Vascular Acquisition
|
Facility
OP
|
$1,227.00
|
|
Service Code
|
CPT 93923
|
Hospital Charge Code |
5376662
|
Hospital Revenue Code
|
921
|
Min. Negotiated Rate |
$154.39 |
Max. Negotiated Rate |
$1,128.84 |
Rate for Payer: Aetna Commercial |
$1,104.30
|
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,055.22
|
Rate for Payer: Aetna Managed Medicare |
$154.39
|
Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$797.55
|
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$613.50
|
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$588.96
|
Rate for Payer: Anthem Medicare Advantage |
$154.39
|
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$650.31
|
Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$154.39
|
Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$154.39
|
Rate for Payer: Cash Price |
$368.10
|
Rate for Payer: Cash Price |
$368.10
|
Rate for Payer: Cigna Commercial |
$1,128.84
|
Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$154.39
|
Rate for Payer: Dean Health DHI/DHP/ASO |
$686.63
|
Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$154.39
|
Rate for Payer: Health EOS Commercial |
$1,092.03
|
Rate for Payer: HFN Commercial |
$1,128.84
|
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$574.33
|
Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$154.39
|
Rate for Payer: Independent Care Health Plan Medicare |
$154.39
|
Rate for Payer: Managed Health Services Medicare Advantage |
$154.39
|
Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$154.39
|
Rate for Payer: Multiplan Commercial |
$981.60
|
Rate for Payer: NAPHCARE Commercial |
$231.58
|
Rate for Payer: Preferred Network Access Commercial |
$1,128.84
|
Rate for Payer: Quartz Beloit One Network |
$601.23
|
Rate for Payer: Quartz Commercial |
$797.55
|
Rate for Payer: Quartz Medicare Advantage |
$154.39
|
Rate for Payer: United Healthcare Medicare Advantage |
$154.39
|
Rate for Payer: United Healthcare PPO |
$920.25
|
Rate for Payer: WEA Trust Commercial |
$674.85
|
Rate for Payer: Wellcare Medicare |
$154.39
|
Rate for Payer: WPS Commercial |
$908.84
|
|
Vascular Acquisition
|
Facility
OP
|
$1,641.00
|
|
Service Code
|
CPT 93971 RT
|
Hospital Charge Code |
5376677
|
Hospital Revenue Code
|
921
|
Min. Negotiated Rate |
$459.48 |
Max. Negotiated Rate |
$6,564.00 |
Rate for Payer: Aetna Commercial |
$1,476.90
|
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,411.26
|
Rate for Payer: Aetna Managed Medicare |
$459.48
|
Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,066.65
|
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$820.50
|
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$787.68
|
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: Dean Health DHI/DHP/ASO |
$918.30
|
Rate for Payer: Health EOS Commercial |
$1,460.49
|
Rate for Payer: HFN Commercial |
$1,509.72
|
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,230.75
|
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 |
$1,066.65
|
Rate for Payer: Quartz Medicare Advantage |
$984.60
|
Rate for Payer: The Alliance Commercial |
$6,564.00
|
Rate for Payer: United Healthcare PPO |
$1,230.75
|
Rate for Payer: WEA Trust Commercial |
$902.55
|
Rate for Payer: WPS Commercial |
$1,215.49
|
|
Vascular Acquisition
|
Facility
OP
|
$1,641.00
|
|
Service Code
|
CPT 93971
|
Hospital Charge Code |
5376671
|
Hospital Revenue Code
|
921
|
Min. Negotiated Rate |
$108.67 |
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: Aetna Managed Medicare |
$108.67
|
Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,066.65
|
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$820.50
|
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$787.68
|
Rate for Payer: Anthem Medicare Advantage |
$108.67
|
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$869.73
|
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 |
$492.30
|
Rate for Payer: Cash Price |
$492.30
|
