|
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
OP
|
$3,327.00
|
|
|
Service Code
|
CPT 93312
|
| Hospital Charge Code |
5376692
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$545.28 |
| Max. Negotiated Rate |
$3,060.84 |
| Rate for Payer: Aetna Commercial |
$2,994.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,861.22
|
| Rate for Payer: Aetna Managed Medicare |
$545.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,162.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,663.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,596.96
|
| Rate for Payer: Anthem Medicare Advantage |
$545.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,763.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$545.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$545.28
|
| Rate for Payer: Cash Price |
$998.10
|
| Rate for Payer: Cash Price |
$998.10
|
| Rate for Payer: Cigna Commercial |
$3,060.84
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$545.28
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$545.28
|
| Rate for Payer: Health EOS Commercial |
$2,961.03
|
| Rate for Payer: HFN Commercial |
$3,060.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,028.44
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$545.28
|
| Rate for Payer: Independent Care Health Plan Medicare |
$545.28
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$545.28
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$545.28
|
| Rate for Payer: Multiplan Commercial |
$2,661.60
|
| Rate for Payer: NAPHCARE Commercial |
$817.92
|
| Rate for Payer: Preferred Network Access Commercial |
$3,060.84
|
| Rate for Payer: Quartz Beloit One Network |
$1,630.23
|
| Rate for Payer: Quartz Commercial |
$2,162.55
|
| Rate for Payer: Quartz Medicare Advantage |
$545.28
|
| Rate for Payer: United Healthcare Medicare Advantage |
$545.28
|
| Rate for Payer: United Healthcare PPO |
$2,495.25
|
| Rate for Payer: WEA Trust Commercial |
$1,829.85
|
| Rate for Payer: Wellcare Medicare |
$545.28
|
| Rate for Payer: WPS Commercial |
$2,464.31
|
|
|
Vascular Acquisition
|
Facility
OP
|
$926.00
|
|
|
Service Code
|
CPT 93882 RT
|
| Hospital Charge Code |
5375860
|
|
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
|
$2,194.00
|
|
|
Service Code
|
CPT 93925
|
| Hospital Charge Code |
5376653
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$242.20 |
| Max. Negotiated Rate |
$2,018.48 |
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,227.76
|
| Rate for Payer: Aetna Commercial |
$1,974.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,886.84
|
| Rate for Payer: Aetna Managed Medicare |
$242.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,426.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,097.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,053.12
|
| Rate for Payer: Anthem Medicare Advantage |
$242.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,162.82
|
| 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 |
$658.20
|
| Rate for Payer: Cash Price |
$658.20
|
| Rate for Payer: Cigna Commercial |
$2,018.48
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$242.20
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$242.20
|
| Rate for Payer: Health EOS Commercial |
$1,952.66
|
| Rate for Payer: HFN Commercial |
$2,018.48
|
| 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 |
$1,755.20
|
| Rate for Payer: NAPHCARE Commercial |
$363.30
|
| 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 |
$1,426.10
|
| Rate for Payer: Quartz Medicare Advantage |
$242.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$242.20
|
| Rate for Payer: United Healthcare PPO |
$1,645.50
|
| Rate for Payer: WEA Trust Commercial |
$1,206.70
|
| Rate for Payer: Wellcare Medicare |
$242.20
|
| Rate for Payer: WPS Commercial |
$1,625.10
|
|
|
Vascular Acquisition
|
Facility
IP
|
$1,826.00
|
|
|
Service Code
|
CPT 93975
|
| Hospital Charge Code |
5375866
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$894.74 |
| Max. Negotiated Rate |
$1,679.92 |
| Rate for Payer: Aetna Commercial |
$1,643.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$967.78
|
| Rate for Payer: Cash Price |
$547.80
|
| Rate for Payer: Cigna Commercial |
$1,679.92
|
| Rate for Payer: Health EOS Commercial |
$1,625.14
|
| Rate for Payer: HFN Commercial |
$1,679.92
|
| Rate for Payer: Multiplan Commercial |
