commercial |
$77.29
|
| Rate for Payer: United Healthcare Medicare Advantage |
$19.32
|
| Rate for Payer: WEA Trust Commercial |
$755.61
|
| Rate for Payer: Wellcare Medicare |
$19.32
|
| Rate for Payer: WPS Commercial |
$1,017.57
|
|
|
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 |
$19.32 |
| Max. Negotiated Rate |
$1,263.93 |
| Rate for Payer: Aetna Commercial |
$1,236.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,181.50
|
| Rate for Payer: Aetna Managed Medicare |
$19.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$893.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$686.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$659.44
|
| Rate for Payer: Anthem Medicare Advantage |
$19.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$728.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$19.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$19.32
|
| Rate for Payer: Cash Price |
$396.30
|
| Rate for Payer: Cash Price |
$396.30
|
| Rate for Payer: Cigna Commercial |
$1,263.93
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$19.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$768.82
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$19.32
|
| Rate for Payer: Health EOS Commercial |
$1,222.72
|
| Rate for Payer: HFN Commercial |
$1,263.93
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$71.88
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$19.32
|
| Rate for Payer: Independent Care Health Plan Medicare |
$19.32
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$19.32
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$19.32
|
| Rate for Payer: Multiplan Commercial |
$1,099.07
|
| Rate for Payer: NAPHCARE Commercial |
$28.98
|
| Rate for Payer: Preferred Network Access Commercial |
$1,263.93
|
| Rate for Payer: Quartz Beloit One Network |
$673.18
|
| Rate for Payer: Quartz Commercial |
$893.00
|
| Rate for Payer: Quartz Medicare Advantage |
$19.32
|
| Rate for Payer: The Alliance Commercial |
$77.29
|
| Rate for Payer: United Healthcare Medicare Advantage |
$19.32
|
| Rate for Payer: WEA Trust Commercial |
$755.61
|
| Rate for Payer: Wellcare Medicare |
$19.32
|
| Rate for Payer: WPS Commercial |
$1,017.57
|
|
|
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 |
$673.18 |
| Max. Negotiated Rate |
$1,263.93 |
| Rate for Payer: Health EOS Commercial |
$1,222.72
|
| Rate for Payer: Aetna Commercial |
$1,236.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,181.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$728.14
|
| Rate for Payer: Cash Price |
$396.30
|
| Rate for Payer: Cigna Commercial |
$1,263.93
|
| Rate for Payer: HFN Commercial |
$1,263.93
|
| Rate for Payer: Multiplan Commercial |
$1,099.07
|
| Rate for Payer: Preferred Network Access Commercial |
$1,263.93
|
| Rate for Payer: Quartz Beloit One Network |
$673.18
|
| Rate for Payer: Quartz Commercial |
$824.30
|
| Rate for Payer: WEA Trust Commercial |
$755.61
|
| Rate for Payer: WPS Commercial |
$1,017.57
|
|
|
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 |
$19.32 |
| Max. Negotiated Rate |
$1,305.15 |
| Rate for Payer: Aetna Commercial |
$1,305.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,181.50
|
| Rate for Payer: Aetna Managed Medicare |
$19.32
|
| Rate for Payer: Anthem Medicare Advantage |
$19.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$19.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$19.32
|
| Rate for Payer: Cash Price |
$396.30
|
| Rate for Payer: Cash Price |
$396.30
|
| Rate for Payer: Cigna Commercial |
$1,305.15
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$686.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$19.32
|
| Rate for Payer: Health EOS Commercial |
$1,250.19
|
| Rate for Payer: HFN Commercial |
$1,305.15
|
| Rate for Payer: Independent Care Health Plan Medicare |
$19.32
|
| Rate for Payer: Multiplan Commercial |
$1,099.07
|
| Rate for Payer: NAPHCARE Commercial |
$28.98
|
| Rate for Payer: Preferred Network Access Commercial |
$1,305.15
|
| Rate for Payer: Quartz Beloit One Network |
$604.49
|
| Rate for Payer: Quartz Commercial |
$783.09
|
| Rate for Payer: Quartz Medicare Advantage |
