|
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
|
$1,692.00
|
|
|
Service Code
|
CPT 93930
|
| Hospital Charge Code |
5376698
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$242.20 |
| Max. Negotiated Rate |
$1,556.64 |
| Rate for Payer: Aetna Commercial |
$1,522.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,455.12
|
| Rate for Payer: Aetna Managed Medicare |
$242.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,099.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$846.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$812.16
|
| Rate for Payer: Anthem Medicare Advantage |
$242.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$896.76
|
| 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 |
$507.60
|
| Rate for Payer: Cash Price |
$507.60
|
| Rate for Payer: Cigna Commercial |
$1,556.64
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$242.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$946.84
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$242.20
|
| Rate for Payer: Health EOS Commercial |
$1,505.88
|
| Rate for Payer: HFN Commercial |
$1,556.64
|
| 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 |
$1,353.60
|
| Rate for Payer: NAPHCARE Commercial |
$363.30
|
| Rate for Payer: Preferred Network Access Commercial |
$1,556.64
|
| Rate for Payer: Quartz Beloit One Network |
$829.08
|
| Rate for Payer: Quartz Commercial |
$1,099.80
|
| Rate for Payer: Quartz Medicare Advantage |
$242.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$242.20
|
| Rate for Payer: United Healthcare PPO |
$1,269.00
|
| Rate for Payer: WEA Trust Commercial |
$930.60
|
| Rate for Payer: Wellcare Medicare |
$242.20
|
| Rate for Payer: WPS Commercial |
$1,253.26
|
|
|
Vascular Acquisition
|
Facility
IP
|
$926.00
|
|
|
Service Code
|
CPT 93882 LT
|
| Hospital Charge Code |
5375857
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$453.74 |
| Max. Negotiated Rate |
$851.92 |
| Rate for Payer: Aetna Commercial |
$833.40
|
| 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: Health EOS Commercial |
$824.14
|
| Rate for Payer: HFN Commercial |
$851.92
|
| 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 |
$555.60
|
| Rate for Payer: WEA Trust Commercial |
$509.30
|
| Rate for Payer: WPS Commercial |
$685.89
|
|
|
Vascular Acquisition
|
Facility
IP
|
$1,274.00
|
|
|
Service Code
|
CPT 93926 LT
|
| Hospital Charge Code |
5376656
|
|
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
|
$1,641.00
|
|
|
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
|
$1,274.00
|
|
|
Service Code
|
CPT 93926 LT
|
| Hospital Charge Code |
5376656
|
|
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
|
| Hospital Charge Code |
5376671
|
|
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
|
$1,641.00
|
|
|
Service Code
|
CPT 93971 LT
|
| Hospital Charge Code |
6195114
|
|
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 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
|
|
|
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: 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
|
$1,641.00
|
|
|
Service Code
|
CPT 93971
|
| Hospital Charge Code |
6195111
|
|
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
|
$591.00
|
|
|
Service Code
|
CPT 76937
|
| Hospital Charge Code |
5376734
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$289.59 |
| Max. Negotiated Rate |
$543.72 |
| Rate for Payer: Aetna Commercial |
$531.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$313.23
|
| 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: 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 |
$354.60
|
| Rate for Payer: WEA Trust Commercial |
$325.05
|
| Rate for Payer: WPS Commercial |
$437.75
|
|
|
Vascular Acquisition
|
Facility
OP
|
$1,104.00
|
|
|
Service Code
|
CPT 93922
|
| Hospital Charge Code |
5376710
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$126.26 |
