|
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 |
$18.19 |
| 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 |
$20.05
|
| Rate for Payer: Anthem Medicare Advantage |
$20.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$20.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$20.05
|
| 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 |
$19.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$18.19
|
| Rate for Payer: Health EOS Commercial |
$1,250.19
|
| Rate for Payer: HFN Commercial |
$1,305.15
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$27.16
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$27.16
|
| Rate for Payer: Independent Care Health Plan Medicare |
$20.05
|
| Rate for Payer: Multiplan Commercial |
$1,099.07
|
| Rate for Payer: NAPHCARE Commercial |
$30.08
|
| 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 |
$20.05
|
| Rate for Payer: The Alliance Commercial |
$55.14
|
| Rate for Payer: United Healthcare Medicaid |
$19.32
|
| Rate for Payer: United Healthcare Medicare Advantage |
$20.05
|
| Rate for Payer: WEA Trust Commercial |
$755.61
|
| Rate for Payer: WPS Commercial |
$45.48
|
|
|
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: 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
|
|
|
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
|
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
|
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: Humana Commercial/EPO/HMO/POS/PPO |
$41.82
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$41.82
|
| 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
|
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: Humana Commercial/EPO/HMO/POS/PPO |
$52.69
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$52.69
|
| 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 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, 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: 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 Beloit One Network |
$44.34
|
| 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, 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: Humana Commercial/EPO/HMO/POS/PPO |
$41.82
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$41.82
|
| 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 Transporter 8 Ab
|
Professional
|
Both
|
$84.45
|
|
|
Service Code
|
CPT 86341
|
| Hospital Charge Code |
6222161
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$24.51 |
| Max. Negotiated Rate |
$107.86 |
| Rate for Payer: Aetna Commercial |
$83.44
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$75.53
|
| Rate for Payer: Aetna Managed Medicare |
$24.51
|
| Rate for Payer: Anthem Medicare Advantage |
$24.51
|
| 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 |
$83.44
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$43.91
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$24.51
|
| Rate for Payer: Health EOS Commercial |
$79.92
|
| Rate for Payer: HFN Commercial |
$83.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$86.53
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$86.53
|
| Rate for Payer: Independent Care Health Plan Medicare |
$24.51
|
| Rate for Payer: Multiplan Commercial |
$70.26
|
| Rate for Payer: NAPHCARE Commercial |
$36.77
|
| Rate for Payer: Preferred Network Access Commercial |
$83.44
|
| Rate for Payer: Quartz Beloit One Network |
$38.64
|
| Rate for Payer: Quartz Commercial |
$50.06
|
| Rate for Payer: Quartz Medicare Advantage |
$24.51
|
| Rate for Payer: The Alliance Commercial |
$96.83
|
| Rate for Payer: United Healthcare Medicare Advantage |
$24.51
|
| Rate for Payer: WEA Trust Commercial |
$48.31
|
| Rate for Payer: WPS Commercial |
$107.86
|
|
|
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
|
|
|
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 |
$14.06 |
| Max. Negotiated Rate |
$184.66 |
| Rate for Payer: Aetna Commercial |
$180.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$172.62
|
| Rate for Payer: Aetna Managed Medicare |
$56.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$130.47
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$100.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$96.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$106.38
|
| Rate for Payer: Cash Price |
$57.90
|
| Rate for Payer: Cash Price |
$57.90
|
| Rate for Payer: Cigna Commercial |
$184.66
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$14.06
|
| Rate for Payer: Health EOS Commercial |
$178.64
|
| Rate for Payer: HFN Commercial |
$184.66
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$150.54
|
| Rate for Payer: Multiplan Commercial |
$160.58
|
| Rate for Payer: NAPHCARE Commercial |
$120.43
|
| Rate for Payer: Preferred Network Access Commercial |
$184.66
|
| Rate for Payer: Quartz Beloit One Network |
$98.35
|
| Rate for Payer: Quartz Commercial |
$130.47
|
| Rate for Payer: Quartz Medicare Advantage |
$120.43
|
| Rate for Payer: The Alliance Commercial |
$100.36
|
| Rate for Payer: WEA Trust Commercial |
$110.40
|
| Rate for Payer: WPS Commercial |
$26.57
|
|
|
