|
Dupixent (dupilumab) 100 mg/0.67 mL subcutaneous syr
|
Facility
IP
|
$3,493.00
|
|
|
Service Code
|
HCPCS J3590
|
| Hospital Charge Code |
6209322
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,711.57 |
| Max. Negotiated Rate |
$3,213.56 |
| Rate for Payer: Aetna Commercial |
$3,143.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,851.29
|
| Rate for Payer: Cash Price |
$1,047.90
|
| Rate for Payer: Cigna Commercial |
$3,213.56
|
| Rate for Payer: Health EOS Commercial |
$3,108.77
|
| Rate for Payer: HFN Commercial |
$3,213.56
|
| Rate for Payer: Multiplan Commercial |
$2,794.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,095.80
|
| Rate for Payer: Preferred Network Access Commercial |
$3,213.56
|
| Rate for Payer: Quartz Beloit One Network |
$1,711.57
|
| Rate for Payer: Quartz Commercial |
$2,095.80
|
| Rate for Payer: WEA Trust Commercial |
$1,921.15
|
| Rate for Payer: WPS Commercial |
$2,587.27
|
|
|
Dupixent (dupilumab) 100 mg/0.67 mL subcutaneous syr
|
Professional
|
$3,493.00
|
|
|
Service Code
|
HCPCS J3590
|
| Hospital Charge Code |
6209322
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,536.92 |
| Max. Negotiated Rate |
$3,318.35 |
| Rate for Payer: Aetna Commercial |
$3,318.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,003.98
|
| Rate for Payer: Cash Price |
$1,047.90
|
| Rate for Payer: Cigna Commercial |
$3,318.35
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,746.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,095.80
|
| Rate for Payer: Health EOS Commercial |
$3,178.63
|
| Rate for Payer: Multiplan Commercial |
$2,794.40
|
| Rate for Payer: Preferred Network Access Commercial |
$3,318.35
|
| Rate for Payer: Quartz Beloit One Network |
$1,536.92
|
| Rate for Payer: Quartz Commercial |
$1,991.01
|
| Rate for Payer: The Alliance Commercial |
$1,746.50
|
| Rate for Payer: WEA Trust Commercial |
$1,921.15
|
| Rate for Payer: WPS Commercial |
$2,587.27
|
|
|
Dupixent (dupilumab) 200 mg/1.14 mL subcutaneous syr
|
Professional
|
$3,493.00
|
|
|
Service Code
|
HCPCS J3590
|
| Hospital Charge Code |
6209323
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,536.92 |
| Max. Negotiated Rate |
$3,318.35 |
| Rate for Payer: Aetna Commercial |
$3,318.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,003.98
|
| Rate for Payer: Cash Price |
$1,047.90
|
| Rate for Payer: Cigna Commercial |
$3,318.35
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,746.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,095.80
|
| Rate for Payer: Health EOS Commercial |
$3,178.63
|
| Rate for Payer: Multiplan Commercial |
$2,794.40
|
| Rate for Payer: Preferred Network Access Commercial |
$3,318.35
|
| Rate for Payer: Quartz Beloit One Network |
$1,536.92
|
| Rate for Payer: Quartz Commercial |
$1,991.01
|
| Rate for Payer: The Alliance Commercial |
$1,746.50
|
| Rate for Payer: WEA Trust Commercial |
$1,921.15
|
| Rate for Payer: WPS Commercial |
$2,587.27
|
|
|
Dupixent (dupilumab) 200 mg/1.14 mL subcutaneous syr
|
Facility
OP
|
$3,493.00
|
|
|
Service Code
|
HCPCS J3590
|
| Hospital Charge Code |
6209323
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$700.24 |
| Max. Negotiated Rate |
$3,213.56 |
| Rate for Payer: Aetna Commercial |
$3,143.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,003.98
|
| Rate for Payer: Aetna Managed Medicare |
$978.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,270.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,746.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,676.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,851.29
|
| Rate for Payer: Cash Price |
$1,047.90
|
| Rate for Payer: Cash Price |
$1,047.90
|
| Rate for Payer: Cigna Commercial |
$3,213.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,954.68
|
| Rate for Payer: Health EOS Commercial |
$3,108.77
|
| Rate for Payer: HFN Commercial |
$3,213.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,619.75
|
| Rate for Payer: Multiplan Commercial |
$2,794.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,095.80
|
| Rate for Payer: Preferred Network Access Commercial |
$3,213.56
|
| Rate for Payer: Quartz Beloit One Network |
$1,711.57
|
| Rate for Payer: Quartz Commercial |
$2,270.45
|
| Rate for Payer: Quartz Medicare Advantage |