$1,460.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,095.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,679.92
|
| Rate for Payer: Quartz Beloit One Network |
$894.74
|
| Rate for Payer: Quartz Commercial |
$1,095.60
|
| Rate for Payer: WEA Trust Commercial |
$1,004.30
|
| Rate for Payer: WPS Commercial |
$1,352.52
|
|
|
Vascular Acquisition
|
Facility
IP
|
$926.00
|
|
|
Service Code
|
CPT 93882 RT
|
| Hospital Charge Code |
5375860
|
|
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
|
$1,376.00
|
|
| Hospital Charge Code |
5375875
|
| Min. Negotiated Rate |
$674.24 |
| Max. Negotiated Rate |
$1,265.92 |
| Rate for Payer: Aetna Commercial |
$1,238.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$729.28
|
| Rate for Payer: Cash Price |
$412.80
|
| Rate for Payer: Cigna Commercial |
$1,265.92
|
| Rate for Payer: Health EOS Commercial |
$1,224.64
|
| Rate for Payer: HFN Commercial |
$1,265.92
|
| Rate for Payer: Multiplan Commercial |
$1,100.80
|
| Rate for Payer: NAPHCARE Commercial |
$825.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,265.92
|
| Rate for Payer: Quartz Beloit One Network |
$674.24
|
| Rate for Payer: Quartz Commercial |
$825.60
|
| Rate for Payer: WEA Trust Commercial |
$756.80
|
| Rate for Payer: WPS Commercial |
$1,019.20
|
|
|
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
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
IP
|
$1,342.00
|
|
|
Service Code
|
CPT 93931 LT
|
| Hospital Charge Code |
5376701
|
|
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
|
$792.00
|
|
|
Service Code
|
CPT 93922
|
| Hospital Charge Code |
5375850
|
|
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
|
$1,274.00
|
|
|
Service Code
|
CPT 93926 LT
|
| Hospital Charge Code |
5376649
|
|
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 |
6195114
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$804.09 |
| Max. Negotiated Rate |
$1,509.72 |
| Rate for Payer: WEA Trust Commercial |
$902.55
|
| 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: WPS Commercial |
$1,215.49
|
|
|
Vascular Acquisition
|
Facility
OP
|
$1,227.00
|
|
|
Service Code
|
CPT 93923
|
| Hospital Charge Code |
5376665
|
|
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
IP
|
$1,274.00
|
|
|
Service Code
|
CPT 93926 LT
|
| Hospital Charge Code |
5376649
|
|
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
|
$1,227.00
|
|
|
Service Code
|
CPT 93923
|
| Hospital Charge Code |
5376707
|
|
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
|
| 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
IP
|
$1,227.00
|
|
|
Service Code
|
CPT 93923
|
| Hospital Charge Code |
5376707
|
|
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
|
$1,274.00
|
|
|
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
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 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: 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 |
$40,449.87 |
| 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 |
$20,943.68
|
| 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
|
$385.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
5242624
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.27 |
| Max. Negotiated Rate |
$365.75 |
| Rate for Payer: Aetna Commercial |
$365.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$331.10
|
| Rate for Payer: Aetna Managed Medicare |
$17.27
|
| Rate for Payer: Anthem Medicare Advantage |
$17.27
|
| 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 |
$365.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$192.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$17.27
|
| Rate for Payer: Health EOS Commercial |
$350.35
|
| 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: Independent Care Health Plan Medicare |
$17.27
|
| 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: Quartz Medicare Advantage |
$17.27
|
| Rate for Payer: The Alliance Commercial |
$68.22
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.27
|
| Rate for Payer: WEA Trust Commercial |
$211.75
|
| Rate for Payer: WPS Commercial |
$75.99
|
|
|
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 |
$1,540.00 |
| 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 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 |
$1,540.00
|
| 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 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: 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
|
|