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 |
$9.52 |
| Max. Negotiated Rate |
$190.68 |
| Rate for Payer: Aetna Commercial |
$190.68
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$172.62
|
| Rate for Payer: Cash Price |
$57.90
|
| Rate for Payer: Cash Price |
$57.90
|
| Rate for Payer: Cigna Commercial |
$190.68
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$9.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$10.63
|
| Rate for Payer: Health EOS Commercial |
$182.66
|
| Rate for Payer: HFN Commercial |
$190.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$27.40
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$27.40
|
| Rate for Payer: Multiplan Commercial |
$160.58
|
| Rate for Payer: Preferred Network Access Commercial |
$190.68
|
| Rate for Payer: Quartz Beloit One Network |
$88.32
|
| Rate for Payer: Quartz Commercial |
$114.41
|
| Rate for Payer: The Alliance Commercial |
$100.36
|
| Rate for Payer: United Healthcare Medicaid |
$9.52
|
| Rate for Payer: WEA Trust Commercial |
$110.40
|
| Rate for Payer: WPS Commercial |
$26.57
|
|
|
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 |
$98.35 |
| Max. Negotiated Rate |
$184.66 |
| Rate for Payer: Aetna Commercial |
$180.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$172.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$106.38
|
| Rate for Payer: Cash Price |
$57.90
|
| Rate for Payer: Cigna Commercial |
$184.66
|
| Rate for Payer: Health EOS Commercial |
$178.64
|
| Rate for Payer: HFN Commercial |
$184.66
|
| Rate for Payer: Multiplan Commercial |
$160.58
|
| Rate for Payer: Preferred Network Access Commercial |
$184.66
|
| Rate for Payer: Quartz Beloit One Network |
$98.35
|
| Rate for Payer: Quartz Commercial |
$120.43
|
| Rate for Payer: WEA Trust Commercial |
$110.40
|
| Rate for Payer: WPS Commercial |
$148.67
|
|
|
Ziprasidone Level
|
Facility
|
IP
|
$178.00
|
|
|
Service Code
|
CPT 80342
|
| Hospital Charge Code |
983443
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$90.71 |
| Max. Negotiated Rate |
$170.31 |
| Rate for Payer: Aetna Commercial |
$166.61
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$159.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$98.11
|
| Rate for Payer: Cash Price |
$53.40
|
| Rate for Payer: Cigna Commercial |
$170.31
|
| Rate for Payer: Health EOS Commercial |
$164.76
|
| Rate for Payer: HFN Commercial |
$170.31
|
| Rate for Payer: Multiplan Commercial |
$148.10
|
| Rate for Payer: Preferred Network Access Commercial |
$170.31
|
| Rate for Payer: Quartz Beloit One Network |
$90.71
|
| Rate for Payer: Quartz Commercial |
$111.07
|
| Rate for Payer: WEA Trust Commercial |
$101.82
|
| Rate for Payer: WPS Commercial |
$137.11
|
|
|
Ziprasidone Level
|
Facility
|
OP
|
$178.00
|
|
|
Service Code
|
CPT 80342
|
| Hospital Charge Code |
983443
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$51.83 |
| Max. Negotiated Rate |
$170.31 |
| Rate for Payer: Aetna Commercial |
$166.61
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$159.20
|
| Rate for Payer: Aetna Managed Medicare |
$51.83
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$120.33
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$92.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$88.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$98.11
|
| Rate for Payer: Cash Price |
$53.40
|
| Rate for Payer: Cigna Commercial |
$170.31
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$103.60
|
| Rate for Payer: Health EOS Commercial |
$164.76
|
| Rate for Payer: HFN Commercial |
$170.31
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$138.84
|
| Rate for Payer: Multiplan Commercial |
$148.10
|
| Rate for Payer: NAPHCARE Commercial |
$111.07
|
| Rate for Payer: Preferred Network Access Commercial |
$170.31
|
| Rate for Payer: Quartz Beloit One Network |
$90.71
|
| Rate for Payer: Quartz Commercial |
$120.33
|
| Rate for Payer: Quartz Medicare Advantage |
$111.07
|
| Rate for Payer: The Alliance Commercial |
$92.56
|
| Rate for Payer: United Healthcare PPO |
$138.84
|
| Rate for Payer: WEA Trust Commercial |
$101.82
|
| Rate for Payer: WPS Commercial |
$137.11
|
|
|
Ziprasidone Level
|
Professional
|
Both
|
$178.00
|
|
|
Service Code
|
CPT 80342
|
| Hospital Charge Code |
983443
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$81.45 |
| Max. Negotiated Rate |
$175.86 |
| Rate for Payer: Aetna Commercial |
$175.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$159.20
|
| Rate for Payer: Cash Price |
$53.40
|
| Rate for Payer: Cash Price |
$53.40
|
| Rate for Payer: Cigna Commercial |
$175.86
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$92.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$111.07
|
| Rate for Payer: Health EOS Commercial |
$168.46
|
| Rate for Payer: HFN Commercial |
$175.86
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$83.26
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$83.26
|
| Rate for Payer: Multiplan Commercial |
$148.10
|
| Rate for Payer: Preferred Network Access Commercial |
$175.86
|
| Rate for Payer: Quartz Beloit One Network |
