|
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
|
|
|
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 |
$459.15 |
| Max. Negotiated Rate |
$862.08 |
| Rate for Payer: Aetna Commercial |
$843.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$805.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$496.63
|
| Rate for Payer: Cash Price |
$270.30
|
| Rate for Payer: Cigna Commercial |
$862.08
|
| Rate for Payer: Health EOS Commercial |
$833.97
|
| Rate for Payer: HFN Commercial |
$862.08
|
| Rate for Payer: Multiplan Commercial |
$749.63
|
| Rate for Payer: Preferred Network Access Commercial |
$862.08
|
| Rate for Payer: Quartz Beloit One Network |
$459.15
|
| Rate for Payer: Quartz Commercial |
$562.22
|
| Rate for Payer: WEA Trust Commercial |
$515.37
|
| Rate for Payer: WPS Commercial |
$694.04
|
|
|
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 |
$262.37 |
| Max. Negotiated Rate |
$862.08 |
| Rate for Payer: Aetna Commercial |
$843.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$805.85
|
| Rate for Payer: Aetna Managed Medicare |
$262.37
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$609.08
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$468.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$449.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$496.63
|
| Rate for Payer: Cash Price |
$270.30
|
| Rate for Payer: Cigna Commercial |
$862.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$524.38
|
| Rate for Payer: Health EOS Commercial |
$833.97
|
| Rate for Payer: HFN Commercial |
$862.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$702.78
|
| Rate for Payer: Multiplan Commercial |
$749.63
|
| Rate for Payer: NAPHCARE Commercial |
$562.22
|
| Rate for Payer: Preferred Network Access Commercial |
$862.08
|
| Rate for Payer: Quartz Beloit One Network |
$459.15
|
| Rate for Payer: Quartz Commercial |
$609.08
|
| Rate for Payer: Quartz Medicare Advantage |
$562.22
|
| Rate for Payer: The Alliance Commercial |
$468.52
|
| Rate for Payer: WEA Trust Commercial |
$515.37
|
| Rate for Payer: WPS Commercial |
$694.04
|
|
|
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 |
$262.37 |
| Max. Negotiated Rate |
$862.08 |
| Rate for Payer: Aetna Commercial |
$843.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$805.85
|
| Rate for Payer: Aetna Managed Medicare |
$262.37
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$609.08
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$468.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$449.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$496.63
|
| Rate for Payer: Cash Price |
$270.30
|
| Rate for Payer: Cigna Commercial |
$862.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$524.38
|
| Rate for Payer: Health EOS Commercial |
$833.97
|
| Rate for Payer: HFN Commercial |
$862.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$702.78
|
| Rate for Payer: Multiplan Commercial |
$749.63
|
| Rate for Payer: NAPHCARE Commercial |
$562.22
|
| Rate for Payer: Preferred Network Access Commercial |
$862.08
|
| Rate for Payer: Quartz Beloit One Network |
$459.15
|
| Rate for Payer: Quartz Commercial |
$609.08
|
| Rate for Payer: Quartz Medicare Advantage |
$562.22
|
| Rate for Payer: The Alliance Commercial |
$468.52
|
| Rate for Payer: WEA Trust Commercial |
$515.37
|
| Rate for Payer: WPS Commercial |
$694.04
|
|
|
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 |
$459.15 |
| Max. Negotiated Rate |
$862.08 |
| Rate for Payer: Aetna Commercial |
$843.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$805.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$496.63
|
| Rate for Payer: Cash Price |
$270.30
|
| Rate for Payer: Cigna Commercial |
$862.08
|
| Rate for Payer: Health EOS Commercial |
$833.97
|
| Rate for Payer: HFN Commercial |
$862.08
|
| Rate for Payer: Multiplan Commercial |
$749.63
|
| Rate for Payer: Preferred Network Access Commercial |
$862.08
|
| Rate for Payer: Quartz Beloit One Network |
$459.15
|
| Rate for Payer: Quartz Commercial |
$562.22
|
| Rate for Payer: WEA Trust Commercial |
$515.37
|
| Rate for Payer: WPS Commercial |