$19.32
|
| Rate for Payer: The Alliance Commercial |
$53.14
|
| Rate for Payer: United Healthcare Medicaid |
$19.32
|
| Rate for Payer: United Healthcare Medicare Advantage |
$19.32
|
| Rate for Payer: WEA Trust Commercial |
$755.61
|
| Rate for Payer: WPS Commercial |
$33.82
|
|
|
Zinc Level
|
Facility
|
IP
|
$162.00
|
|
|
Service Code
|
CPT 84630
|
| Hospital Charge Code |
978099
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$82.56 |
| Max. Negotiated Rate |
$155.00 |
| Rate for Payer: Aetna Commercial |
$151.63
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$144.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$89.29
|
| Rate for Payer: Cash Price |
$48.60
|
| Rate for Payer: Cigna Commercial |
$155.00
|
| Rate for Payer: Health EOS Commercial |
$149.95
|
| Rate for Payer: HFN Commercial |
$155.00
|
| Rate for Payer: Multiplan Commercial |
$134.78
|
| Rate for Payer: Preferred Network Access Commercial |
$155.00
|
| Rate for Payer: Quartz Beloit One Network |
$82.56
|
| Rate for Payer: Quartz Commercial |
$101.09
|
| Rate for Payer: WEA Trust Commercial |
$92.66
|
| Rate for Payer: WPS Commercial |
$124.79
|
|
|
Zinc Level
|
Facility
|
OP
|
$162.00
|
|
|
Service Code
|
CPT 84630
|
| Hospital Charge Code |
978099
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.85 |
| Max. Negotiated Rate |
$155.00 |
| Rate for Payer: Aetna Commercial |
$151.63
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$144.89
|
| Rate for Payer: Aetna Managed Medicare |
$11.85
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$44.42
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$20.73
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$19.66
|
| Rate for Payer: Anthem Medicare Advantage |
$11.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$89.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$11.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$11.85
|
| Rate for Payer: Cash Price |
$48.60
|
| Rate for Payer: Cash Price |
$48.60
|
| Rate for Payer: Cigna Commercial |
$155.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$11.85
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$94.28
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$11.85
|
| Rate for Payer: Health EOS Commercial |
$149.95
|
| Rate for Payer: HFN Commercial |
$155.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$44.07
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$11.85
|
| Rate for Payer: Independent Care Health Plan Medicare |
$11.85
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$11.85
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$11.85
|
| Rate for Payer: Multiplan Commercial |
$134.78
|
| Rate for Payer: NAPHCARE Commercial |
$17.77
|
| Rate for Payer: Preferred Network Access Commercial |
$155.00
|
| Rate for Payer: Quartz Beloit One Network |
$82.56
|
| Rate for Payer: Quartz Commercial |
$109.51
|
| Rate for Payer: Quartz Medicare Advantage |
$11.85
|
| Rate for Payer: The Alliance Commercial |
$47.38
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11.85
|
| Rate for Payer: United Healthcare PPO |
$126.36
|
| Rate for Payer: WEA Trust Commercial |
$92.66
|
| Rate for Payer: Wellcare Medicare |
$11.85
|
| Rate for Payer: WPS Commercial |
$124.79
|
|
|
Zinc Level
|
Professional
|
Both
|
$162.00
|
|
|
Service Code
|
CPT 84630
|
| Hospital Charge Code |
978099
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.85 |
| Max. Negotiated Rate |
$160.06 |
| Rate for Payer: Aetna Commercial |
$160.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$144.89
|
| Rate for Payer: Aetna Managed Medicare |
$11.85
|
| Rate for Payer: Anthem Medicare Advantage |
$11.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$11.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$11.85
|
| Rate for Payer: Cash Price |
$48.60
|
| Rate for Payer: Cash Price |
$48.60
|
| Rate for Payer: Cigna Commercial |
$160.06
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$84.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$11.85
|
| Rate for Payer: Health EOS Commercial |
$153.32
|
| Rate for Payer: HFN Commercial |
$160.06
|
