|
Vascular Acquisition
|
Facility
|
IP
|
$1,274.00
|
|
|
Service Code
|
CPT 93926 RT
|
| Hospital Charge Code |
5375806
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$624.26 |
| Max. Negotiated Rate |
$1,172.08 |
| Rate for Payer: Aetna Commercial |
$1,146.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,095.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$675.22
|
| Rate for Payer: Cash Price |
$382.20
|
| Rate for Payer: Cigna Commercial |
$1,172.08
|
| Rate for Payer: Health EOS Commercial |
$1,133.86
|
| Rate for Payer: HFN Commercial |
$1,172.08
|
| Rate for Payer: Multiplan Commercial |
$1,019.20
|
| Rate for Payer: NAPHCARE Commercial |
$764.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,172.08
|
| Rate for Payer: Quartz Beloit One Network |
$624.26
|
| Rate for Payer: Quartz Commercial |
$764.40
|
| Rate for Payer: WEA Trust Commercial |
$700.70
|
| Rate for Payer: WPS Commercial |
$943.65
|
|
|
Vascular Acquisition
|
Facility
|
IP
|
$2,085.00
|
|
|
Service Code
|
CPT 93970
|
| Hospital Charge Code |
5376680
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$1,021.65 |
| Max. Negotiated Rate |
$1,918.20 |
| Rate for Payer: Aetna Commercial |
$1,876.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,793.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,105.05
|
| Rate for Payer: Cash Price |
$625.50
|
| Rate for Payer: Cigna Commercial |
$1,918.20
|
| Rate for Payer: Health EOS Commercial |
$1,855.65
|
| Rate for Payer: HFN Commercial |
$1,918.20
|
| Rate for Payer: Multiplan Commercial |
$1,668.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,251.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,918.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,021.65
|
| Rate for Payer: Quartz Commercial |
$1,251.00
|
| Rate for Payer: WEA Trust Commercial |
$1,146.75
|
| Rate for Payer: WPS Commercial |
$1,544.36
|
|
|
Vascular Acquisition
|
Facility
|
OP
|
$1,274.00
|
|
|
Service Code
|
CPT 93926 RT
|
| Hospital Charge Code |
5376659
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$108.67 |
| Max. Negotiated Rate |
$1,172.08 |
| Rate for Payer: Aetna Commercial |
$1,146.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,095.64
|
| Rate for Payer: Aetna Managed Medicare |
$108.67
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$828.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$637.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$611.52
|
| Rate for Payer: Anthem Medicare Advantage |
$108.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$675.22
|
| 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 |
$382.20
|
| Rate for Payer: Cash Price |
$382.20
|
| Rate for Payer: Cigna Commercial |
$1,172.08
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$108.67
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$712.93
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$108.67
|
| Rate for Payer: Health EOS Commercial |
$1,133.86
|
| Rate for Payer: HFN Commercial |
$1,172.08
|
| 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 |
$1,019.20
|
| Rate for Payer: NAPHCARE Commercial |
$163.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,172.08
|
| Rate for Payer: Quartz Beloit One Network |
$624.26
|
| Rate for Payer: Quartz Commercial |
$828.10
|
| Rate for Payer: Quartz Medicare Advantage |
$108.67
|
| Rate for Payer: The Alliance Commercial |
$434.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$108.67
|
| Rate for Payer: United Healthcare PPO |
$955.50
|
| Rate for Payer: WEA Trust Commercial |
$700.70
|
| Rate for Payer: Wellcare Medicare |
$108.67
|
| Rate for Payer: WPS Commercial |
$943.65
|
|
|
Vascular Acquisition
|
Facility
|
OP
|
$1,274.00
|
|
|
Service Code
|
CPT 93926 RT
|
| Hospital Charge Code |
5375806
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$108.67 |
| Max. Negotiated Rate |
$1,172.08 |
| Rate for Payer: Aetna Commercial |
$1,146.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,095.64
|
| Rate for Payer: Aetna Managed Medicare |
$108.67