$81.45
|
| Rate for Payer: Quartz Commercial |
$105.52
|
| Rate for Payer: The Alliance Commercial |
$92.56
|
| Rate for Payer: WEA Trust Commercial |
$101.82
|
| Rate for Payer: WPS Commercial |
$137.11
|
|
|
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 |
$294.69 |
| Max. Negotiated Rate |
$968.28 |
| Rate for Payer: Aetna Commercial |
$947.23
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$905.13
|
| Rate for Payer: Aetna Managed Medicare |
$294.69
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$684.11
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$526.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$505.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$557.81
|
| Rate for Payer: Cash Price |
$303.60
|
| Rate for Payer: Cigna Commercial |
$968.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$588.98
|
| Rate for Payer: Health EOS Commercial |
$936.71
|
| Rate for Payer: HFN Commercial |
$968.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$789.36
|
| Rate for Payer: Multiplan Commercial |
$841.98
|
| Rate for Payer: NAPHCARE Commercial |
$631.49
|
| Rate for Payer: Preferred Network Access Commercial |
$968.28
|
| Rate for Payer: Quartz Beloit One Network |
$515.72
|
| Rate for Payer: Quartz Commercial |
$684.11
|
| Rate for Payer: Quartz Medicare Advantage |
$631.49
|
| Rate for Payer: The Alliance Commercial |
$526.24
|
| Rate for Payer: WEA Trust Commercial |
$578.86
|
| Rate for Payer: WPS Commercial |
$779.54
|
|
|
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 |
$515.72 |
| Max. Negotiated Rate |
$968.28 |
| Rate for Payer: Aetna Commercial |
$947.23
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$905.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$557.81
|
| Rate for Payer: Cash Price |
$303.60
|
| Rate for Payer: Cigna Commercial |
$968.28
|
| Rate for Payer: Health EOS Commercial |
$936.71
|
| Rate for Payer: HFN Commercial |
$968.28
|
| Rate for Payer: Multiplan Commercial |
$841.98
|
| Rate for Payer: Preferred Network Access Commercial |
$968.28
|
| Rate for Payer: Quartz Beloit One Network |
$515.72
|
| Rate for Payer: Quartz Commercial |
$631.49
|
| Rate for Payer: WEA Trust Commercial |
$578.86
|
| Rate for Payer: WPS Commercial |
$779.54
|
|
|
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 |
$87.94 |
| Max. Negotiated Rate |
$288.95 |
| Rate for Payer: Aetna Commercial |
$282.67
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$270.11
|
| Rate for Payer: Aetna Managed Medicare |
$87.94
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$204.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$157.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$150.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$166.46
|
| Rate for Payer: Cash Price |
$90.60
|
| Rate for Payer: Cigna Commercial |
$288.95
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$175.76
|
| Rate for Payer: Health EOS Commercial |
$279.53
|
| Rate for Payer: HFN Commercial |
$288.95
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$235.56
|
| Rate for Payer: Multiplan Commercial |
$251.26
|
| Rate for Payer: NAPHCARE Commercial |
$188.45
|
| Rate for Payer: Preferred Network Access Commercial |
$288.95
|
| Rate for Payer: Quartz Beloit One Network |
$153.90
|
| Rate for Payer: Quartz Commercial |
$204.15
|
| Rate for Payer: Quartz Medicare Advantage |
$188.45
|
| Rate for Payer: The Alliance Commercial |
$157.04
|
| Rate for Payer: WEA Trust Commercial |
$172.74
|
| Rate for Payer: WPS Commercial |
$232.63
|
|
|
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 |
$153.90 |
| Max. Negotiated Rate |
$288.95 |
| Rate for Payer: Aetna Commercial |
$282.67
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$270.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$166.46
|
| Rate for Payer: Cash Price |
$90.60
|
| Rate for Payer: Cigna Commercial |
$288.95
|
| Rate for Payer: Health EOS Commercial |
$279.53
|
| Rate for Payer: HFN Commercial |
$288.95
|
| Rate for Payer: Multiplan Commercial |
$251.26
|
| Rate for Payer: Preferred Network Access Commercial |
$288.95
|
| Rate for Payer: Quartz Beloit One Network |
$153.90
|
| Rate for Payer: Quartz Commercial |
$188.45
|
| Rate for Payer: WEA Trust Commercial |
$172.74
|
| Rate for Payer: WPS Commercial |
$232.63
|
|
|
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 |
$398.00 |
| Max. Negotiated Rate |
$747.26 |
| Rate for Payer: Aetna Commercial |
$731.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$698.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$430.49
|
| Rate for Payer: Cash Price |
$234.30
|
| Rate for Payer: Cigna Commercial |
$747.26
|
| Rate for Payer: Health EOS Commercial |
$722.89
|
| Rate for Payer: HFN Commercial |
$747.26
|
| Rate for Payer: Multiplan Commercial |
$649.79
|
| Rate for Payer: Preferred Network Access Commercial |
$747.26
|
| Rate for Payer: Quartz Beloit One Network |
$398.00
|
| Rate for Payer: Quartz Commercial |
$487.34
|
| Rate for Payer: WEA Trust Commercial |
$446.73
|
| Rate for Payer: WPS Commercial |
$601.60
|
|
