|
VASCULAR GRAFT 28MM X 15CM GELWEAVE VALSALVA 730028ADP
|
Facility
OP
|
$13,590.00
|
|
| Hospital Charge Code |
3595504
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,805.20 |
| Max. Negotiated Rate |
$54,360.00 |
| Rate for Payer: Aetna Commercial |
$12,231.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$11,687.40
|
| Rate for Payer: Aetna Managed Medicare |
$3,805.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$8,833.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$6,795.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$6,523.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,202.70
|
| Rate for Payer: Cash Price |
$4,077.00
|
| Rate for Payer: Cigna Commercial |
$12,502.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$7,604.96
|
| Rate for Payer: Health EOS Commercial |
$12,095.10
|
| Rate for Payer: HFN Commercial |
$12,502.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$10,192.50
|
| Rate for Payer: Multiplan Commercial |
$10,872.00
|
| Rate for Payer: NAPHCARE Commercial |
$8,154.00
|
| Rate for Payer: Preferred Network Access Commercial |
$12,502.80
|
| Rate for Payer: Quartz Beloit One Network |
$6,659.10
|
| Rate for Payer: Quartz Commercial |
$8,833.50
|
| Rate for Payer: Quartz Medicare Advantage |
$8,154.00
|
| Rate for Payer: The Alliance Commercial |
$54,360.00
|
| Rate for Payer: WEA Trust Commercial |
$7,474.50
|
| Rate for Payer: WPS Commercial |
$10,066.11
|
|
|
VASCULAR GRAFT 28MM X 15CM GELWEAVE VALSALVA 730028ADP
|
Facility
IP
|
$13,590.00
|
|
| Hospital Charge Code |
3595504
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,659.10 |
| Max. Negotiated Rate |
$12,502.80 |
| Rate for Payer: Aetna Commercial |
$12,231.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,202.70
|
| Rate for Payer: Cash Price |
$4,077.00
|
| Rate for Payer: Cigna Commercial |
$12,502.80
|
| Rate for Payer: Health EOS Commercial |
$12,095.10
|
| Rate for Payer: HFN Commercial |
$12,502.80
|
| Rate for Payer: Multiplan Commercial |
$10,872.00
|
| Rate for Payer: NAPHCARE Commercial |
$8,154.00
|
| Rate for Payer: Preferred Network Access Commercial |
$12,502.80
|
| Rate for Payer: Quartz Beloit One Network |
$6,659.10
|
| Rate for Payer: Quartz Commercial |
$8,154.00
|
| Rate for Payer: WEA Trust Commercial |
$7,474.50
|
| Rate for Payer: WPS Commercial |
$10,066.11
|
|
|
VASCULAR GRAFT 30MM X 15CM GELWEAVE VALSALVA 730030ADP
|
Facility
OP
|
$13,590.00
|
|
| Hospital Charge Code |
5286886
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,805.20 |
| Max. Negotiated Rate |
$54,360.00 |
| Rate for Payer: Aetna Commercial |
$12,231.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$11,687.40
|
| Rate for Payer: Aetna Managed Medicare |
$3,805.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$8,833.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$6,795.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$6,523.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,202.70
|
| Rate for Payer: Cash Price |
$4,077.00
|
| Rate for Payer: Cigna Commercial |
$12,502.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$7,604.96
|
| Rate for Payer: Health EOS Commercial |
$12,095.10
|
| Rate for Payer: HFN Commercial |
$12,502.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$10,192.50
|
| Rate for Payer: Multiplan Commercial |
$10,872.00
|
| Rate for Payer: NAPHCARE Commercial |
$8,154.00
|
| Rate for Payer: Preferred Network Access Commercial |
$12,502.80
|
| Rate for Payer: Quartz Beloit One Network |
$6,659.10
|
| Rate for Payer: Quartz Commercial |
$8,833.50
|
| Rate for Payer: Quartz Medicare Advantage |
$8,154.00
|
| Rate for Payer: The Alliance Commercial |
$54,360.00
|
| Rate for Payer: WEA Trust Commercial |
$7,474.50
|
| Rate for Payer: WPS Commercial |
$10,066.11
|
|
|
VASCULAR GRAFT 30MM X 15CM GELWEAVE VALSALVA 730030ADP
|
Facility
IP
|
$13,590.00
|
|
| Hospital Charge Code |
5286886
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,659.10 |
| Max. Negotiated Rate |
$12,502.80 |
| Rate for Payer: Aetna Commercial |