$2,095.80
|
| Rate for Payer: The Alliance Commercial |
$700.24
|
| Rate for Payer: WEA Trust Commercial |
$1,921.15
|
| Rate for Payer: WPS Commercial |
$2,587.27
|
|
|
Dupixent (dupilumab) 200 mg/1.14 mL subcutaneous syr
|
Facility
IP
|
$3,493.00
|
|
|
Service Code
|
HCPCS J3590
|
| Hospital Charge Code |
6209323
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,711.57 |
| Max. Negotiated Rate |
$3,213.56 |
| Rate for Payer: Aetna Commercial |
$3,143.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,851.29
|
| Rate for Payer: Cash Price |
$1,047.90
|
| Rate for Payer: Cigna Commercial |
$3,213.56
|
| Rate for Payer: Health EOS Commercial |
$3,108.77
|
| Rate for Payer: HFN Commercial |
$3,213.56
|
| Rate for Payer: Multiplan Commercial |
$2,794.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,095.80
|
| Rate for Payer: Preferred Network Access Commercial |
$3,213.56
|
| Rate for Payer: Quartz Beloit One Network |
$1,711.57
|
| Rate for Payer: Quartz Commercial |
$2,095.80
|
| Rate for Payer: WEA Trust Commercial |
$1,921.15
|
| Rate for Payer: WPS Commercial |
$2,587.27
|
|
|
Dupixent (dupilumab) 300 mg/2 mL subcutaneous syr
|
Facility
IP
|
$3,493.00
|
|
|
Service Code
|
HCPCS J3590
|
| Hospital Charge Code |
6209324
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,711.57 |
| Max. Negotiated Rate |
$3,213.56 |
| Rate for Payer: Aetna Commercial |
$3,143.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,851.29
|
| Rate for Payer: Cash Price |
$1,047.90
|
| Rate for Payer: Cigna Commercial |
$3,213.56
|
| Rate for Payer: Health EOS Commercial |
$3,108.77
|
| Rate for Payer: HFN Commercial |
$3,213.56
|
| Rate for Payer: Multiplan Commercial |
$2,794.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,095.80
|
| Rate for Payer: Preferred Network Access Commercial |
$3,213.56
|
| Rate for Payer: Quartz Beloit One Network |
$1,711.57
|
| Rate for Payer: Quartz Commercial |
$2,095.80
|
| Rate for Payer: WEA Trust Commercial |
$1,921.15
|
| Rate for Payer: WPS Commercial |
$2,587.27
|
|
|
Dupixent (dupilumab) 300 mg/2 mL subcutaneous syr
|
Professional
|
$3,493.00
|
|
|
Service Code
|
HCPCS J3590
|
| Hospital Charge Code |
6209324
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,536.92 |
| Max. Negotiated Rate |
$3,318.35 |
| Rate for Payer: Aetna Commercial |
$3,318.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,003.98
|
| Rate for Payer: Cash Price |
$1,047.90
|
| Rate for Payer: Cigna Commercial |
$3,318.35
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,746.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,095.80
|
| Rate for Payer: Health EOS Commercial |
$3,178.63
|
| Rate for Payer: Multiplan Commercial |
$2,794.40
|
| Rate for Payer: Preferred Network Access Commercial |
$3,318.35
|
| Rate for Payer: Quartz Beloit One Network |
$1,536.92
|
| Rate for Payer: Quartz Commercial |
$1,991.01
|
| Rate for Payer: The Alliance Commercial |
$1,746.50
|
| Rate for Payer: WEA Trust Commercial |
$1,921.15
|
| Rate for Payer: WPS Commercial |
$2,587.27
|
|
|
Dupixent (dupilumab) 300 mg/2 mL subcutaneous syr
|
Facility
OP
|
$3,493.00
|
|
|
Service Code
|
HCPCS J3590
|
| Hospital Charge Code |
6209324
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$700.24 |
| Max. Negotiated Rate |
$3,213.56 |
| Rate for Payer: Aetna Commercial |
$3,143.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,003.98
|
| Rate for Payer: Aetna Managed Medicare |
$978.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,270.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,746.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,676.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,851.29
|
| Rate for Payer: Cash Price |
$1,047.90
|
| Rate for Payer: Cash Price |
$1,047.90
|
| Rate for Payer: Cigna Commercial |
$3,213.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,954.68
|
| Rate for Payer: Health EOS Commercial |
$3,108.77
|
| Rate for Payer: HFN Commercial |
$3,213.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,619.75
|
| Rate for Payer: Multiplan Commercial |
$2,794.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,095.80
|
| Rate for Payer: Preferred Network Access Commercial |
$3,213.56
|
| Rate for Payer: Quartz Beloit One Network |