| Rate for Payer: Independent Care Health Plan Medicare |
$11.85
|
| Rate for Payer: Multiplan Commercial |
$134.78
|
| Rate for Payer: NAPHCARE Commercial |
$17.77
|
| Rate for Payer: Preferred Network Access Commercial |
$160.06
|
| Rate for Payer: Quartz Beloit One Network |
$74.13
|
| Rate for Payer: Quartz Commercial |
$96.03
|
| Rate for Payer: Quartz Medicare Advantage |
$11.85
|
| Rate for Payer: The Alliance Commercial |
$46.79
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11.85
|
| Rate for Payer: WEA Trust Commercial |
$92.66
|
| Rate for Payer: WPS Commercial |
$52.12
|
|
|
Zinc Protoporphyrin
|
Facility
|
IP
|
$255.00
|
|
|
Service Code
|
CPT 84202
|
| Hospital Charge Code |
978100
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$129.95 |
| Max. Negotiated Rate |
$243.98 |
| Rate for Payer: Aetna Commercial |
$238.68
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$228.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$140.56
|
| Rate for Payer: Cash Price |
$76.50
|
| Rate for Payer: Cigna Commercial |
$243.98
|
| Rate for Payer: Health EOS Commercial |
$236.03
|
| Rate for Payer: HFN Commercial |
$243.98
|
| Rate for Payer: Multiplan Commercial |
$212.16
|
| Rate for Payer: Preferred Network Access Commercial |
$243.98
|
| Rate for Payer: Quartz Beloit One Network |
$129.95
|
| Rate for Payer: Quartz Commercial |
$159.12
|
| Rate for Payer: WEA Trust Commercial |
$145.86
|
| Rate for Payer: WPS Commercial |
$196.43
|
|
|
Zinc Protoporphyrin
|
Facility
|
OP
|
$255.00
|
|
|
Service Code
|
CPT 84202
|
| Hospital Charge Code |
978100
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.92 |
| Max. Negotiated Rate |
$243.98 |
| Rate for Payer: Aetna Commercial |
$238.68
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$228.07
|
| Rate for Payer: Aetna Managed Medicare |
$14.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$55.97
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$26.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$24.77
|
| Rate for Payer: Anthem Medicare Advantage |
$14.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$140.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$14.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$14.92
|
| Rate for Payer: Cash Price |
$76.50
|
| Rate for Payer: Cash Price |
$76.50
|
| Rate for Payer: Cigna Commercial |
$243.98
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$14.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$148.41
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$14.92
|
| Rate for Payer: Health EOS Commercial |
$236.03
|
| Rate for Payer: HFN Commercial |
$243.98
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$55.52
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$14.92
|
| Rate for Payer: Independent Care Health Plan Medicare |
$14.92
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$14.92
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$14.92
|
| Rate for Payer: Multiplan Commercial |
$212.16
|
| Rate for Payer: NAPHCARE Commercial |
$22.39
|
| Rate for Payer: Preferred Network Access Commercial |
$243.98
|
| Rate for Payer: Quartz Beloit One Network |
$129.95
|
| Rate for Payer: Quartz Commercial |
$172.38
|
| Rate for Payer: Quartz Medicare Advantage |
$14.92
|
| Rate for Payer: The Alliance Commercial |
$59.70
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14.92
|
| Rate for Payer: United Healthcare PPO |
$198.90
|
| Rate for Payer: WEA Trust Commercial |
$145.86
|
| Rate for Payer: Wellcare Medicare |
$14.92
|
| Rate for Payer: WPS Commercial |
$196.43
|
|
|
Zinc Protoporphyrin
|
Professional
|
Both
|
$255.00
|
|
|
Service Code
|
CPT 84202
|
| Hospital Charge Code |
978100
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.92 |
| Max. Negotiated Rate |
$251.94 |
| Rate for Payer: Aetna Commercial |
$251.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$228.07
|
| Rate for Payer: Aetna Managed Medicare |
$14.92
|
| Rate for Payer: Anthem Medicare Advantage |
$14.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$14.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$14.92
|
| Rate for Payer: Cash Price |