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$828.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$637.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$611.52
|
| Rate for Payer: Anthem Medicare Advantage |
$108.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$675.22
|
| 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 |
$382.20
|
| Rate for Payer: Cash Price |
$382.20
|
| Rate for Payer: Cigna Commercial |
$1,172.08
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$108.67
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$712.93
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$108.67
|
| Rate for Payer: Health EOS Commercial |
$1,133.86
|
| Rate for Payer: HFN Commercial |
$1,172.08
|
| 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 |
$1,019.20
|
| Rate for Payer: NAPHCARE Commercial |
$163.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,172.08
|
| Rate for Payer: Quartz Beloit One Network |
$624.26
|
| Rate for Payer: Quartz Commercial |
$828.10
|
| Rate for Payer: Quartz Medicare Advantage |
$108.67
|
| Rate for Payer: The Alliance Commercial |
$434.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$108.67
|
| Rate for Payer: United Healthcare PPO |
$955.50
|
| Rate for Payer: WEA Trust Commercial |
$700.70
|
| Rate for Payer: Wellcare Medicare |
$108.67
|
| Rate for Payer: WPS Commercial |
$943.65
|
|
|
Vascular Acquisition
|
Facility
|
OP
|
$1,644.00
|
|
|
Service Code
|
CPT 93971 RT
|
| Hospital Charge Code |
5376722
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$108.67 |
| Max. Negotiated Rate |
$1,512.48 |
| Rate for Payer: Aetna Commercial |
$1,479.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,413.84
|
| Rate for Payer: Aetna Managed Medicare |
$108.67
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,068.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$822.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$789.12
|
| Rate for Payer: Anthem Medicare Advantage |
$108.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$871.32
|
| 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 |
$493.20
|
| Rate for Payer: Cash Price |
$493.20
|
| Rate for Payer: Cigna Commercial |
$1,512.48
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$108.67
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$919.98
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$108.67
|
| Rate for Payer: Health EOS Commercial |
$1,463.16
|
| Rate for Payer: HFN Commercial |
$1,512.48
|
| 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 |
$1,315.20
|
| Rate for Payer: NAPHCARE Commercial |
$163.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,512.48
|
| Rate for Payer: Quartz Beloit One Network |
$805.56
|
| Rate for Payer: Quartz Commercial |
$1,068.60
|
| Rate for Payer: Quartz Medicare Advantage |
$108.67
|
| Rate for Payer: The Alliance Commercial |
$434.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$108.67
|
| Rate for Payer: United Healthcare PPO |
$1,233.00
|
| Rate for Payer: WEA Trust Commercial |
$904.20
|
| Rate for Payer: Wellcare Medicare |
$108.67
|
| Rate for Payer: WPS Commercial |
$1,217.71
|
|
|
Vascular Acquisition
|
Facility
|
IP
|
$1,641.00
|
|
|
Service Code
|
CPT 93971 LT
|
| Hospital Charge Code |
5376683
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$804.09 |
| Max. Negotiated Rate |
$1,509.72 |
| Rate for Payer: Aetna Commercial |
$1,476.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,411.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$869.73
|
| Rate for Payer: Cash Price |
$492.30
|
| Rate for Payer: Cigna Commercial |
$1,509.72
|
| Rate for Payer: Health EOS Commercial |
$1,460.49
|
| Rate for Payer: HFN Commercial |
$1,509.72
|
| Rate for Payer: Multiplan Commercial |
$1,312.80
|
| Rate for Payer: NAPHCARE Commercial |
$984.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,509.72
|
| Rate for Payer: Quartz Beloit One Network |
$804.09
|
| Rate for Payer: Quartz Commercial |
$984.60
|
| Rate for Payer: WEA Trust Commercial |
$902.55
|
| Rate for Payer: WPS Commercial |
$1,215.49
|
|
|
Vascular Acquisition