$1,711.57
|
| Rate for Payer: Quartz Commercial |
$2,270.45
|
| Rate for Payer: Quartz Medicare Advantage |
$2,095.80
|
| Rate for Payer: The Alliance Commercial |
$700.24
|
| Rate for Payer: WEA Trust Commercial |
$1,921.15
|
| Rate for Payer: WPS Commercial |
$2,587.27
|
|
|
DUPLEX SCAN HEMO COMPL BI STUDY 93985
|
Professional
|
$228.00
|
|
|
Service Code
|
CPT 93985
|
| Hospital Charge Code |
5565293
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$100.32 |
| Max. Negotiated Rate |
$949.68 |
| Rate for Payer: Aetna Commercial |
$216.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$196.08
|
| Rate for Payer: Aetna Managed Medicare |
$237.42
|
| Rate for Payer: Anthem Medicare Advantage |
$237.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$237.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$237.42
|
| Rate for Payer: Cash Price |
$68.40
|
| Rate for Payer: Cash Price |
$68.40
|
| Rate for Payer: Cigna Commercial |
$216.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$114.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$237.42
|
| Rate for Payer: Health EOS Commercial |
$207.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$903.43
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$903.43
|
| Rate for Payer: Independent Care Health Plan Medicare |
$237.42
|
| Rate for Payer: Multiplan Commercial |
$182.40
|
| Rate for Payer: Preferred Network Access Commercial |
$216.60
|
| Rate for Payer: Quartz Beloit One Network |
$100.32
|
| Rate for Payer: Quartz Commercial |
$129.96
|
| Rate for Payer: Quartz Medicare Advantage |
$237.42
|
| Rate for Payer: The Alliance Commercial |
$593.55
|
| Rate for Payer: United Healthcare Medicaid |
$205.14
|
| Rate for Payer: United Healthcare Medicare Advantage |
$237.42
|
| Rate for Payer: WEA Trust Commercial |
$125.40
|
| Rate for Payer: WPS Commercial |
$949.68
|
|
|
DUPLEX SCAN HEMO COMPL BI STUDY 9398526
|
Professional
|
$228.00
|
|
|
Service Code
|
CPT 93985 26
|
| Hospital Charge Code |
5586204
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$34.83 |
| Max. Negotiated Rate |
$216.60 |
| Rate for Payer: Aetna Commercial |
$216.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$196.08
|
| Rate for Payer: Aetna Managed Medicare |
$34.83
|
| Rate for Payer: Anthem Medicare Advantage |
$34.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$34.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$34.83
|
| Rate for Payer: Cash Price |
$68.40
|
| Rate for Payer: Cash Price |
$68.40
|
| Rate for Payer: Cigna Commercial |
$216.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$114.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$34.83
|
| Rate for Payer: Health EOS Commercial |
$207.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$126.90
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$126.90
|
| Rate for Payer: Independent Care Health Plan Medicare |
$34.83
|
| Rate for Payer: Multiplan Commercial |
$182.40
|
| Rate for Payer: Preferred Network Access Commercial |
$216.60
|
| Rate for Payer: Quartz Beloit One Network |
$100.32
|
| Rate for Payer: Quartz Commercial |
$129.96
|
| Rate for Payer: Quartz Medicare Advantage |
$34.83
|
| Rate for Payer: The Alliance Commercial |
$87.08
|
| Rate for Payer: United Healthcare Medicare Advantage |
$34.83
|
| Rate for Payer: WEA Trust Commercial |
$125.40
|
| Rate for Payer: WPS Commercial |
$139.32
|
|
|
Duplex scan hemo compl uni study
|
Facility
OP
|
$1,503.00
|
|
|
Service Code
|
CPT 93986
|
| Hospital Charge Code |
5595414
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$108.67 |
| Max. Negotiated Rate |
$1,382.76 |
| Rate for Payer: Aetna Commercial |
$1,352.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,292.58
|
| Rate for Payer: Aetna Managed Medicare |
$108.67
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$976.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$751.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$721.44
|
| Rate for Payer: Anthem Medicare Advantage |
$108.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$796.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$108.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$108.67
|
| Rate for Payer: Cash Price |
$450.90
|