$694.04
|
|
|
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 |
$283.63 |
| Max. Negotiated Rate |
$931.92 |
| Rate for Payer: Aetna Commercial |
$911.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$871.15
|
| Rate for Payer: Aetna Managed Medicare |
$283.63
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$658.42
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$506.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$486.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$536.87
|
| Rate for Payer: Cash Price |
$292.20
|
| Rate for Payer: Cigna Commercial |
$931.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$566.87
|
| Rate for Payer: Health EOS Commercial |
$901.53
|
| Rate for Payer: HFN Commercial |
$931.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$759.72
|
| Rate for Payer: Multiplan Commercial |
$810.37
|
| Rate for Payer: NAPHCARE Commercial |
$607.78
|
| Rate for Payer: Preferred Network Access Commercial |
$931.92
|
| Rate for Payer: Quartz Beloit One Network |
$496.35
|
| Rate for Payer: Quartz Commercial |
$658.42
|
| Rate for Payer: Quartz Medicare Advantage |
$607.78
|
| Rate for Payer: The Alliance Commercial |
$506.48
|
| Rate for Payer: WEA Trust Commercial |
$557.13
|
| Rate for Payer: WPS Commercial |
$750.27
|
|
|
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 |
$496.35 |
| Max. Negotiated Rate |
$931.92 |
| Rate for Payer: Aetna Commercial |
$911.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$871.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$536.87
|
| Rate for Payer: Cash Price |
$292.20
|
| Rate for Payer: Cigna Commercial |
$931.92
|
| Rate for Payer: Health EOS Commercial |
$901.53
|
| Rate for Payer: HFN Commercial |
$931.92
|
| Rate for Payer: Multiplan Commercial |
$810.37
|
| Rate for Payer: Preferred Network Access Commercial |
$931.92
|
| Rate for Payer: Quartz Beloit One Network |
$496.35
|
| Rate for Payer: Quartz Commercial |
$607.78
|
| Rate for Payer: WEA Trust Commercial |
$557.13
|
| Rate for Payer: WPS Commercial |
$750.27
|
|
|
Zonisamide (Zonegran)
|
Professional
|
Both
|
$235.00
|
|
|
Service Code
|
CPT 80203
|
| Hospital Charge Code |
983444
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.78 |
| Max. Negotiated Rate |
$232.18 |
| Rate for Payer: Aetna Commercial |
$232.18
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$210.18
|
| Rate for Payer: Aetna Managed Medicare |
$13.78
|
| Rate for Payer: Anthem Medicare Advantage |
$13.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13.78
|
| Rate for Payer: Cash Price |
$70.50
|
| Rate for Payer: Cash Price |
$70.50
|
| Rate for Payer: Cigna Commercial |
$232.18
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$122.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$13.78
|
| Rate for Payer: Health EOS Commercial |
$222.40
|
| Rate for Payer: HFN Commercial |
$232.18
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$48.64
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$48.64
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13.78
|
| Rate for Payer: Multiplan Commercial |
$195.52
|
| Rate for Payer: NAPHCARE Commercial |
$20.67
|
| Rate for Payer: Preferred Network Access Commercial |
$232.18
|
| Rate for Payer: Quartz Beloit One Network |
$107.54
|
| Rate for Payer: Quartz Commercial |
$139.31
|
| Rate for Payer: Quartz Medicare Advantage |
$13.78
|
| Rate for Payer: The Alliance Commercial |
$54.43
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.78
|
| Rate for Payer: WEA Trust Commercial |
$134.42
|
| Rate for Payer: WPS Commercial |
$60.63
|
|
|
Zonisamide (Zonegran)
|
Facility
|
IP
|
$235.00
|
|
|
Service Code
|
CPT 80203
|
| Hospital Charge Code |
983444
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$119.76 |
| Max. Negotiated Rate |
$224.85 |
| Rate for Payer: Aetna Commercial |
$219.96
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$210.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$129.53
|
| Rate for Payer: Cash Price |
$70.50
|
| Rate for Payer: Cigna Commercial |
$224.85
|
| Rate for Payer: Health EOS Commercial |
$217.52
|