|
Facility
|
IP
|
$2,194.00
|
|
|
Service Code
|
CPT 93925
|
| Hospital Charge Code |
5376653
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$1,075.06 |
| Max. Negotiated Rate |
$2,018.48 |
| Rate for Payer: Aetna Commercial |
$1,974.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,886.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,162.82
|
| Rate for Payer: Cash Price |
$658.20
|
| Rate for Payer: Cigna Commercial |
$2,018.48
|
| Rate for Payer: Health EOS Commercial |
$1,952.66
|
| Rate for Payer: HFN Commercial |
$2,018.48
|
| Rate for Payer: Multiplan Commercial |
$1,755.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,316.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,018.48
|
| Rate for Payer: Quartz Beloit One Network |
$1,075.06
|
| Rate for Payer: Quartz Commercial |
$1,316.40
|
| Rate for Payer: WEA Trust Commercial |
$1,206.70
|
| Rate for Payer: WPS Commercial |
$1,625.10
|
|
|
Vascular Acquisition
|
Facility
|
IP
|
$1,104.00
|
|
|
Service Code
|
CPT 93922
|
| Hospital Charge Code |
5376710
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$540.96 |
| Max. Negotiated Rate |
$1,015.68 |
| Rate for Payer: Aetna Commercial |
$993.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$949.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$585.12
|
| Rate for Payer: Cash Price |
$331.20
|
| Rate for Payer: Cigna Commercial |
$1,015.68
|
| Rate for Payer: Health EOS Commercial |
$982.56
|
| Rate for Payer: HFN Commercial |
$1,015.68
|
| Rate for Payer: Multiplan Commercial |
$883.20
|
| Rate for Payer: NAPHCARE Commercial |
$662.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,015.68
|
| Rate for Payer: Quartz Beloit One Network |
$540.96
|
| Rate for Payer: Quartz Commercial |
$662.40
|
| Rate for Payer: WEA Trust Commercial |
$607.20
|
| Rate for Payer: WPS Commercial |
$817.73
|
|
|
VASCULAR EMBOLIZATION, TUMORS, ORGAN SCHEMIA/INFARCTION
|
Facility
|
IP
|
$19,949.00
|
|
|
Service Code
|
CPT 37243
|
| Hospital Charge Code |
5464766
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$9,775.01 |
| Max. Negotiated Rate |
$18,353.08 |
| Rate for Payer: Aetna Commercial |
$17,954.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$17,156.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$10,572.97
|
| Rate for Payer: Cash Price |
$5,984.70
|
| Rate for Payer: Cigna Commercial |
$18,353.08
|
| Rate for Payer: Health EOS Commercial |
$17,754.61
|
| Rate for Payer: HFN Commercial |
$18,353.08
|
| Rate for Payer: Multiplan Commercial |
$15,959.20
|
| Rate for Payer: NAPHCARE Commercial |
$11,969.40
|
| Rate for Payer: Preferred Network Access Commercial |
$18,353.08
|
| Rate for Payer: Quartz Beloit One Network |
$9,775.01
|
| Rate for Payer: Quartz Commercial |
$11,969.40
|
| Rate for Payer: WEA Trust Commercial |
$10,971.95
|
| Rate for Payer: WPS Commercial |
$14,776.22
|
|
|
VASCULAR EMBOLIZATION, TUMORS, ORGAN SCHEMIA/INFARCTION
|
Facility
|
OP
|
$19,949.00
|
|
|
Service Code
|
CPT 37243
|
| Hospital Charge Code |
5464766
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$9,596.00 |
| Max. Negotiated Rate |
$43,494.48 |
| Rate for Payer: Aetna Commercial |
$17,954.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$17,156.14
|
| Rate for Payer: Aetna Managed Medicare |
$10,873.62
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$18,649.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$18,649.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$17,230.00
|
| Rate for Payer: Anthem Medicare Advantage |
$10,873.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$10,572.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$10,873.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$10,873.62
|
| Rate for Payer: Cash Price |
$5,984.70
|
| Rate for Payer: Cash Price |
$5,984.70
|
| Rate for Payer: Cash Price |
$5,984.70
|
| Rate for Payer: Cigna Commercial |
$18,353.08
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$10,873.62
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$11,874.87