| Rate for Payer: Cash Price |
$450.90
|
| Rate for Payer: Cigna Commercial |
$1,382.76
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$108.67
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$841.08
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$108.67
|
| Rate for Payer: Health EOS Commercial |
$1,337.67
|
| Rate for Payer: HFN Commercial |
$1,382.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$404.25
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$108.67
|
| Rate for Payer: Independent Care Health Plan Medicare |
$108.67
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$108.67
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$108.67
|
| Rate for Payer: Multiplan Commercial |
$1,202.40
|
| Rate for Payer: NAPHCARE Commercial |
$163.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,382.76
|
| Rate for Payer: Quartz Beloit One Network |
$736.47
|
| Rate for Payer: Quartz Commercial |
$976.95
|
| Rate for Payer: Quartz Medicare Advantage |
$108.67
|
| Rate for Payer: United Healthcare Medicare Advantage |
$108.67
|
| Rate for Payer: WEA Trust Commercial |
$826.65
|
| Rate for Payer: Wellcare Medicare |
$108.67
|
| Rate for Payer: WPS Commercial |
$1,113.27
|
|
|
Duplex scan hemo compl uni study
|
Facility
IP
|
$1,503.00
|
|
|
Service Code
|
CPT 93986
|
| Hospital Charge Code |
5595414
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$736.47 |
| Max. Negotiated Rate |
$1,382.76 |
| Rate for Payer: Aetna Commercial |
$1,352.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$796.59
|
| Rate for Payer: Cash Price |
$450.90
|
| Rate for Payer: Cigna Commercial |
$1,382.76
|
| Rate for Payer: Health EOS Commercial |
$1,337.67
|
| Rate for Payer: HFN Commercial |
$1,382.76
|
| Rate for Payer: Multiplan Commercial |
$1,202.40
|
| Rate for Payer: NAPHCARE Commercial |
$901.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,382.76
|
| Rate for Payer: Quartz Beloit One Network |
$736.47
|
| Rate for Payer: Quartz Commercial |
$901.80
|
| Rate for Payer: WEA Trust Commercial |
$826.65
|
| Rate for Payer: WPS Commercial |
$1,113.27
|
|
|
DUPLEX SCAN HEMO COMPL UNI STUDY 93986
|
Professional
|
$140.00
|
|
|
Service Code
|
CPT 93986
|
| Hospital Charge Code |
5565307
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$61.60 |
| Max. Negotiated Rate |
$566.08 |
| Rate for Payer: Aetna Commercial |
$133.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$120.40
|
| Rate for Payer: Aetna Managed Medicare |
$141.52
|
| Rate for Payer: Anthem Medicare Advantage |
$141.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$141.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$141.52
|
| Rate for Payer: Cash Price |
$42.00
|
| Rate for Payer: Cash Price |
$42.00
|
| Rate for Payer: Cigna Commercial |
$133.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$70.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$141.52
|
| Rate for Payer: Health EOS Commercial |
$127.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$522.83
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$522.83
|
| Rate for Payer: Independent Care Health Plan Medicare |
$141.52
|
| Rate for Payer: Multiplan Commercial |
$112.00
|
| Rate for Payer: Preferred Network Access Commercial |
$133.00
|
| Rate for Payer: Quartz Beloit One Network |
$61.60
|
| Rate for Payer: Quartz Commercial |
$79.80
|
| Rate for Payer: Quartz Medicare Advantage |
$141.52
|
| Rate for Payer: The Alliance Commercial |
$353.80
|
| Rate for Payer: United Healthcare Medicaid |
$118.55
|
| Rate for Payer: United Healthcare Medicare Advantage |
$141.52
|
| Rate for Payer: WEA Trust Commercial |
$77.00
|
| Rate for Payer: WPS Commercial |
$566.08
|
|
|
DUPLEX SCAN HEMO COMPL UNI STUDY 9398626
|
Professional
|
$140.00
|
|
|
Service Code
|
CPT 93986 26
|
| Hospital Charge Code |
5586205
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$21.87 |
| Max. Negotiated Rate |
$133.00 |
| Rate for Payer: Aetna Commercial |
$133.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$120.40
|
| Rate for Payer: Aetna Managed Medicare |
$21.87
|
| Rate for Payer: Anthem Medicare Advantage |
$21.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$21.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$21.87
|