Rate for Payer: Cigna Commercial |
$1,509.72
|
Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$108.67
|
Rate for Payer: Dean Health DHI/DHP/ASO |
$918.30
|
Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$108.67
|
Rate for Payer: Health EOS Commercial |
$1,460.49
|
Rate for Payer: HFN Commercial |
$1,509.72
|
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 |
$1,312.80
|
Rate for Payer: NAPHCARE Commercial |
$163.00
|
Rate for Payer: Preferred Network Access Commercial |
$1,509.72
|
Rate for Payer: Quartz Beloit One Network |
$804.09
|
Rate for Payer: Quartz Commercial |
$1,066.65
|
Rate for Payer: Quartz Medicare Advantage |
$108.67
|
Rate for Payer: United Healthcare Medicare Advantage |
$108.67
|
Rate for Payer: United Healthcare PPO |
$1,230.75
|
Rate for Payer: WEA Trust Commercial |
$902.55
|
Rate for Payer: Wellcare Medicare |
$108.67
|
Rate for Payer: WPS Commercial |
$1,215.49
|
|
Vascular Acquisition
|
Facility
OP
|
$1,641.00
|
|
Service Code
|
CPT 93971 LT
|
Hospital Charge Code |
5376719
|
Hospital Revenue Code
|
921
|
Min. Negotiated Rate |
$459.48 |
Max. Negotiated Rate |
$6,564.00 |
Rate for Payer: Aetna Commercial |
$1,476.90
|
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,411.26
|
Rate for Payer: Aetna Managed Medicare |
$459.48
|
Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,066.65
|
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$820.50
|
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$787.68
|
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: Dean Health DHI/DHP/ASO |
$918.30
|
Rate for Payer: Health EOS Commercial |
$1,460.49
|
Rate for Payer: HFN Commercial |
$1,509.72
|
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,230.75
|
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 |
$1,066.65
|
Rate for Payer: Quartz Medicare Advantage |
$984.60
|
Rate for Payer: The Alliance Commercial |
$6,564.00
|
Rate for Payer: United Healthcare PPO |
$1,230.75
|
Rate for Payer: WEA Trust Commercial |
$902.55
|
Rate for Payer: WPS Commercial |
$1,215.49
|
|
Vascular Acquisition
|
Facility
OP
|
$1,644.00
|
|
Service Code
|
CPT 93971 RT
|
Hospital Charge Code |
5376722
|
Hospital Revenue Code
|
921
|
Min. Negotiated Rate |
$460.32 |
Max. Negotiated Rate |
$6,576.00 |
Rate for Payer: Aetna Commercial |
$1,479.60
|
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,413.84
|
Rate for Payer: Aetna Managed Medicare |
$460.32
|
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: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$871.32
|
Rate for Payer: Cash Price |
$493.20
|
Rate for Payer: Cigna Commercial |
$1,512.48
|
Rate for Payer: Dean Health DHI/DHP/ASO |
$919.98
|
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 |
$1,233.00
|
Rate for Payer: Multiplan Commercial |
$1,315.20
|
Rate for Payer: NAPHCARE Commercial |
$986.40
|
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 |
$986.40
|
Rate for Payer: The Alliance Commercial |
$6,576.00
|
Rate for Payer: United Healthcare PPO |
$1,233.00
|
Rate for Payer: WEA Trust Commercial |
$904.20
|
Rate for Payer: WPS Commercial |
$1,217.71
|
|
Vascular Acquisition
|
Facility
IP
|
$1,641.00
|
|
Service Code
|
CPT 93971 RT
|
Hospital Charge Code |
5376677
|
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: 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
OP
|
$1,342.00
|
|
Service Code
|
CPT 93931 LT
|
Hospital Charge Code |
5376701
|
Hospital Revenue Code
|
921
|
Min. Negotiated Rate |
$375.76 |
Max. Negotiated Rate |
$5,368.00 |
Rate for Payer: Aetna Commercial |
$1,207.80
|
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,154.12
|
Rate for Payer: Aetna Managed Medicare |
$375.76
|
Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$872.30
|
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$671.00
|
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$644.16
|
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$711.26
|