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$10,873.62
|
| Rate for Payer: Health EOS Commercial |
$17,754.61
|
| Rate for Payer: HFN Commercial |
$18,353.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$40,449.87
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$10,873.62
|
| Rate for Payer: Independent Care Health Plan Medicare |
$10,873.62
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$10,873.62
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$10,873.62
|
| Rate for Payer: Multiplan Commercial |
$15,959.20
|
| Rate for Payer: NAPHCARE Commercial |
$16,310.43
|
| Rate for Payer: Preferred Network Access Commercial |
$18,353.08
|
| Rate for Payer: Quartz Beloit One Network |
$9,775.01
|
| Rate for Payer: Quartz Commercial |
$12,966.85
|
| Rate for Payer: Quartz Medicare Advantage |
$10,873.62
|
| Rate for Payer: The Alliance Commercial |
$43,494.48
|
| Rate for Payer: United Healthcare Medicare Advantage |
$10,873.62
|
| Rate for Payer: United Healthcare PPO |
$9,596.00
|
| Rate for Payer: WEA Trust Commercial |
$10,971.95
|
| Rate for Payer: Wellcare Medicare |
$10,873.62
|
| Rate for Payer: WPS Commercial |
$14,776.22
|
|
|
Vascular Endothelial Growth Factor (VEGF)
|
Professional
|
Both
|
$385.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
5242624
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$60.96 |
| Max. Negotiated Rate |
$365.75 |
| Rate for Payer: Aetna Commercial |
$365.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$331.10
|
| Rate for Payer: Cash Price |
$115.50
|
| Rate for Payer: Cash Price |
$115.50
|
| Rate for Payer: Cigna Commercial |
$365.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$192.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$231.00
|
| Rate for Payer: Health EOS Commercial |
$350.35
|
| Rate for Payer: HFN Commercial |
$365.75
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$60.96
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$60.96
|
| Rate for Payer: Multiplan Commercial |
$308.00
|
| Rate for Payer: Preferred Network Access Commercial |
$365.75
|
| Rate for Payer: Quartz Beloit One Network |
$169.40
|
| Rate for Payer: Quartz Commercial |
$219.45
|
| Rate for Payer: The Alliance Commercial |
$192.50
|
| Rate for Payer: WEA Trust Commercial |
$211.75
|
| Rate for Payer: WPS Commercial |
$285.17
|
|
|
Vascular Endothelial Growth Factor (VEGF)
|
Facility
|
IP
|
$385.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
5242624
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$188.65 |
| Max. Negotiated Rate |
$354.20 |
| Rate for Payer: Aetna Commercial |
$346.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$331.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$204.05
|
| Rate for Payer: Cash Price |
$115.50
|
| Rate for Payer: Cigna Commercial |
$354.20
|
| Rate for Payer: Health EOS Commercial |
$342.65
|
| Rate for Payer: HFN Commercial |
$354.20
|
| Rate for Payer: Multiplan Commercial |
$308.00
|
| Rate for Payer: NAPHCARE Commercial |
$231.00
|
| Rate for Payer: Preferred Network Access Commercial |
$354.20
|
| Rate for Payer: Quartz Beloit One Network |
$188.65
|
| Rate for Payer: Quartz Commercial |
$231.00
|
| Rate for Payer: WEA Trust Commercial |
$211.75
|
| Rate for Payer: WPS Commercial |
$285.17
|
|
|
Vascular Endothelial Growth Factor (VEGF)
|
Facility
|
OP
|
$385.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
5242624
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.27 |
| Max. Negotiated Rate |
$354.20 |
| Rate for Payer: Aetna Commercial |
$346.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$331.10
|
| Rate for Payer: Aetna Managed Medicare |
$17.27
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$64.76
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$30.22
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$28.67
|
| Rate for Payer: Anthem Medicaid |
$17.85
|
| Rate for Payer: Anthem Medicare Advantage |
$17.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$204.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$17.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$17.27