| Rate for Payer: Cash Price |
$42.00
|
| Rate for Payer: Cash Price |
$42.00
|
| Rate for Payer: Cigna Commercial |
$133.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$70.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$21.87
|
| Rate for Payer: Health EOS Commercial |
$127.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$78.86
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$78.86
|
| Rate for Payer: Independent Care Health Plan Medicare |
$21.87
|
| Rate for Payer: Multiplan Commercial |
$112.00
|
| Rate for Payer: Preferred Network Access Commercial |
$133.00
|
| Rate for Payer: Quartz Beloit One Network |
$61.60
|
| Rate for Payer: Quartz Commercial |
$79.80
|
| Rate for Payer: Quartz Medicare Advantage |
$21.87
|
| Rate for Payer: The Alliance Commercial |
$54.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$21.87
|
| Rate for Payer: WEA Trust Commercial |
$77.00
|
| Rate for Payer: WPS Commercial |
$87.48
|
|
|
DUPUYTREN'S CONTRACTURE RELEASE
|
Facility
IP
|
$1,337.00
|
|
| Hospital Charge Code |
2959999
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$655.13 |
| Max. Negotiated Rate |
$1,230.04 |
| Rate for Payer: Aetna Commercial |
$1,203.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$708.61
|
| Rate for Payer: Cash Price |
$401.10
|
| Rate for Payer: Cigna Commercial |
$1,230.04
|
| Rate for Payer: Health EOS Commercial |
$1,189.93
|
| Rate for Payer: HFN Commercial |
$1,230.04
|
| Rate for Payer: Multiplan Commercial |
$1,069.60
|
| Rate for Payer: NAPHCARE Commercial |
$802.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,230.04
|
| Rate for Payer: Quartz Beloit One Network |
$655.13
|
| Rate for Payer: Quartz Commercial |
$802.20
|
| Rate for Payer: WEA Trust Commercial |
$735.35
|
| Rate for Payer: WPS Commercial |
$990.32
|
|
|
DUPUYTREN'S CONTRACTURE RELEASE
|
Facility
OP
|
$1,337.00
|
|
| Hospital Charge Code |
2959999
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$374.36 |
| Max. Negotiated Rate |
$5,348.00 |
| Rate for Payer: Aetna Commercial |
$1,203.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,149.82
|
| Rate for Payer: Aetna Managed Medicare |
$374.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$869.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$668.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$641.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$708.61
|
| Rate for Payer: Cash Price |
$401.10
|
| Rate for Payer: Cigna Commercial |
$1,230.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$748.19
|
| Rate for Payer: Health EOS Commercial |
$1,189.93
|
| Rate for Payer: HFN Commercial |
$1,230.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,002.75
|
| Rate for Payer: Multiplan Commercial |
$1,069.60
|
| Rate for Payer: NAPHCARE Commercial |
$802.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,230.04
|
| Rate for Payer: Quartz Beloit One Network |
$655.13
|
| Rate for Payer: Quartz Commercial |
$869.05
|
| Rate for Payer: Quartz Medicare Advantage |
$802.20
|
| Rate for Payer: The Alliance Commercial |
$5,348.00
|
| Rate for Payer: WEA Trust Commercial |
$735.35
|
| Rate for Payer: WPS Commercial |
$990.32
|
|
|
Durysta 10 mcg J7351
|
Professional
|
$4,715.00
|
|
|
Service Code
|
HCPCS J7351
|
| Hospital Charge Code |
5965658
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$206.19 |
| Max. Negotiated Rate |
$4,479.25 |
| Rate for Payer: Aetna Commercial |
$4,479.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,054.90
|
| Rate for Payer: Aetna Managed Medicare |
$206.41
|
| Rate for Payer: Anthem Medicare Advantage |
$206.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$206.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$206.41
|
| Rate for Payer: Cash Price |
$1,414.50
|
| Rate for Payer: Cash Price |
$1,414.50
|
| Rate for Payer: Cigna Commercial |
$4,479.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,357.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$206.19
|
| Rate for Payer: Health EOS Commercial |
$4,290.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$301.56
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$301.56
|
| Rate for Payer: Independent Care Health Plan Medicare |
$206.41
|
| Rate for Payer: Multiplan Commercial |