Rate for Payer: Cash Price |
$402.60
|
Rate for Payer: Cigna Commercial |
$1,234.64
|
Rate for Payer: Dean Health DHI/DHP/ASO |
$750.98
|
Rate for Payer: Health EOS Commercial |
$1,194.38
|
Rate for Payer: HFN Commercial |
$1,234.64
|
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,006.50
|
Rate for Payer: Multiplan Commercial |
$1,073.60
|
Rate for Payer: NAPHCARE Commercial |
$805.20
|
Rate for Payer: Preferred Network Access Commercial |
$1,234.64
|
Rate for Payer: Quartz Beloit One Network |
$657.58
|
Rate for Payer: Quartz Commercial |
$872.30
|
Rate for Payer: Quartz Medicare Advantage |
$805.20
|
Rate for Payer: The Alliance Commercial |
$5,368.00
|
Rate for Payer: United Healthcare PPO |
$1,006.50
|
Rate for Payer: WEA Trust Commercial |
$738.10
|
Rate for Payer: WPS Commercial |
$994.02
|
|
Vascular Acquisition
|
Facility
IP
|
$1,274.00
|
|
Service Code
|
CPT 93926 RT
|
Hospital Charge Code |
5376659
|
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: 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
|
$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: 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
OP
|
$926.00
|
|
Service Code
|
CPT 93882 LT
|
Hospital Charge Code |
5375857
|
Hospital Revenue Code
|
921
|
Min. Negotiated Rate |
$259.28 |
Max. Negotiated Rate |
$3,704.00 |
Rate for Payer: Aetna Commercial |
$833.40
|
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$796.36
|
Rate for Payer: Aetna Managed Medicare |
$259.28
|
Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$601.90
|
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$463.00
|
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$444.48
|
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$490.78
|
Rate for Payer: Cash Price |
$277.80
|
Rate for Payer: Cigna Commercial |
$851.92
|
Rate for Payer: Dean Health DHI/DHP/ASO |
$518.19
|
Rate for Payer: Health EOS Commercial |
$824.14
|
Rate for Payer: HFN Commercial |
$851.92
|
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$694.50
|
Rate for Payer: Multiplan Commercial |
$740.80
|
Rate for Payer: NAPHCARE Commercial |
$555.60
|
Rate for Payer: Preferred Network Access Commercial |
$851.92
|
Rate for Payer: Quartz Beloit One Network |
$453.74
|
Rate for Payer: Quartz Commercial |
$601.90
|
Rate for Payer: Quartz Medicare Advantage |
$555.60
|
Rate for Payer: The Alliance Commercial |
$3,704.00
|
Rate for Payer: United Healthcare PPO |
$694.50
|
Rate for Payer: WEA Trust Commercial |
$509.30
|
Rate for Payer: WPS Commercial |
$685.89
|
|
Vascular Acquisition
|
Facility
OP
|
$1,274.00
|
|
Service Code
|
CPT 93926 RT
|
Hospital Charge Code |
5375806
|
Hospital Revenue Code
|
921
|
Min. Negotiated Rate |
$356.72 |
Max. Negotiated Rate |
$5,096.00 |
Rate for Payer: Aetna Commercial |
$1,146.60
|
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,095.64
|
Rate for Payer: Aetna Managed Medicare |
$356.72
|
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: 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: Dean Health DHI/DHP/ASO |
$712.93
|
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 |
$955.50
|
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 |
$828.10
|
Rate for Payer: Quartz Medicare Advantage |
$764.40
|
Rate for Payer: The Alliance Commercial |
$5,096.00
|
Rate for Payer: United Healthcare PPO |
$955.50
|
Rate for Payer: WEA Trust Commercial |
$700.70
|
Rate for Payer: WPS Commercial |
$943.65
|
|
Vascular Acquisition
|
Facility
IP
|
$1,641.00
|
|
Service Code
|
CPT 93971 LT
|
Hospital Charge Code |
5376719
|
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: 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
OP
|
$792.00
|
|
Service Code
|
CPT 93922
|
Hospital Charge Code |
5376713
|
Hospital Revenue Code
|
921
|
Min. Negotiated Rate |
$126.26 |
Max. Negotiated Rate |
$728.64 |
Rate for Payer: Aetna Commercial |
$712.80
|
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$681.12