|
| Rate for Payer: Cash Price |
$115.50
|
| Rate for Payer: Cash Price |
$115.50
|
| Rate for Payer: Cigna Commercial |
$354.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$17.27
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$17.85
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$215.45
|
| Rate for Payer: Dean Health Medicaid |
$17.85
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$17.27
|
| Rate for Payer: Health EOS Commercial |
$342.65
|
| Rate for Payer: HFN Commercial |
$354.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$64.24
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$17.27
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$17.85
|
| Rate for Payer: Independent Care Health Plan Medicare |
$17.27
|
| Rate for Payer: Managed Health Services Medicaid |
$18.56
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$17.27
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$17.27
|
| Rate for Payer: Multiplan Commercial |
$308.00
|
| Rate for Payer: NAPHCARE Commercial |
$25.90
|
| Rate for Payer: Preferred Network Access Commercial |
$354.20
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$17.85
|
| Rate for Payer: Quartz Beloit One Network |
$188.65
|
| Rate for Payer: Quartz Commercial |
$250.25
|
| Rate for Payer: Quartz Medicare Advantage |
$17.27
|
| Rate for Payer: The Alliance Commercial |
$69.08
|
| Rate for Payer: United Healthcare Medicaid |
$17.85
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.27
|
| Rate for Payer: United Healthcare PPO |
$288.75
|
| Rate for Payer: WEA Trust Commercial |
$211.75
|
| Rate for Payer: Wellcare Medicare |
$17.27
|
| Rate for Payer: WMAP Medicaid |
$17.85
|
| Rate for Payer: WPS Commercial |
$285.17
|
|
|
VASCULAR GRAFT 28MM X 15CM GELWEAVE VALSALVA 730028ADP
|
Facility
|
OP
|
$13,590.00
|
|
| Hospital Charge Code |
3595504
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,805.20 |
| Max. Negotiated Rate |
$54,360.00 |
| Rate for Payer: Aetna Commercial |
$12,231.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$11,687.40
|
| Rate for Payer: Aetna Managed Medicare |
$3,805.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$8,833.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$6,795.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$6,523.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,202.70
|
| Rate for Payer: Cash Price |
$4,077.00
|
| Rate for Payer: Cigna Commercial |
$12,502.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$7,604.96
|
| Rate for Payer: Health EOS Commercial |
$12,095.10
|
| Rate for Payer: HFN Commercial |
$12,502.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$10,192.50
|
| Rate for Payer: Multiplan Commercial |
$10,872.00
|
| Rate for Payer: NAPHCARE Commercial |
$8,154.00
|
| Rate for Payer: Preferred Network Access Commercial |
$12,502.80
|
| Rate for Payer: Quartz Beloit One Network |
$6,659.10
|
| Rate for Payer: Quartz Commercial |
$8,833.50
|
| Rate for Payer: Quartz Medicare Advantage |
$8,154.00
|
| Rate for Payer: The Alliance Commercial |
$54,360.00
|
| Rate for Payer: WEA Trust Commercial |
$7,474.50
|
| Rate for Payer: WPS Commercial |
$10,066.11
|
|
|
VASCULAR GRAFT 28MM X 15CM GELWEAVE VALSALVA 730028ADP
|
Facility
|
IP
|
$13,590.00
|
|
| Hospital Charge Code |
3595504
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,659.10 |
| Max. Negotiated Rate |
$12,502.80 |
| Rate for Payer: Aetna Commercial |
$12,231.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$11,687.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,202.70
|
| Rate for Payer: Cash Price |
$4,077.00
|
| Rate for Payer: Cigna Commercial |
$12,502.80
|
| Rate for Payer: Health EOS Commercial |
$12,095.10
|
| Rate for Payer: HFN Commercial |
$12,502.80
|
| Rate for Payer: Multiplan Commercial |
$10,872.00
|
| Rate for Payer: NAPHCARE Commercial |
$8,154.00
|
| Rate for Payer: Preferred Network Access Commercial |
$12,502.80
|
| Rate for Payer: Quartz Beloit One Network |
$6,659.10
|
| Rate for Payer: Quartz Commercial |
$8,154.00