$3,772.00
|
| Rate for Payer: Preferred Network Access Commercial |
$4,479.25
|
| Rate for Payer: Quartz Beloit One Network |
$2,074.60
|
| Rate for Payer: Quartz Commercial |
$2,687.55
|
| Rate for Payer: Quartz Medicare Advantage |
$206.41
|
| Rate for Payer: The Alliance Commercial |
$567.62
|
| Rate for Payer: United Healthcare Medicaid |
$206.19
|
| Rate for Payer: United Healthcare Medicare Advantage |
$206.41
|
| Rate for Payer: WEA Trust Commercial |
$2,593.25
|
| Rate for Payer: WPS Commercial |
$515.48
|
|
|
Durysta 10 mcg J7351
|
Facility
IP
|
$4,715.00
|
|
|
Service Code
|
HCPCS J7351
|
| Hospital Charge Code |
5965658
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,310.35 |
| Max. Negotiated Rate |
$4,337.80 |
| Rate for Payer: Aetna Commercial |
$4,243.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,498.95
|
| Rate for Payer: Cash Price |
$1,414.50
|
| Rate for Payer: Cigna Commercial |
$4,337.80
|
| Rate for Payer: Health EOS Commercial |
$4,196.35
|
| Rate for Payer: HFN Commercial |
$4,337.80
|
| Rate for Payer: Multiplan Commercial |
$3,772.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,829.00
|
| Rate for Payer: Preferred Network Access Commercial |
$4,337.80
|
| Rate for Payer: Quartz Beloit One Network |
$2,310.35
|
| Rate for Payer: Quartz Commercial |
$2,829.00
|
| Rate for Payer: WEA Trust Commercial |
$2,593.25
|
| Rate for Payer: WPS Commercial |
$3,492.40
|
|
|
Durysta 10 mcg J7351
|
Facility
OP
|
$4,715.00
|
|
|
Service Code
|
HCPCS J7351
|
| Hospital Charge Code |
5965658
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$206.20 |
| Max. Negotiated Rate |
$4,337.80 |
| Rate for Payer: Aetna Commercial |
$4,243.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,054.90
|
| Rate for Payer: Aetna Managed Medicare |
$206.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,064.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,357.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,263.20
|
| Rate for Payer: Anthem Medicare Advantage |
$206.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,498.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$206.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$206.20
|
| Rate for Payer: Cash Price |
$1,414.50
|
| Rate for Payer: Cash Price |
$1,414.50
|
| Rate for Payer: Cigna Commercial |
$4,337.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$206.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$272.79
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$206.20
|
| Rate for Payer: Health EOS Commercial |
$4,196.35
|
| Rate for Payer: HFN Commercial |
$4,337.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$767.08
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$206.20
|
| Rate for Payer: Independent Care Health Plan Medicare |
$206.20
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$206.20
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$206.20
|
| Rate for Payer: Multiplan Commercial |
$3,772.00
|
| Rate for Payer: NAPHCARE Commercial |
$309.31
|
| Rate for Payer: Preferred Network Access Commercial |
$4,337.80
|
| Rate for Payer: Quartz Beloit One Network |
$2,310.35
|
| Rate for Payer: Quartz Commercial |
$3,064.75
|
| Rate for Payer: Quartz Medicare Advantage |
$206.20
|
| Rate for Payer: The Alliance Commercial |
$2,732.52
|
| Rate for Payer: United Healthcare Medicare Advantage |
$206.20
|
| Rate for Payer: WEA Trust Commercial |
$2,593.25
|
| Rate for Payer: Wellcare Medicare |
$206.20
|
| Rate for Payer: WPS Commercial |
$515.48
|
|
|
DVT-bilateral 93970
|
Professional
|
$428.00
|
|
|
Service Code
|
CPT 93970
|
| Hospital Charge Code |
3015440
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$169.05 |
| Max. Negotiated Rate |
$723.68 |
| Rate for Payer: Aetna Commercial |
$406.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$368.08
|
| Rate for Payer: Aetna Managed Medicare |
$180.92
|
| Rate for Payer: Anthem Medicare Advantage |
$180.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$180.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$180.92
|
| Rate for Payer: Cash Price |
$128.40
|
| Rate for Payer: Cash Price |
$128.40
|
| Rate for Payer: Cigna Commercial |