$76.50
|
| Rate for Payer: Cash Price |
$76.50
|
| Rate for Payer: Cigna Commercial |
$251.94
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$132.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$14.92
|
| Rate for Payer: Health EOS Commercial |
$241.33
|
| Rate for Payer: HFN Commercial |
$251.94
|
| Rate for Payer: Independent Care Health Plan Medicare |
$14.92
|
| Rate for Payer: Multiplan Commercial |
$212.16
|
| Rate for Payer: NAPHCARE Commercial |
$22.39
|
| Rate for Payer: Preferred Network Access Commercial |
$251.94
|
| Rate for Payer: Quartz Beloit One Network |
$116.69
|
| Rate for Payer: Quartz Commercial |
$151.16
|
| Rate for Payer: Quartz Medicare Advantage |
$14.92
|
| Rate for Payer: The Alliance Commercial |
$58.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14.92
|
| Rate for Payer: WEA Trust Commercial |
$145.86
|
| Rate for Payer: WPS Commercial |
$65.67
|
|
|
Zinc, RBC
|
Professional
|
Both
|
$87.00
|
|
|
Service Code
|
CPT 84630
|
| Hospital Charge Code |
4048791
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.85 |
| Max. Negotiated Rate |
$85.96 |
| Rate for Payer: Aetna Commercial |
$85.96
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$77.81
|
| Rate for Payer: Aetna Managed Medicare |
$11.85
|
| Rate for Payer: Anthem Medicare Advantage |
$11.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$11.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$11.85
|
| Rate for Payer: Cash Price |
$26.10
|
| Rate for Payer: Cash Price |
$26.10
|
| Rate for Payer: Cigna Commercial |
$85.96
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$45.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$11.85
|
| Rate for Payer: Health EOS Commercial |
$82.34
|
| Rate for Payer: HFN Commercial |
$85.96
|
| Rate for Payer: Independent Care Health Plan Medicare |
$11.85
|
| Rate for Payer: Multiplan Commercial |
$72.38
|
| Rate for Payer: NAPHCARE Commercial |
$17.77
|
| Rate for Payer: Preferred Network Access Commercial |
$85.96
|
| Rate for Payer: Quartz Beloit One Network |
$39.81
|
| Rate for Payer: Quartz Commercial |
$51.57
|
| Rate for Payer: Quartz Medicare Advantage |
$11.85
|
| Rate for Payer: The Alliance Commercial |
$46.79
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11.85
|
| Rate for Payer: WEA Trust Commercial |
$49.76
|
| Rate for Payer: WPS Commercial |
$52.12
|
|
|
Zinc, RBC
|
Facility
|
IP
|
$87.00
|
|
|
Service Code
|
CPT 84630
|
| Hospital Charge Code |
4048791
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$44.34 |
| Max. Negotiated Rate |
$83.24 |
| Rate for Payer: Aetna Commercial |
$81.43
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$77.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$47.95
|
| Rate for Payer: Cash Price |
$26.10
|
| Rate for Payer: Cigna Commercial |
$83.24
|
| Rate for Payer: Health EOS Commercial |
$80.53
|
| Rate for Payer: HFN Commercial |
$83.24
|
| Rate for Payer: Multiplan Commercial |
$72.38
|
| Rate for Payer: Preferred Network Access Commercial |
$83.24
|
| Rate for Payer: Quartz Beloit One Network |
$44.34
|
| Rate for Payer: Quartz Commercial |
$54.29
|
| Rate for Payer: WEA Trust Commercial |
$49.76
|
| Rate for Payer: WPS Commercial |
$67.02
|
|
|
Zinc, RBC
|
Facility
|
OP
|
$87.00
|
|
|
Service Code
|
CPT 84630
|
| Hospital Charge Code |
4048791
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.85 |
| Max. Negotiated Rate |
$83.24 |
| Rate for Payer: Quartz Beloit One Network |
$44.34
|
| Rate for Payer: Aetna Commercial |
$81.43
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$77.81
|
| Rate for Payer: Aetna Managed Medicare |
$11.85
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$44.42
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$20.73
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$19.66
|
| Rate for Payer: Anthem Medicare Advantage |
$11.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$47.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$11.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$11.85
|
| Rate for Payer: Cash Price |
$26.10
|
| Rate for Payer: Cash Price |
$26.10
|
| Rate for Payer: Cigna Commercial |