|
| Rate for Payer: WEA Trust Commercial |
$7,474.50
|
| Rate for Payer: WPS Commercial |
$10,066.11
|
|
|
VASCULAR GRAFT 30MM X 15CM GELWEAVE VALSALVA 730030ADP
|
Facility
|
IP
|
$13,590.00
|
|
| Hospital Charge Code |
5286886
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,659.10 |
| Max. Negotiated Rate |
$12,502.80 |
| Rate for Payer: Aetna Commercial |
$12,231.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$11,687.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,202.70
|
| Rate for Payer: Cash Price |
$4,077.00
|
| Rate for Payer: Cigna Commercial |
$12,502.80
|
| Rate for Payer: Health EOS Commercial |
$12,095.10
|
| Rate for Payer: HFN Commercial |
$12,502.80
|
| Rate for Payer: Multiplan Commercial |
$10,872.00
|
| Rate for Payer: NAPHCARE Commercial |
$8,154.00
|
| Rate for Payer: Preferred Network Access Commercial |
$12,502.80
|
| Rate for Payer: Quartz Beloit One Network |
$6,659.10
|
| Rate for Payer: Quartz Commercial |
$8,154.00
|
| Rate for Payer: WEA Trust Commercial |
$7,474.50
|
| Rate for Payer: WPS Commercial |
$10,066.11
|
|
|
VASCULAR GRAFT 30MM X 15CM GELWEAVE VALSALVA 730030ADP
|
Facility
|
OP
|
$13,590.00
|
|
| Hospital Charge Code |
5286886
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,805.20 |
| Max. Negotiated Rate |
$54,360.00 |
| Rate for Payer: Aetna Commercial |
$12,231.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$11,687.40
|
| Rate for Payer: Aetna Managed Medicare |
$3,805.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$8,833.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$6,795.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$6,523.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,202.70
|
| Rate for Payer: Cash Price |
$4,077.00
|
| Rate for Payer: Cigna Commercial |
$12,502.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$7,604.96
|
| Rate for Payer: Health EOS Commercial |
$12,095.10
|
| Rate for Payer: HFN Commercial |
$12,502.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$10,192.50
|
| Rate for Payer: Multiplan Commercial |
$10,872.00
|
| Rate for Payer: NAPHCARE Commercial |
$8,154.00
|
| Rate for Payer: Preferred Network Access Commercial |
$12,502.80
|
| Rate for Payer: Quartz Beloit One Network |
$6,659.10
|
| Rate for Payer: Quartz Commercial |
$8,833.50
|
| Rate for Payer: Quartz Medicare Advantage |
$8,154.00
|
| Rate for Payer: The Alliance Commercial |
$54,360.00
|
| Rate for Payer: WEA Trust Commercial |
$7,474.50
|
| Rate for Payer: WPS Commercial |
$10,066.11
|
|
|
VASCULAR GRAFT 32MM X 15CM GELWEAVE VALSALVA 730032ADP
|
Facility
|
IP
|
$14,112.00
|
|
| Hospital Charge Code |
5286741
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,914.88 |
| Max. Negotiated Rate |
$12,983.04 |
| Rate for Payer: Aetna Commercial |
$12,700.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$12,136.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,479.36
|
| Rate for Payer: Cash Price |
$4,233.60
|
| Rate for Payer: Cigna Commercial |
$12,983.04
|
| Rate for Payer: Health EOS Commercial |
$12,559.68
|
| Rate for Payer: HFN Commercial |
$12,983.04
|
| Rate for Payer: Multiplan Commercial |
$11,289.60
|
| Rate for Payer: NAPHCARE Commercial |
$8,467.20
|
| Rate for Payer: Preferred Network Access Commercial |
$12,983.04
|
| Rate for Payer: Quartz Beloit One Network |
$6,914.88
|
| Rate for Payer: Quartz Commercial |
$8,467.20
|
| Rate for Payer: WEA Trust Commercial |
$7,761.60
|
| Rate for Payer: WPS Commercial |
$10,452.76
|
|
|
VASCULAR GRAFT 32MM X 15CM GELWEAVE VALSALVA 730032ADP
|
Facility
|
OP
|
$14,112.00
|
|
| Hospital Charge Code |
5286741
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,951.36 |
| Max. Negotiated Rate |
$56,448.00 |
| Rate for Payer: Aetna Commercial |
$12,700.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$12,136.32
|
| Rate for Payer: Aetna Managed Medicare |
$3,951.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$9,172.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$7,056.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$6,773.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,479.36