$406.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$214.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$180.92
|
| Rate for Payer: Health EOS Commercial |
$389.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$665.44
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$665.44
|
| Rate for Payer: Independent Care Health Plan Medicare |
$180.92
|
| Rate for Payer: Multiplan Commercial |
$342.40
|
| Rate for Payer: Preferred Network Access Commercial |
$406.60
|
| Rate for Payer: Quartz Beloit One Network |
$188.32
|
| Rate for Payer: Quartz Commercial |
$243.96
|
| Rate for Payer: Quartz Medicare Advantage |
$180.92
|
| Rate for Payer: The Alliance Commercial |
$452.30
|
| Rate for Payer: United Healthcare Medicaid |
$169.05
|
| Rate for Payer: United Healthcare Medicare Advantage |
$180.92
|
| Rate for Payer: WEA Trust Commercial |
$235.40
|
| Rate for Payer: WPS Commercial |
$723.68
|
|
|
DVT UNILATERAL 93971
|
Professional
|
$327.00
|
|
|
Service Code
|
CPT 93971
|
| Hospital Charge Code |
3015445
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$108.68 |
| Max. Negotiated Rate |
$458.88 |
| Rate for Payer: Aetna Commercial |
$310.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$281.22
|
| Rate for Payer: Aetna Managed Medicare |
$114.72
|
| Rate for Payer: Anthem Medicare Advantage |
$114.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$114.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$114.72
|
| Rate for Payer: Cash Price |
$98.10
|
| Rate for Payer: Cash Price |
$98.10
|
| Rate for Payer: Cigna Commercial |
$310.65
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$163.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$114.72
|
| Rate for Payer: Health EOS Commercial |
$297.57
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$418.09
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$418.09
|
| Rate for Payer: Independent Care Health Plan Medicare |
$114.72
|
| Rate for Payer: Multiplan Commercial |
$261.60
|
| Rate for Payer: Preferred Network Access Commercial |
$310.65
|
| Rate for Payer: Quartz Beloit One Network |
$143.88
|
| Rate for Payer: Quartz Commercial |
$186.39
|
| Rate for Payer: Quartz Medicare Advantage |
$114.72
|
| Rate for Payer: The Alliance Commercial |
$286.80
|
| Rate for Payer: United Healthcare Medicaid |
$108.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$114.72
|
| Rate for Payer: WEA Trust Commercial |
$179.85
|
| Rate for Payer: WPS Commercial |
$458.88
|
|
|
DVT UNILATERAL 9397126
|
Professional
|
$327.00
|
|
|
Service Code
|
CPT 93971 26
|
| Hospital Charge Code |
3015447
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$20.18 |
| Max. Negotiated Rate |
$310.65 |
| Rate for Payer: Aetna Commercial |
$310.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$281.22
|
| Rate for Payer: Aetna Managed Medicare |
$20.18
|
| Rate for Payer: Anthem Medicare Advantage |
$20.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$20.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$20.18
|
| Rate for Payer: Cash Price |
$98.10
|
| Rate for Payer: Cash Price |
$98.10
|
| Rate for Payer: Cigna Commercial |
$310.65
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$163.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$20.18
|
| Rate for Payer: Health EOS Commercial |
$297.57
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$73.14
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$73.14
|
| Rate for Payer: Independent Care Health Plan Medicare |
$20.18
|
| Rate for Payer: Multiplan Commercial |
$261.60
|
| Rate for Payer: Preferred Network Access Commercial |
$310.65
|
| Rate for Payer: Quartz Beloit One Network |
$143.88
|
| Rate for Payer: Quartz Commercial |
$186.39
|
| Rate for Payer: Quartz Medicare Advantage |
$20.18
|
| Rate for Payer: The Alliance Commercial |
$50.45
|
| Rate for Payer: United Healthcare Medicare Advantage |
$20.18
|
| Rate for Payer: WEA Trust Commercial |
$179.85
|
| Rate for Payer: WPS Commercial |
$80.72
|
|
|
DXA Bone Denisity, Axial 77080
|
Professional
|
$97.00
|
|
|
Service Code
|
CPT 77080
|
| Hospital Charge Code |
3243523
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$36.61 |
| Max. Negotiated Rate |
$183.05 |
| Rate for Payer: Aetna Commercial |
$92.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$83.42