|
Rate for Payer: Aetna Managed Medicare |
$126.26
|
Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$514.80
|
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$396.00
|
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$380.16
|
Rate for Payer: Anthem Medicare Advantage |
$126.26
|
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$419.76
|
Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$126.26
|
Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$126.26
|
Rate for Payer: Cash Price |
$237.60
|
Rate for Payer: Cash Price |
$237.60
|
Rate for Payer: Cigna Commercial |
$728.64
|
Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$126.26
|
Rate for Payer: Dean Health DHI/DHP/ASO |
$443.20
|
Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$126.26
|
Rate for Payer: Health EOS Commercial |
$704.88
|
Rate for Payer: HFN Commercial |
$728.64
|
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$469.69
|
Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$126.26
|
Rate for Payer: Independent Care Health Plan Medicare |
$126.26
|
Rate for Payer: Managed Health Services Medicare Advantage |
$126.26
|
Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$126.26
|
Rate for Payer: Multiplan Commercial |
$633.60
|
Rate for Payer: NAPHCARE Commercial |
$189.39
|
Rate for Payer: Preferred Network Access Commercial |
$728.64
|
Rate for Payer: Quartz Beloit One Network |
$388.08
|
Rate for Payer: Quartz Commercial |
$514.80
|
Rate for Payer: Quartz Medicare Advantage |
$126.26
|
Rate for Payer: United Healthcare Medicare Advantage |
$126.26
|
Rate for Payer: United Healthcare PPO |
$594.00
|
Rate for Payer: WEA Trust Commercial |
$435.60
|
Rate for Payer: Wellcare Medicare |
$126.26
|
Rate for Payer: WPS Commercial |
$586.63
|
|
Vascular Acquisition
|
Facility
IP
|
$1,329.00
|
|
Service Code
|
CPT 93978
|
Hospital Charge Code |
5376637
|
Hospital Revenue Code
|
921
|
Min. Negotiated Rate |
$651.21 |
Max. Negotiated Rate |
$1,222.68 |
Rate for Payer: Aetna Commercial |
$1,196.10
|
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$704.37
|
Rate for Payer: Cash Price |
$398.70
|
Rate for Payer: Cigna Commercial |
$1,222.68
|
Rate for Payer: Health EOS Commercial |
$1,182.81
|
Rate for Payer: HFN Commercial |
$1,222.68
|
Rate for Payer: Multiplan Commercial |
$1,063.20
|
Rate for Payer: NAPHCARE Commercial |
$797.40
|
Rate for Payer: Preferred Network Access Commercial |
$1,222.68
|
Rate for Payer: Quartz Beloit One Network |
$651.21
|
Rate for Payer: Quartz Commercial |
$797.40
|
Rate for Payer: WEA Trust Commercial |
$730.95
|
Rate for Payer: WPS Commercial |
$984.39
|
|
Vascular Acquisition
|
Facility
IP
|
$1,692.00
|
|
Service Code
|
CPT 93930
|
Hospital Charge Code |
5376698
|
Hospital Revenue Code
|
921
|
Min. Negotiated Rate |
$829.08 |
Max. Negotiated Rate |
$1,556.64 |
Rate for Payer: Aetna Commercial |
$1,522.80
|
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$896.76
|
Rate for Payer: Cash Price |
$507.60
|
Rate for Payer: Cigna Commercial |
$1,556.64
|
Rate for Payer: Health EOS Commercial |
$1,505.88
|
Rate for Payer: HFN Commercial |
$1,556.64
|
Rate for Payer: Multiplan Commercial |
$1,353.60
|
Rate for Payer: NAPHCARE Commercial |
$1,015.20
|
Rate for Payer: Preferred Network Access Commercial |
$1,556.64
|
Rate for Payer: Quartz Beloit One Network |
$829.08
|
Rate for Payer: Quartz Commercial |
$1,015.20
|
Rate for Payer: WEA Trust Commercial |
$930.60
|
Rate for Payer: WPS Commercial |
$1,253.26
|
|
Vascular Acquisition
|
Facility
IP
|
$1,342.00
|
|
Service Code
|
CPT 93931 RT
|
Hospital Charge Code |
5376704
|
Hospital Revenue Code
|
921
|
Min. Negotiated Rate |
$657.58 |
Max. Negotiated Rate |
$1,234.64 |
Rate for Payer: Aetna Commercial |
$1,207.80
|
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$711.26
|
Rate for Payer: Cash Price |
$402.60
|
Rate for Payer: Cigna Commercial |
$1,234.64