| Rate for Payer: HFN Commercial |
$224.85
|
| Rate for Payer: Multiplan Commercial |
$195.52
|
| Rate for Payer: Preferred Network Access Commercial |
$224.85
|
| Rate for Payer: Quartz Beloit One Network |
$119.76
|
| Rate for Payer: Quartz Commercial |
$146.64
|
| Rate for Payer: WEA Trust Commercial |
$134.42
|
| Rate for Payer: WPS Commercial |
$181.02
|
|
|
Zonisamide (Zonegran)
|
Facility
|
OP
|
$235.00
|
|
|
Service Code
|
CPT 80203
|
| Hospital Charge Code |
983444
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.78 |
| Max. Negotiated Rate |
$224.85 |
| Rate for Payer: Aetna Commercial |
$219.96
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$210.18
|
| Rate for Payer: Aetna Managed Medicare |
$13.78
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$51.67
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$24.11
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$22.87
|
| Rate for Payer: Anthem Medicare Advantage |
$13.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$129.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13.78
|
| Rate for Payer: Cash Price |
$70.50
|
| Rate for Payer: Cash Price |
$70.50
|
| Rate for Payer: Cigna Commercial |
$224.85
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$13.78
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$136.77
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$13.78
|
| Rate for Payer: Health EOS Commercial |
$217.52
|
| Rate for Payer: HFN Commercial |
$224.85
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$51.26
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$13.78
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13.78
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$13.78
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$13.78
|
| Rate for Payer: Multiplan Commercial |
$195.52
|
| Rate for Payer: NAPHCARE Commercial |
$20.67
|
| Rate for Payer: Preferred Network Access Commercial |
$224.85
|
| Rate for Payer: Quartz Beloit One Network |
$119.76
|
| Rate for Payer: Quartz Commercial |
$158.86
|
| Rate for Payer: Quartz Medicare Advantage |
$13.78
|
| Rate for Payer: The Alliance Commercial |
$55.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.78
|
| Rate for Payer: United Healthcare PPO |
$183.30
|
| Rate for Payer: WEA Trust Commercial |
$134.42
|
| Rate for Payer: Wellcare Medicare |
$13.78
|
| Rate for Payer: WPS Commercial |
$181.02
|
|
|
Zoster Vacc, SC 90736 man
|
Facility
|
OP
|
$484.00
|
|
|
Service Code
|
CPT 90736
|
| Hospital Charge Code |
3369597
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$140.94 |
| Max. Negotiated Rate |
$463.09 |
| Rate for Payer: Aetna Commercial |
$453.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$432.89
|
| Rate for Payer: Aetna Managed Medicare |
$140.94
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$327.18
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$251.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$241.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$266.78
|
| Rate for Payer: Cash Price |
$145.20
|
| Rate for Payer: Cigna Commercial |
$463.09
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$281.69
|
| Rate for Payer: Health EOS Commercial |
$447.99
|
| Rate for Payer: HFN Commercial |
$463.09
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$377.52
|
| Rate for Payer: Multiplan Commercial |
$402.69
|
| Rate for Payer: NAPHCARE Commercial |
$302.02
|
| Rate for Payer: Preferred Network Access Commercial |
$463.09
|
| Rate for Payer: Quartz Beloit One Network |
$246.65
|
| Rate for Payer: Quartz Commercial |
$327.18
|
| Rate for Payer: Quartz Medicare Advantage |
$302.02
|
| Rate for Payer: The Alliance Commercial |
$251.68
|
| Rate for Payer: WEA Trust Commercial |
$276.85
|
| Rate for Payer: WPS Commercial |
$372.83
|
|
|
Zoster Vacc, SC 90736 man
|
Professional
|
Both
|
$484.00
|
|
|
Service Code
|
CPT 90736
|
| Hospital Charge Code |
3369597
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$221.48 |
| Max. Negotiated Rate |
$478.19 |
| Rate for Payer: Aetna Commercial |
$478.19
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$432.89
|