|
| Rate for Payer: Cash Price |
$4,233.60
|
| Rate for Payer: Cigna Commercial |
$12,983.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$7,897.08
|
| Rate for Payer: Health EOS Commercial |
$12,559.68
|
| Rate for Payer: HFN Commercial |
$12,983.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$10,584.00
|
| Rate for Payer: Multiplan Commercial |
$11,289.60
|
| Rate for Payer: NAPHCARE Commercial |
$8,467.20
|
| Rate for Payer: Preferred Network Access Commercial |
$12,983.04
|
| Rate for Payer: Quartz Beloit One Network |
$6,914.88
|
| Rate for Payer: Quartz Commercial |
$9,172.80
|
| Rate for Payer: Quartz Medicare Advantage |
$8,467.20
|
| Rate for Payer: The Alliance Commercial |
$56,448.00
|
| Rate for Payer: WEA Trust Commercial |
$7,761.60
|
| Rate for Payer: WPS Commercial |
$10,452.76
|
|
|
VASCULAR GRAFT 34MM X 15CM GELWEAVE VALSALVA 730034ADP
|
Facility
|
OP
|
$23,619.00
|
|
| Hospital Charge Code |
6234137
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,613.32 |
| Max. Negotiated Rate |
$94,476.00 |
| Rate for Payer: Aetna Commercial |
$21,257.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$20,312.34
|
| Rate for Payer: Aetna Managed Medicare |
$6,613.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$15,352.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$11,809.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$11,337.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$12,518.07
|
| Rate for Payer: Cash Price |
$7,085.70
|
| Rate for Payer: Cigna Commercial |
$21,729.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$13,217.19
|
| Rate for Payer: Health EOS Commercial |
$21,020.91
|
| Rate for Payer: HFN Commercial |
$21,729.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$17,714.25
|
| Rate for Payer: Multiplan Commercial |
$18,895.20
|
| Rate for Payer: NAPHCARE Commercial |
$14,171.40
|
| Rate for Payer: Preferred Network Access Commercial |
$21,729.48
|
| Rate for Payer: Quartz Beloit One Network |
$11,573.31
|
| Rate for Payer: Quartz Commercial |
$15,352.35
|
| Rate for Payer: Quartz Medicare Advantage |
$14,171.40
|
| Rate for Payer: The Alliance Commercial |
$94,476.00
|
| Rate for Payer: WEA Trust Commercial |
$12,990.45
|
| Rate for Payer: WPS Commercial |
$17,494.59
|
|
|
VASCULAR GRAFT 34MM X 15CM GELWEAVE VALSALVA 730034ADP
|
Facility
|
IP
|
$23,619.00
|
|
| Hospital Charge Code |
6234137
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$11,573.31 |
| Max. Negotiated Rate |
$21,729.48 |
| Rate for Payer: Aetna Commercial |
$21,257.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$20,312.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$12,518.07
|
| Rate for Payer: Cash Price |
$7,085.70
|
| Rate for Payer: Cigna Commercial |
$21,729.48
|
| Rate for Payer: Health EOS Commercial |
$21,020.91
|
| Rate for Payer: HFN Commercial |
$21,729.48
|
| Rate for Payer: Multiplan Commercial |
$18,895.20
|
| Rate for Payer: NAPHCARE Commercial |
$14,171.40
|
| Rate for Payer: Preferred Network Access Commercial |
$21,729.48
|
| Rate for Payer: Quartz Beloit One Network |
$11,573.31
|
| Rate for Payer: Quartz Commercial |
$14,171.40
|
| Rate for Payer: WEA Trust Commercial |
$12,990.45
|
| Rate for Payer: WPS Commercial |
$17,494.59
|
|
|
VASCULAR GRAFT HYBRID 6-7MM X 50CM 0650HYB0705A
|
Facility
|
OP
|
$15,313.00
|
|
| Hospital Charge Code |
3525502
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,287.64 |
| Max. Negotiated Rate |
$61,252.00 |
| Rate for Payer: Aetna Commercial |
$13,781.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$13,169.18
|
| Rate for Payer: Aetna Managed Medicare |
$4,287.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$9,953.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$7,656.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,350.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$8,115.89
|
| Rate for Payer: Cash Price |
$4,593.90
|
| Rate for Payer: Cigna Commercial |
$14,087.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$8,569.15