|
Rate for Payer: Health EOS Commercial |
$1,194.38
|
Rate for Payer: HFN Commercial |
$1,234.64
|
Rate for Payer: Multiplan Commercial |
$1,073.60
|
Rate for Payer: NAPHCARE Commercial |
$805.20
|
Rate for Payer: Preferred Network Access Commercial |
$1,234.64
|
Rate for Payer: Quartz Beloit One Network |
$657.58
|
Rate for Payer: Quartz Commercial |
$805.20
|
Rate for Payer: WEA Trust Commercial |
$738.10
|
Rate for Payer: WPS Commercial |
$994.02
|
|
Vascular Acquisition
|
Facility
OP
|
$812.00
|
|
Service Code
|
CPT 93990
|
Hospital Charge Code |
5375869
|
Hospital Revenue Code
|
921
|
Min. Negotiated Rate |
$108.67 |
Max. Negotiated Rate |
$747.04 |
Rate for Payer: Aetna Commercial |
$730.80
|
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$698.32
|
Rate for Payer: Aetna Managed Medicare |
$108.67
|
Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$527.80
|
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$406.00
|
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$389.76
|
Rate for Payer: Anthem Medicare Advantage |
$108.67
|
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$430.36
|
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 |
$243.60
|
Rate for Payer: Cash Price |
$243.60
|
Rate for Payer: Cigna Commercial |
$747.04
|
Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$108.67
|
Rate for Payer: Dean Health DHI/DHP/ASO |
$454.40
|
Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$108.67
|
Rate for Payer: Health EOS Commercial |
$722.68
|
Rate for Payer: HFN Commercial |
$747.04
|
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 |
$649.60
|
Rate for Payer: NAPHCARE Commercial |
$163.00
|
Rate for Payer: Preferred Network Access Commercial |
$747.04
|
Rate for Payer: Quartz Beloit One Network |
$397.88
|
Rate for Payer: Quartz Commercial |
$527.80
|
Rate for Payer: Quartz Medicare Advantage |
$108.67
|
Rate for Payer: United Healthcare Medicare Advantage |
$108.67
|
Rate for Payer: United Healthcare PPO |
$609.00
|
Rate for Payer: WEA Trust Commercial |
$446.60
|
Rate for Payer: Wellcare Medicare |
$108.67
|
Rate for Payer: WPS Commercial |
$601.45
|
|
Vascular Acquisition
|
Facility
OP
|
$1,791.00
|
|
Service Code
|
CPT 93880
|
Hospital Charge Code |
5375854
|
Hospital Revenue Code
|
921
|
Min. Negotiated Rate |
$242.20 |
Max. Negotiated Rate |
$1,647.72 |
Rate for Payer: Aetna Commercial |
$1,611.90
|
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,540.26
|
Rate for Payer: Aetna Managed Medicare |
$242.20
|
Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,164.15
|
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$895.50
|
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$859.68
|
Rate for Payer: Anthem Medicare Advantage |
$242.20
|
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$949.23
|
Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$242.20
|
Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$242.20
|
Rate for Payer: Cash Price |
$537.30
|
Rate for Payer: Cash Price |
$537.30
|
Rate for Payer: Cigna Commercial |
$1,647.72
|
Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$242.20
|
Rate for Payer: Dean Health DHI/DHP/ASO |
$1,002.24
|
Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$242.20
|
Rate for Payer: Health EOS Commercial |
$1,593.99
|
Rate for Payer: HFN Commercial |
$1,647.72
|
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$900.98
|
Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$242.20
|
Rate for Payer: Independent Care Health Plan Medicare |
$242.20
|
Rate for Payer: Managed Health Services Medicare Advantage |
$242.20
|
Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$242.20
|
Rate for Payer: Multiplan Commercial |
$1,432.80
|
Rate for Payer: NAPHCARE Commercial |
$363.30
|
Rate for Payer: Preferred Network Access Commercial |
$1,647.72
|
Rate for Payer: Quartz Beloit One Network |
$877.59
|
Rate for Payer: Quartz Commercial |