| Rate for Payer: Cash Price |
$145.20
|
| Rate for Payer: Cash Price |
$145.20
|
| Rate for Payer: Cigna Commercial |
$478.19
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$251.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$302.02
|
| Rate for Payer: Health EOS Commercial |
$458.06
|
| Rate for Payer: HFN Commercial |
$478.19
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$368.12
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$368.12
|
| Rate for Payer: Multiplan Commercial |
$402.69
|
| Rate for Payer: Preferred Network Access Commercial |
$478.19
|
| Rate for Payer: Quartz Beloit One Network |
$221.48
|
| Rate for Payer: Quartz Commercial |
$286.92
|
| Rate for Payer: The Alliance Commercial |
$251.68
|
| Rate for Payer: WEA Trust Commercial |
$276.85
|
| Rate for Payer: WPS Commercial |
$372.83
|
|
|
Zoster Vacc, SC 90736 man
|
Facility
|
IP
|
$484.00
|
|
|
Service Code
|
CPT 90736
|
| Hospital Charge Code |
3369597
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$246.65 |
| Max. Negotiated Rate |
$463.09 |
| Rate for Payer: Aetna Commercial |
$453.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$432.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$266.78
|
| Rate for Payer: Cash Price |
$145.20
|
| Rate for Payer: Cigna Commercial |
$463.09
|
| Rate for Payer: Health EOS Commercial |
$447.99
|
| Rate for Payer: HFN Commercial |
$463.09
|
| Rate for Payer: Multiplan Commercial |
$402.69
|
| Rate for Payer: Preferred Network Access Commercial |
$463.09
|
| Rate for Payer: Quartz Beloit One Network |
$246.65
|
| Rate for Payer: Quartz Commercial |
$302.02
|
| Rate for Payer: WEA Trust Commercial |
$276.85
|
| Rate for Payer: WPS Commercial |
$372.83
|
|
|
Z-PLASTY WOUND REVISION
|
Facility
|
OP
|
$1,006.00
|
|
| Hospital Charge Code |
2960515
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$292.95 |
| Max. Negotiated Rate |
$962.54 |
| Rate for Payer: Aetna Commercial |
$941.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$899.77
|
| Rate for Payer: Aetna Managed Medicare |
$292.95
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$680.06
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$523.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$502.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$554.51
|
| Rate for Payer: Cash Price |
$301.80
|
| Rate for Payer: Cigna Commercial |
$962.54
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$585.49
|
| Rate for Payer: Health EOS Commercial |
$931.15
|
| Rate for Payer: HFN Commercial |
$962.54
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$784.68
|
| Rate for Payer: Multiplan Commercial |
$836.99
|
| Rate for Payer: NAPHCARE Commercial |
$627.74
|
| Rate for Payer: Preferred Network Access Commercial |
$962.54
|
| Rate for Payer: Quartz Beloit One Network |
$512.66
|
| Rate for Payer: Quartz Commercial |
$680.06
|
| Rate for Payer: Quartz Medicare Advantage |
$627.74
|
| Rate for Payer: The Alliance Commercial |
$523.12
|
| Rate for Payer: WEA Trust Commercial |
$575.43
|
| Rate for Payer: WPS Commercial |
$774.92
|
|
|
Z-PLASTY WOUND REVISION
|
Facility
|
IP
|
$1,006.00
|
|
| Hospital Charge Code |
2960515
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$512.66 |
| Max. Negotiated Rate |
$962.54 |
| Rate for Payer: Aetna Commercial |
$941.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$899.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$554.51
|
| Rate for Payer: Cash Price |
$301.80
|
| Rate for Payer: Cigna Commercial |
$962.54
|
| Rate for Payer: Health EOS Commercial |
$931.15
|
| Rate for Payer: HFN Commercial |
$962.54
|
| Rate for Payer: Multiplan Commercial |
$836.99
|
| Rate for Payer: Preferred Network Access Commercial |
$962.54
|
| Rate for Payer: Quartz Beloit One Network |
$512.66
|
| Rate for Payer: Quartz Commercial |
$627.74
|
| Rate for Payer: WEA Trust Commercial |
$575.43
|
| Rate for Payer: WPS Commercial |
$774.92
|
|
|
Zurpaz Steerable Sheath
|
Facility
|
OP
|
$6,742.00
|
|
|
Service Code
|
HCPCS C1766
|
| Hospital Charge Code |
4534617
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,963.27 |
| Max. Negotiated Rate |