| 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: Aetna Managed Medicare |
$126.26
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$717.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$552.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$529.92
|
| Rate for Payer: Anthem Medicare Advantage |
$126.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$585.12
|
| 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 |
$331.20
|
| Rate for Payer: Cash Price |
$331.20
|
| Rate for Payer: Cigna Commercial |
$1,015.68
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$126.26
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$617.80
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$126.26
|
| Rate for Payer: Health EOS Commercial |
$982.56
|
| Rate for Payer: HFN Commercial |
$1,015.68
|
| 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 |
$883.20
|
| Rate for Payer: NAPHCARE Commercial |
$189.39
|
| Rate for Payer: Preferred Network Access Commercial |
$1,015.68
|
| Rate for Payer: Quartz Beloit One Network |
$540.96
|
| Rate for Payer: Quartz Commercial |
$717.60
|
| Rate for Payer: Quartz Medicare Advantage |
$126.26
|
| Rate for Payer: United Healthcare Medicare Advantage |
$126.26
|
| Rate for Payer: United Healthcare PPO |
$828.00
|
| Rate for Payer: WEA Trust Commercial |
$607.20
|
| Rate for Payer: Wellcare Medicare |
$126.26
|
| Rate for Payer: WPS Commercial |
$817.73
|
|
|
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
IP
|
$2,442.00
|
|
|
Service Code
|
CPT 93925
|
| Hospital Charge Code |
5376646
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$1,196.58 |
| Max. Negotiated Rate |
$2,246.64 |
| Rate for Payer: Aetna Commercial |
$2,197.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,294.26
|
| Rate for Payer: Cash Price |
$732.60
|
| Rate for Payer: Cigna Commercial |
$2,246.64
|
| Rate for Payer: Health EOS Commercial |
$2,173.38
|
| Rate for Payer: HFN Commercial |
$2,246.64
|
| Rate for Payer: Multiplan Commercial |
$1,953.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,465.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,246.64
|
| Rate for Payer: Quartz Beloit One Network |
$1,196.58
|
| Rate for Payer: Quartz Commercial |
$1,465.20
|
| Rate for Payer: WEA Trust Commercial |
$1,343.10
|
| Rate for Payer: WPS Commercial |
$1,808.79
|
|
|
Vascular Acquisition
|
Facility
IP
|
$812.00
|
|
|
Service Code
|
CPT 93990
|
| Hospital Charge Code |
5375869
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$397.88 |
| Max. Negotiated Rate |
$747.04 |
| Rate for Payer: Aetna Commercial |
$730.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$430.36
|
| Rate for Payer: Cash Price |
$243.60
|
| Rate for Payer: Cigna Commercial |
$747.04
|
| Rate for Payer: Health EOS Commercial |
$722.68
|
| Rate for Payer: HFN Commercial |
$747.04
|
| Rate for Payer: Multiplan Commercial |
$649.60
|
| Rate for Payer: NAPHCARE Commercial |
$487.20
|
| Rate for Payer: Preferred Network Access Commercial |
$747.04
|
| Rate for Payer: Quartz Beloit One Network |
$397.88
|
| Rate for Payer: Quartz Commercial |
$487.20
|
| Rate for Payer: WEA Trust Commercial |
$446.60
|
| Rate for Payer: WPS Commercial |
$601.45
|
|
|
Vascular Acquisition
|
Facility
IP
|
$1,791.00
|
|
|
Service Code
|
CPT 93880
|
| Hospital Charge Code |
5375854
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$877.59 |
| Max. Negotiated Rate |
$1,647.72 |
| Rate for Payer: Aetna Commercial |
$1,611.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$949.23
|
| Rate for Payer: Cash Price |
$537.30
|
| Rate for Payer: Cigna Commercial |
$1,647.72
|
| Rate for Payer: Health EOS Commercial |
$1,593.99
|
| Rate for Payer: HFN Commercial |
$1,647.72
|
| Rate for Payer: Multiplan Commercial |
$1,432.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,074.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,647.72
|
| Rate for Payer: Quartz Beloit One Network |