$1,164.15
|
Rate for Payer: Quartz Medicare Advantage |
$242.20
|
Rate for Payer: United Healthcare Medicare Advantage |
$242.20
|
Rate for Payer: United Healthcare PPO |
$1,343.25
|
Rate for Payer: WEA Trust Commercial |
$985.05
|
Rate for Payer: Wellcare Medicare |
$242.20
|
Rate for Payer: WPS Commercial |
$1,326.59
|
|
Vascular Acquisition
|
Facility
IP
|
$1,641.00
|
|
Service Code
|
CPT 93971 RT
|
Hospital Charge Code |
6195140
|
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: 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
OP
|
$591.00
|
|
Service Code
|
CPT 76937
|
Hospital Charge Code |
5376734
|
Hospital Revenue Code
|
921
|
Min. Negotiated Rate |
$96.52 |
Max. Negotiated Rate |
$543.72 |
Rate for Payer: Aetna Commercial |
$531.90
|
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$508.26
|
Rate for Payer: Aetna Managed Medicare |
$165.48
|
Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$384.15
|
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$295.50
|
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$283.68
|
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$313.23
|
Rate for Payer: Cash Price |
$177.30
|
Rate for Payer: Cash Price |
$177.30
|
Rate for Payer: Cigna Commercial |
$543.72
|
Rate for Payer: Health EOS Commercial |
$525.99
|
Rate for Payer: HFN Commercial |
$543.72
|
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$443.25
|
Rate for Payer: Multiplan Commercial |
$472.80
|
Rate for Payer: NAPHCARE Commercial |
$354.60
|
Rate for Payer: Preferred Network Access Commercial |
$543.72
|
Rate for Payer: Quartz Beloit One Network |
$289.59
|
Rate for Payer: Quartz Commercial |
$384.15
|
Rate for Payer: Quartz Medicare Advantage |
$354.60
|
Rate for Payer: The Alliance Commercial |
$96.52
|
Rate for Payer: United Healthcare PPO |
$443.25
|
Rate for Payer: WEA Trust Commercial |
$325.05
|
Rate for Payer: WPS Commercial |
$437.75
|
|
Vascular Acquisition
|
Facility
OP
|
$792.00
|
|
Service Code
|
CPT 93922
|
Hospital Charge Code |
5375850
|
Hospital Revenue Code
|
921
|
Min. Negotiated Rate |
$126.26 |
Max. Negotiated Rate |
$728.64 |
Rate for Payer: Aetna Commercial |
$712.80
|
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$681.12
|
Rate for Payer: Aetna Managed Medicare |
$126.26
|
Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$514.80
|
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$396.00
|
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$380.16
|
Rate for Payer: Anthem Medicare Advantage |
$126.26
|
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$419.76
|
Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$126.26
|
Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$126.26
|
Rate for Payer: Cash Price |
$237.60
|
Rate for Payer: Cash Price |
$237.60
|
Rate for Payer: Cigna Commercial |
$728.64
|
Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$126.26
|
Rate for Payer: Dean Health DHI/DHP/ASO |
$443.20
|
Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$126.26
|
Rate for Payer: Health EOS Commercial |
$704.88
|
Rate for Payer: HFN Commercial |
$728.64
|
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$469.69
|
Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$126.26
|
Rate for Payer: Independent Care Health Plan Medicare |
$126.26
|
Rate for Payer: Managed Health Services Medicare Advantage |
$126.26
|
Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$126.26
|
Rate for Payer: Multiplan Commercial |
$633.60
|
Rate for Payer: NAPHCARE Commercial |
$189.39
|
Rate for Payer: Preferred Network Access Commercial |
$728.64
|
Rate for Payer: Quartz Beloit One Network |
$388.08
|
Rate for Payer: Quartz Commercial |
$514.80
|
Rate for Payer: Quartz Medicare Advantage |
$126.26
|
Rate for Payer: United Healthcare Medicare Advantage |
$126.26
|
Rate for Payer: United Healthcare PPO |
$594.00
|
Rate for Payer: WEA Trust Commercial |
$435.60
|