$6,450.75 |
| Rate for Payer: Aetna Commercial |
$6,310.51
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,030.04
|
| Rate for Payer: Aetna Managed Medicare |
$1,963.27
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,557.59
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,505.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,365.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,716.19
|
| Rate for Payer: Cash Price |
$2,022.60
|
| Rate for Payer: Cigna Commercial |
$6,450.75
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,923.84
|
| Rate for Payer: Health EOS Commercial |
$6,240.40
|
| Rate for Payer: HFN Commercial |
$6,450.75
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,258.76
|
| Rate for Payer: Multiplan Commercial |
$5,609.34
|
| Rate for Payer: NAPHCARE Commercial |
$4,207.01
|
| Rate for Payer: Preferred Network Access Commercial |
$6,450.75
|
| Rate for Payer: Quartz Beloit One Network |
$3,435.72
|
| Rate for Payer: Quartz Commercial |
$4,557.59
|
| Rate for Payer: Quartz Medicare Advantage |
$4,207.01
|
| Rate for Payer: The Alliance Commercial |
$3,505.84
|
| Rate for Payer: WEA Trust Commercial |
$3,856.42
|
| Rate for Payer: WPS Commercial |
$5,193.36
|
|
|
Zurpaz Steerable Sheath
|
Facility
|
IP
|
$6,742.00
|
|
|
Service Code
|
HCPCS C1766
|
| Hospital Charge Code |
4534617
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,435.72 |
| Max. Negotiated Rate |
$6,450.75 |
| Rate for Payer: Aetna Commercial |
$6,310.51
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,030.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,716.19
|
| Rate for Payer: Cash Price |
$2,022.60
|
| Rate for Payer: Cigna Commercial |
$6,450.75
|
| Rate for Payer: Health EOS Commercial |
$6,240.40
|
| Rate for Payer: HFN Commercial |
$6,450.75
|
| Rate for Payer: Multiplan Commercial |
$5,609.34
|
| Rate for Payer: Preferred Network Access Commercial |
$6,450.75
|
| Rate for Payer: Quartz Beloit One Network |
$3,435.72
|
| Rate for Payer: Quartz Commercial |
$4,207.01
|
| Rate for Payer: WEA Trust Commercial |
$3,856.42
|
| Rate for Payer: WPS Commercial |
$5,193.36
|
|
|
ZYGOMATIC COMPLEX FRACTURE
|
Facility
|
OP
|
$4,324.00
|
|
| Hospital Charge Code |
2950465
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,259.15 |
| Max. Negotiated Rate |
$4,137.20 |
| Rate for Payer: Aetna Commercial |
$4,047.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,867.39
|
| Rate for Payer: Aetna Managed Medicare |
$1,259.15
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,923.02
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,248.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,158.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,383.39
|
| Rate for Payer: Cash Price |
$1,297.20
|
| Rate for Payer: Cigna Commercial |
$4,137.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,516.57
|
| Rate for Payer: Health EOS Commercial |
$4,002.29
|
| Rate for Payer: HFN Commercial |
$4,137.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,372.72
|
| Rate for Payer: Multiplan Commercial |
$3,597.57
|
| Rate for Payer: NAPHCARE Commercial |
$2,698.18
|
| Rate for Payer: Preferred Network Access Commercial |
$4,137.20
|
| Rate for Payer: Quartz Beloit One Network |
$2,203.51
|
| Rate for Payer: Quartz Commercial |
$2,923.02
|
| Rate for Payer: Quartz Medicare Advantage |
$2,698.18
|
| Rate for Payer: The Alliance Commercial |
$2,248.48
|
| Rate for Payer: WEA Trust Commercial |
$2,473.33
|
| Rate for Payer: WPS Commercial |
$3,330.78
|
|
|
ZYGOMATIC COMPLEX FRACTURE
|
Facility
|
IP
|
$4,324.00
|
|
| Hospital Charge Code |
2950465
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,203.51 |
| Max. Negotiated Rate |
$4,137.20 |
| Rate for Payer: Aetna Commercial |
$4,047.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,867.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,383.39
|
| Rate for Payer: Cash Price |
$1,297.20
|
| Rate for Payer: Cigna Commercial |
$4,137.20
|
| Rate for Payer: Health EOS Commercial |
$4,002.29
|
| Rate for Payer: HFN Commercial |
$4,137.20
|
| Rate for Payer: Multiplan Commercial |