$877.59
|
| Rate for Payer: Quartz Commercial |
$1,074.60
|
| Rate for Payer: WEA Trust Commercial |
$985.05
|
| Rate for Payer: WPS Commercial |
$1,326.59
|
|
|
Vascular Acquisition
|
Facility
OP
|
$1,234.00
|
|
|
Service Code
|
CPT 93979 LT
|
| Hospital Charge Code |
5376640
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$345.52 |
| Max. Negotiated Rate |
$4,936.00 |
| Rate for Payer: Aetna Commercial |
$1,110.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,061.24
|
| Rate for Payer: Aetna Managed Medicare |
$345.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$802.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$617.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$592.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$654.02
|
| Rate for Payer: Cash Price |
$370.20
|
| Rate for Payer: Cigna Commercial |
$1,135.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$690.55
|
| Rate for Payer: Health EOS Commercial |
$1,098.26
|
| Rate for Payer: HFN Commercial |
$1,135.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$925.50
|
| Rate for Payer: Multiplan Commercial |
$987.20
|
| Rate for Payer: NAPHCARE Commercial |
$740.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,135.28
|
| Rate for Payer: Quartz Beloit One Network |
$604.66
|
| Rate for Payer: Quartz Commercial |
$802.10
|
| Rate for Payer: Quartz Medicare Advantage |
$740.40
|
| Rate for Payer: The Alliance Commercial |
$4,936.00
|
| Rate for Payer: United Healthcare PPO |
$925.50
|
| Rate for Payer: WEA Trust Commercial |
$678.70
|
| Rate for Payer: WPS Commercial |
$914.02
|
|
|
Vascular Acquisition
|
Facility
OP
|
$1,641.00
|
|
|
Service Code
|
CPT 93971 RT
|
| Hospital Charge Code |
6195140
|
|
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
IP
|
$1,227.00
|
|
|
Service Code
|
CPT 93923
|
| Hospital Charge Code |
5376662
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$601.23 |
| Max. Negotiated Rate |
$1,128.84 |
| Rate for Payer: Aetna Commercial |
$1,104.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$650.31
|
| Rate for Payer: Cash Price |
$368.10
|
| Rate for Payer: Cigna Commercial |
$1,128.84
|
| Rate for Payer: Health EOS Commercial |
$1,092.03
|
| Rate for Payer: HFN Commercial |
$1,128.84
|
| Rate for Payer: Multiplan Commercial |
$981.60
|
| Rate for Payer: NAPHCARE Commercial |
$736.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,128.84
|
| Rate for Payer: Quartz Beloit One Network |
$601.23
|
| Rate for Payer: Quartz Commercial |
$736.20
|
| Rate for Payer: WEA Trust Commercial |
$674.85
|
| Rate for Payer: WPS Commercial |
$908.84
|
|
|
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
IP
|
$1,227.00
|
|
|
Service Code
|
CPT 93923
|
| Hospital Charge Code |
5376665
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$601.23 |
| Max. Negotiated Rate |
$1,128.84 |
| Rate for Payer: Aetna Commercial |
$1,104.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$650.31
|
| Rate for Payer: Cash Price |
$368.10
|
| Rate for Payer: Cigna Commercial |
$1,128.84
|
| Rate for Payer: Health EOS Commercial |
$1,092.03
|
| Rate for Payer: HFN Commercial |
$1,128.84
|
| Rate for Payer: Multiplan Commercial |
$981.60
|
| Rate for Payer: NAPHCARE Commercial |
$736.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,128.84
|
| Rate for Payer: Quartz Beloit One Network |
$601.23
|
| Rate for Payer: Quartz Commercial |
$736.20
|
| Rate for Payer: WEA Trust Commercial |
$674.85
|
| Rate for Payer: WPS Commercial |
$908.84
|
|
|
Vascular Acquisition
|
Facility
OP
|
$1,641.00
|
|
|
Service Code
|
CPT 93971 RT
|
| Hospital Charge Code |
5376731
|
|
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
|
$1,342.00
|
|
|
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
|
$1,104.00
|
|
|
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: 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
|
|