|
| Rate for Payer: Health EOS Commercial |
$13,628.57
|
| Rate for Payer: HFN Commercial |
$14,087.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$11,484.75
|
| Rate for Payer: Multiplan Commercial |
$12,250.40
|
| Rate for Payer: NAPHCARE Commercial |
$9,187.80
|
| Rate for Payer: Preferred Network Access Commercial |
$14,087.96
|
| Rate for Payer: Quartz Beloit One Network |
$7,503.37
|
| Rate for Payer: Quartz Commercial |
$9,953.45
|
| Rate for Payer: Quartz Medicare Advantage |
$9,187.80
|
| Rate for Payer: The Alliance Commercial |
$61,252.00
|
| Rate for Payer: WEA Trust Commercial |
$8,422.15
|
| Rate for Payer: WPS Commercial |
$11,342.34
|
|
|
VASCULAR GRAFT HYBRID 6-7MM X 50CM 0650HYB0705A
|
Facility
|
IP
|
$15,313.00
|
|
| Hospital Charge Code |
3525502
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,503.37 |
| Max. Negotiated Rate |
$14,087.96 |
| Rate for Payer: Aetna Commercial |
$13,781.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$13,169.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$8,115.89
|
| Rate for Payer: Cash Price |
$4,593.90
|
| Rate for Payer: Cigna Commercial |
$14,087.96
|
| Rate for Payer: Health EOS Commercial |
$13,628.57
|
| Rate for Payer: HFN Commercial |
$14,087.96
|
| Rate for Payer: Multiplan Commercial |
$12,250.40
|
| Rate for Payer: NAPHCARE Commercial |
$9,187.80
|
| Rate for Payer: Preferred Network Access Commercial |
$14,087.96
|
| Rate for Payer: Quartz Beloit One Network |
$7,503.37
|
| Rate for Payer: Quartz Commercial |
$9,187.80
|
| Rate for Payer: WEA Trust Commercial |
$8,422.15
|
| Rate for Payer: WPS Commercial |
$11,342.34
|
|
|
VASCULAR GRAFT HYBRID 6-8MM X 50CM 0650HYB0805A
|
Facility
|
IP
|
$15,313.00
|
|
| Hospital Charge Code |
3525503
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,503.37 |
| Max. Negotiated Rate |
$14,087.96 |
| Rate for Payer: Aetna Commercial |
$13,781.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$13,169.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$8,115.89
|
| Rate for Payer: Cash Price |
$4,593.90
|
| Rate for Payer: Cigna Commercial |
$14,087.96
|
| Rate for Payer: Health EOS Commercial |
$13,628.57
|
| Rate for Payer: HFN Commercial |
$14,087.96
|
| Rate for Payer: Multiplan Commercial |
$12,250.40
|
| Rate for Payer: NAPHCARE Commercial |
$9,187.80
|
| Rate for Payer: Preferred Network Access Commercial |
$14,087.96
|
| Rate for Payer: Quartz Beloit One Network |
$7,503.37
|
| Rate for Payer: Quartz Commercial |
$9,187.80
|
| Rate for Payer: WEA Trust Commercial |
$8,422.15
|
| Rate for Payer: WPS Commercial |
$11,342.34
|
|
|
VASCULAR GRAFT HYBRID 6-8MM X 50CM 0650HYB0805A
|
Facility
|
OP
|
$15,313.00
|
|
| Hospital Charge Code |
3525503
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,287.64 |
| Max. Negotiated Rate |
$61,252.00 |
| Rate for Payer: Aetna Commercial |
$13,781.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$13,169.18
|
| Rate for Payer: Aetna Managed Medicare |
$4,287.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$9,953.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$7,656.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,350.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$8,115.89
|
| Rate for Payer: Cash Price |
$4,593.90
|
| Rate for Payer: Cigna Commercial |
$14,087.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$8,569.15
|
| Rate for Payer: Health EOS Commercial |
$13,628.57
|
| Rate for Payer: HFN Commercial |
$14,087.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$11,484.75
|
| Rate for Payer: Multiplan Commercial |
$12,250.40
|
| Rate for Payer: NAPHCARE Commercial |
$9,187.80
|
| Rate for Payer: Preferred Network Access Commercial |
$14,087.96
|
| Rate for Payer: Quartz Beloit One Network |
$7,503.37
|
| Rate for Payer: Quartz Commercial |
$9,953.45
|
| Rate for Payer: Quartz Medicare Advantage |
$9,187.80
|
| Rate for Payer: The Alliance Commercial |
$61,252.00
|
| Rate for Payer: WEA Trust Commercial |
$8,422.15
|
| Rate for Payer: WPS Commercial |
$11,342.34
|
|