$3,597.57
|
| Rate for Payer: Preferred Network Access Commercial |
$4,137.20
|
| Rate for Payer: Quartz Beloit One Network |
$2,203.51
|
| Rate for Payer: Quartz Commercial |
$2,698.18
|
| Rate for Payer: WEA Trust Commercial |
$2,473.33
|
| Rate for Payer: WPS Commercial |
$3,330.78
|
|
|
zzAlbumin CSF
|
Facility
|
OP
|
$92.00
|
|
|
Service Code
|
CPT 82042
|
| Hospital Charge Code |
1114851
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.09 |
| Max. Negotiated Rate |
$88.03 |
| Rate for Payer: Aetna Commercial |
$86.11
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$82.28
|
| Rate for Payer: Aetna Managed Medicare |
$8.09
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$30.34
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$14.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$13.43
|
| Rate for Payer: Anthem Medicare Advantage |
$8.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$50.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$8.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$8.09
|
| Rate for Payer: Cash Price |
$27.60
|
| Rate for Payer: Cash Price |
$27.60
|
| Rate for Payer: Cigna Commercial |
$88.03
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$8.09
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$53.54
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$8.09
|
| Rate for Payer: Health EOS Commercial |
$85.16
|
| Rate for Payer: HFN Commercial |
$88.03
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$30.10
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$8.09
|
| Rate for Payer: Independent Care Health Plan Medicare |
$8.09
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$8.09
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$8.09
|
| Rate for Payer: Multiplan Commercial |
$76.54
|
| Rate for Payer: NAPHCARE Commercial |
$12.14
|
| Rate for Payer: Preferred Network Access Commercial |
$88.03
|
| Rate for Payer: Quartz Beloit One Network |
$46.88
|
| Rate for Payer: Quartz Commercial |
$62.19
|
| Rate for Payer: Quartz Medicare Advantage |
$8.09
|
| Rate for Payer: The Alliance Commercial |
$32.36
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8.09
|
| Rate for Payer: United Healthcare PPO |
$71.76
|
| Rate for Payer: WEA Trust Commercial |
$52.62
|
| Rate for Payer: Wellcare Medicare |
$8.09
|
| Rate for Payer: WPS Commercial |
$70.87
|
|
|
zzAlbumin CSF
|
Facility
|
IP
|
$92.00
|
|
|
Service Code
|
CPT 82042
|
| Hospital Charge Code |
1114851
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$46.88 |
| Max. Negotiated Rate |
$88.03 |
| Rate for Payer: Aetna Commercial |
$86.11
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$82.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$50.71
|
| Rate for Payer: Cash Price |
$27.60
|
| Rate for Payer: Cigna Commercial |
$88.03
|
| Rate for Payer: Health EOS Commercial |
$85.16
|
| Rate for Payer: HFN Commercial |
$88.03
|
| Rate for Payer: Multiplan Commercial |
$76.54
|
| Rate for Payer: Preferred Network Access Commercial |
$88.03
|
| Rate for Payer: Quartz Beloit One Network |
$46.88
|
| Rate for Payer: Quartz Commercial |
$57.41
|
| Rate for Payer: WEA Trust Commercial |
$52.62
|
| Rate for Payer: WPS Commercial |
$70.87
|
|
|
zzAlbumin Serum (Quest)
|
Facility
|
OP
|
$54.00
|
|
|
Service Code
|
CPT 82040
|
| Hospital Charge Code |
1114854
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.15 |
| Max. Negotiated Rate |
$51.67 |
| Rate for Payer: Aetna Commercial |
$50.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$48.30
|
| Rate for Payer: Aetna Managed Medicare |
$5.15
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$19.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$9.01
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$8.55
|
| Rate for Payer: Anthem Medicare Advantage |
$5.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$29.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5.15
|
| Rate for Payer: Cash Price |
$16.20
|
| Rate for Payer: Cash Price |
$16.20
|
| Rate for Payer: Cigna Commercial |
$51.67
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$5.15