Rate for Payer: Wellcare Medicare |
$126.26
|
Rate for Payer: WPS Commercial |
$586.63
|
|
Vascular Acquisition
|
Facility
IP
|
$1,641.00
|
|
Service Code
|
CPT 93971 LT
|
Hospital Charge Code |
5376728
|
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: 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
|
$792.00
|
|
Service Code
|
CPT 93922
|
Hospital Charge Code |
5376713
|
Hospital Revenue Code
|
921
|
Min. Negotiated Rate |
$388.08 |
Max. Negotiated Rate |
$728.64 |
Rate for Payer: Aetna Commercial |
$712.80
|
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$419.76
|
Rate for Payer: Cash Price |
$237.60
|
Rate for Payer: Cigna Commercial |
$728.64
|
Rate for Payer: Health EOS Commercial |
$704.88
|
Rate for Payer: HFN Commercial |
$728.64
|
Rate for Payer: Multiplan Commercial |
$633.60
|
Rate for Payer: NAPHCARE Commercial |
$475.20
|
Rate for Payer: Preferred Network Access Commercial |
$728.64
|
Rate for Payer: Quartz Beloit One Network |
$388.08
|
Rate for Payer: Quartz Commercial |
$475.20
|
Rate for Payer: WEA Trust Commercial |
$435.60
|
Rate for Payer: WPS Commercial |
$586.63
|
|
Vascular Acquisition
|
Facility
OP
|
$626.00
|
|
Service Code
|
CPT 93976
|
Hospital Charge Code |
5375863
|
Hospital Revenue Code
|
921
|
Min. Negotiated Rate |
$108.67 |
Max. Negotiated Rate |
$575.92 |
Rate for Payer: Aetna Commercial |
$563.40
|
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$538.36
|
Rate for Payer: Aetna Managed Medicare |
$108.67
|
Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$406.90
|
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$313.00
|
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$300.48
|
Rate for Payer: Anthem Medicare Advantage |
$108.67
|
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$331.78
|
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 |
$187.80
|
Rate for Payer: Cash Price |
$187.80
|
Rate for Payer: Cigna Commercial |
$575.92
|
Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$108.67
|
Rate for Payer: Dean Health DHI/DHP/ASO |
$350.31
|
Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$108.67
|
Rate for Payer: Health EOS Commercial |
$557.14
|
Rate for Payer: HFN Commercial |
$575.92
|
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 |
$500.80
|
Rate for Payer: NAPHCARE Commercial |
$163.00
|
Rate for Payer: Preferred Network Access Commercial |
$575.92
|
Rate for Payer: Quartz Beloit One Network |
$306.74
|
Rate for Payer: Quartz Commercial |
$406.90
|
Rate for Payer: Quartz Medicare Advantage |
$108.67
|
Rate for Payer: United Healthcare Medicare Advantage |
$108.67
|
Rate for Payer: United Healthcare PPO |
$469.50
|
Rate for Payer: WEA Trust Commercial |
$344.30
|
Rate for Payer: Wellcare Medicare |
$108.67
|
Rate for Payer: WPS Commercial |
$463.68
|
|
Vascular Acquisition
|
Facility
OP
|
$1,641.00
|
|
Service Code
|
CPT 93971 LT
|
Hospital Charge Code |
5376683
|
Hospital Revenue Code
|
921
|
Min. Negotiated Rate |
$459.48 |
Max. Negotiated Rate |
$6,564.00 |
Rate for Payer: Aetna Commercial |
$1,476.90
|
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,411.26
|
Rate for Payer: Aetna Managed Medicare |
$459.48
|
Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,066.65
|
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$820.50
|
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$787.68
|
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: Dean Health DHI/DHP/ASO |
$918.30
|
Rate for Payer: Health EOS Commercial |
$1,460.49
|
Rate for Payer: HFN Commercial |
$1,509.72
|
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,230.75
|
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 |
$1,066.65
|
Rate for Payer: Quartz Medicare Advantage |
$984.60
|
Rate for Payer: The Alliance Commercial |
$6,564.00
|
Rate for Payer: United Healthcare PPO |
$1,230.75
|
Rate for Payer: WEA Trust Commercial |
$902.55
|
Rate for Payer: WPS Commercial |
$1,215.49
|
|