|
| Rate for Payer: Aetna Managed Medicare |
$36.61
|
| Rate for Payer: Anthem Medicare Advantage |
$36.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$36.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$36.61
|
| Rate for Payer: Cash Price |
$29.10
|
| Rate for Payer: Cash Price |
$29.10
|
| Rate for Payer: Cigna Commercial |
$92.15
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$48.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$36.61
|
| Rate for Payer: Health EOS Commercial |
$88.27
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$128.63
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$128.63
|
| Rate for Payer: Independent Care Health Plan Medicare |
$36.61
|
| Rate for Payer: Multiplan Commercial |
$77.60
|
| Rate for Payer: Preferred Network Access Commercial |
$92.15
|
| Rate for Payer: Quartz Beloit One Network |
$42.68
|
| Rate for Payer: Quartz Commercial |
$55.29
|
| Rate for Payer: Quartz Medicare Advantage |
$36.61
|
| Rate for Payer: The Alliance Commercial |
$139.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$36.61
|
| Rate for Payer: WEA Trust Commercial |
$53.35
|
| Rate for Payer: WPS Commercial |
$183.05
|
|
|
DXA Bone Density, Axial 7708026
|
Professional
|
$97.00
|
|
|
Service Code
|
CPT 77080 26
|
| Hospital Charge Code |
3242174
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$9.14 |
| Max. Negotiated Rate |
$92.15 |
| Rate for Payer: Aetna Commercial |
$92.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$83.42
|
| Rate for Payer: Aetna Managed Medicare |
$9.14
|
| Rate for Payer: Anthem Medicare Advantage |
$9.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$9.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$9.14
|
| Rate for Payer: Cash Price |
$29.10
|
| Rate for Payer: Cash Price |
$29.10
|
| Rate for Payer: Cigna Commercial |
$92.15
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$48.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$9.14
|
| Rate for Payer: Health EOS Commercial |
$88.27
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$33.11
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$33.11
|
| Rate for Payer: Independent Care Health Plan Medicare |
$9.14
|
| Rate for Payer: Multiplan Commercial |
$77.60
|
| Rate for Payer: Preferred Network Access Commercial |
$92.15
|
| Rate for Payer: Quartz Beloit One Network |
$42.68
|
| Rate for Payer: Quartz Commercial |
$55.29
|
| Rate for Payer: Quartz Medicare Advantage |
$9.14
|
| Rate for Payer: The Alliance Commercial |
$34.73
|
| Rate for Payer: United Healthcare Medicare Advantage |
$9.14
|
| Rate for Payer: WEA Trust Commercial |
$53.35
|
| Rate for Payer: WPS Commercial |
$45.70
|
|
|
DXA Bone Density/Peripheral 7708126
|
Professional
|
$163.00
|
|
|
Service Code
|
CPT 77081 26
|
| Hospital Charge Code |
3358866
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$9.46 |
| Max. Negotiated Rate |
$154.85 |
| Rate for Payer: Aetna Commercial |
$154.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$140.18
|
| Rate for Payer: Aetna Managed Medicare |
$9.46
|
| Rate for Payer: Anthem Medicare Advantage |
$9.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$9.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$9.46
|
| Rate for Payer: Cash Price |
$48.90
|
| Rate for Payer: Cash Price |
$48.90
|
| Rate for Payer: Cigna Commercial |
$154.85
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$81.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$9.46
|
| Rate for Payer: Health EOS Commercial |
$148.33
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$34.28
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$34.28
|
| Rate for Payer: Independent Care Health Plan Medicare |
$9.46
|
| Rate for Payer: Multiplan Commercial |
$130.40
|
| Rate for Payer: Preferred Network Access Commercial |
$154.85
|
| Rate for Payer: Quartz Beloit One Network |
$71.72
|
| Rate for Payer: Quartz Commercial |
$92.91
|
| Rate for Payer: Quartz Medicare Advantage |
$9.46
|
| Rate for Payer: The Alliance Commercial |
$35.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$9.46
|
| Rate for Payer: WEA Trust Commercial |
$89.65
|
| Rate for Payer: WPS Commercial |
$47.30
|
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