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$31.43
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$5.15
|
| Rate for Payer: Health EOS Commercial |
$49.98
|
| Rate for Payer: HFN Commercial |
$51.67
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$19.15
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$5.15
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5.15
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$5.15
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$5.15
|
| Rate for Payer: Multiplan Commercial |
$44.93
|
| Rate for Payer: NAPHCARE Commercial |
$7.72
|
| Rate for Payer: Preferred Network Access Commercial |
$51.67
|
| Rate for Payer: Quartz Beloit One Network |
$27.52
|
| Rate for Payer: Quartz Commercial |
$36.50
|
| Rate for Payer: Quartz Medicare Advantage |
$5.15
|
| Rate for Payer: The Alliance Commercial |
$20.59
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.15
|
| Rate for Payer: United Healthcare PPO |
$42.12
|
| Rate for Payer: WEA Trust Commercial |
$30.89
|
| Rate for Payer: Wellcare Medicare |
$5.15
|
| Rate for Payer: WPS Commercial |
$41.60
|
|
|
zzAlbumin Serum (Quest)
|
Facility
|
IP
|
$54.00
|
|
|
Service Code
|
CPT 82040
|
| Hospital Charge Code |
1114854
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$27.52 |
| Max. Negotiated Rate |
$51.67 |
| Rate for Payer: Aetna Commercial |
$50.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$48.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$29.76
|
| Rate for Payer: Cash Price |
$16.20
|
| Rate for Payer: Cigna Commercial |
$51.67
|
| Rate for Payer: Health EOS Commercial |
$49.98
|
| Rate for Payer: HFN Commercial |
$51.67
|
| Rate for Payer: Multiplan Commercial |
$44.93
|
| Rate for Payer: Preferred Network Access Commercial |
$51.67
|
| Rate for Payer: Quartz Beloit One Network |
$27.52
|
| Rate for Payer: Quartz Commercial |
$33.70
|
| Rate for Payer: WEA Trust Commercial |
$30.89
|
| Rate for Payer: WPS Commercial |
$41.60
|
|
|
zzANA, IFA Panel Comprehensive
|
Facility
|
OP
|
$250.00
|
|
| Hospital Charge Code |
980020
|
| Min. Negotiated Rate |
$72.80 |
| Max. Negotiated Rate |
$239.20 |
| Rate for Payer: Aetna Commercial |
$234.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$223.60
|
| Rate for Payer: Aetna Managed Medicare |
$72.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$169.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$130.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$124.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$137.80
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Cigna Commercial |
$239.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$145.50
|
| Rate for Payer: Health EOS Commercial |
$231.40
|
| Rate for Payer: HFN Commercial |
$239.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$195.00
|
| Rate for Payer: Multiplan Commercial |
$208.00
|
| Rate for Payer: NAPHCARE Commercial |
$156.00
|
| Rate for Payer: Preferred Network Access Commercial |
$239.20
|
| Rate for Payer: Quartz Beloit One Network |
$127.40
|
| Rate for Payer: Quartz Commercial |
$169.00
|
| Rate for Payer: Quartz Medicare Advantage |
$156.00
|
| Rate for Payer: The Alliance Commercial |
$130.00
|
| Rate for Payer: WEA Trust Commercial |
$143.00
|
| Rate for Payer: WPS Commercial |
$192.57
|
|
|
zzANA, IFA Panel Comprehensive
|
Facility
|
IP
|
$250.00
|
|
| Hospital Charge Code |
980020
|
| Min. Negotiated Rate |
$127.40 |
| Max. Negotiated Rate |
$239.20 |
| Rate for Payer: Aetna Commercial |
$234.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$223.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$137.80
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Cigna Commercial |
$239.20
|
| Rate for Payer: Health EOS Commercial |
$231.40
|
| Rate for Payer: HFN Commercial |
$239.20
|
| Rate for Payer: Multiplan Commercial |
$208.00
|
| Rate for Payer: Preferred Network Access Commercial |
$239.20
|
| Rate for Payer: Quartz Beloit One Network |
$127.40
|
| Rate for Payer: Quartz Commercial |
$156.00
|
| Rate for Payer: WEA Trust Commercial |
$143.00
|
| Rate for Payer: WPS Commercial |
$192.57
|
|