$83.24
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$11.85
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$50.63
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$11.85
|
| Rate for Payer: Health EOS Commercial |
$80.53
|
| Rate for Payer: HFN Commercial |
$83.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$44.07
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$11.85
|
| Rate for Payer: Independent Care Health Plan Medicare |
$11.85
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$11.85
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$11.85
|
| Rate for Payer: Multiplan Commercial |
$72.38
|
| Rate for Payer: NAPHCARE Commercial |
$17.77
|
| Rate for Payer: Preferred Network Access Commercial |
$83.24
|
| Rate for Payer: Quartz Commercial |
$58.81
|
| Rate for Payer: Quartz Medicare Advantage |
$11.85
|
| Rate for Payer: The Alliance Commercial |
$47.38
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11.85
|
| Rate for Payer: United Healthcare PPO |
$67.86
|
| Rate for Payer: WEA Trust Commercial |
$49.76
|
| Rate for Payer: Wellcare Medicare |
$11.85
|
| Rate for Payer: WPS Commercial |
$67.02
|
|
|
Zinc Transporter 8 Ab
|
Facility
|
IP
|
$84.45
|
|
|
Service Code
|
CPT 86341
|
| Hospital Charge Code |
6222161
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$43.04 |
| Max. Negotiated Rate |
$80.80 |
| Rate for Payer: Aetna Commercial |
$79.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$75.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$46.55
|
| Rate for Payer: Cash Price |
$25.34
|
| Rate for Payer: Cigna Commercial |
$80.80
|
| Rate for Payer: Health EOS Commercial |
$78.17
|
| Rate for Payer: HFN Commercial |
$80.80
|
| Rate for Payer: Multiplan Commercial |
$70.26
|
| Rate for Payer: Preferred Network Access Commercial |
$80.80
|
| Rate for Payer: Quartz Beloit One Network |
$43.04
|
| Rate for Payer: Quartz Commercial |
$52.70
|
| Rate for Payer: WEA Trust Commercial |
$48.31
|
| Rate for Payer: WPS Commercial |
$65.05
|
|
|
Zinc Transporter 8 Ab
|
Facility
|
OP
|
$84.45
|
|
|
Service Code
|
CPT 86341
|
| Hospital Charge Code |
6222161
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$24.51 |
| Max. Negotiated Rate |
$98.05 |
| Rate for Payer: Aetna Commercial |
$79.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$75.53
|
| Rate for Payer: Aetna Managed Medicare |
$24.51
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$91.92
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$42.90
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$40.69
|
| Rate for Payer: Anthem Medicare Advantage |
$24.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$46.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$24.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$24.51
|
| Rate for Payer: Cash Price |
$25.34
|
| Rate for Payer: Cash Price |
$25.34
|
| Rate for Payer: Cigna Commercial |
$80.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$24.51
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$49.15
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$24.51
|
| Rate for Payer: Health EOS Commercial |
$78.17
|
| Rate for Payer: HFN Commercial |
$80.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$91.19
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$24.51
|
| Rate for Payer: Independent Care Health Plan Medicare |
$24.51
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$24.51
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$24.51
|
| Rate for Payer: Multiplan Commercial |
$70.26
|
| Rate for Payer: NAPHCARE Commercial |
$36.77
|
| Rate for Payer: Preferred Network Access Commercial |
$80.80
|
| Rate for Payer: Quartz Beloit One Network |
$43.04
|
| Rate for Payer: Quartz Commercial |
$57.09
|
| Rate for Payer: Quartz Medicare Advantage |
$24.51
|
| Rate for Payer: The Alliance Commercial |
$98.05
|
| Rate for Payer: United Healthcare Medicare Advantage |
$24.51
|
| Rate for Payer: United Healthcare PPO |
$65.87
|
| Rate for Payer: WEA Trust Commercial |
$48.31
|
| Rate for Payer: Wellcare Medicare |
$24.51
|
| Rate for Payer: WPS Commercial |
$65.05
|
|