$12,231.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,202.70
|
| Rate for Payer: Cash Price |
$4,077.00
|
| Rate for Payer: Cigna Commercial |
$12,502.80
|
| Rate for Payer: Health EOS Commercial |
$12,095.10
|
| Rate for Payer: HFN Commercial |
$12,502.80
|
| Rate for Payer: Multiplan Commercial |
$10,872.00
|
| Rate for Payer: NAPHCARE Commercial |
$8,154.00
|
| Rate for Payer: Preferred Network Access Commercial |
$12,502.80
|
| Rate for Payer: Quartz Beloit One Network |
$6,659.10
|
| Rate for Payer: Quartz Commercial |
$8,154.00
|
| Rate for Payer: WEA Trust Commercial |
$7,474.50
|
| Rate for Payer: WPS Commercial |
$10,066.11
|
|
|
VASCULAR GRAFT 32MM X 15CM GELWEAVE VALSALVA 730032ADP
|
Facility
OP
|
$14,112.00
|
|
| Hospital Charge Code |
5286741
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,951.36 |
| Max. Negotiated Rate |
$56,448.00 |
| Rate for Payer: Aetna Commercial |
$12,700.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$12,136.32
|
| Rate for Payer: Aetna Managed Medicare |
$3,951.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$9,172.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$7,056.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$6,773.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,479.36
|
| Rate for Payer: Cash Price |
$4,233.60
|
| Rate for Payer: Cigna Commercial |
$12,983.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$7,897.08
|
| Rate for Payer: Health EOS Commercial |
$12,559.68
|
| Rate for Payer: HFN Commercial |
$12,983.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$10,584.00
|
| Rate for Payer: Multiplan Commercial |
$11,289.60
|
| Rate for Payer: NAPHCARE Commercial |
$8,467.20
|
| Rate for Payer: Preferred Network Access Commercial |
$12,983.04
|
| Rate for Payer: Quartz Beloit One Network |
$6,914.88
|
| Rate for Payer: Quartz Commercial |
$9,172.80
|
| Rate for Payer: Quartz Medicare Advantage |
$8,467.20
|
| Rate for Payer: The Alliance Commercial |
$56,448.00
|
| Rate for Payer: WEA Trust Commercial |
$7,761.60
|
| Rate for Payer: WPS Commercial |
$10,452.76
|
|
|
VASCULAR GRAFT 32MM X 15CM GELWEAVE VALSALVA 730032ADP
|
Facility
IP
|
$14,112.00
|
|
| Hospital Charge Code |
5286741
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,914.88 |
| Max. Negotiated Rate |
$12,983.04 |
| Rate for Payer: Aetna Commercial |
$12,700.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,479.36
|
| Rate for Payer: Cash Price |
$4,233.60
|
| Rate for Payer: Cigna Commercial |
$12,983.04
|
| Rate for Payer: Health EOS Commercial |
$12,559.68
|
| Rate for Payer: HFN Commercial |
$12,983.04
|
| Rate for Payer: Multiplan Commercial |
$11,289.60
|
| Rate for Payer: NAPHCARE Commercial |
$8,467.20
|
| Rate for Payer: Preferred Network Access Commercial |
$12,983.04
|
| Rate for Payer: Quartz Beloit One Network |
$6,914.88
|
| Rate for Payer: Quartz Commercial |
$8,467.20
|
| Rate for Payer: WEA Trust Commercial |
$7,761.60
|
| Rate for Payer: WPS Commercial |
$10,452.76
|
|
|
VASCULAR GRAFT 34MM X 15CM GELWEAVE VALSALVA 730034ADP
|
Facility
OP
|
$23,619.00
|
|
| Hospital Charge Code |
6234137
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,613.32 |
| Max. Negotiated Rate |
$94,476.00 |
| Rate for Payer: Aetna Commercial |
$21,257.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$20,312.34
|
| Rate for Payer: Aetna Managed Medicare |
$6,613.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$15,352.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$11,809.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$11,337.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$12,518.07
|
| Rate for Payer: Cash Price |
$7,085.70
|
| Rate for Payer: Cigna Commercial |
$21,729.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$13,217.19
|
| Rate for Payer: Health EOS Commercial |
$21,020.91
|
| Rate for Payer: HFN Commercial |
$21,729.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$17,714.25
|
| Rate for Payer: Multiplan Commercial |
$18,895.20
|
| Rate for Payer: NAPHCARE Commercial |
$14,171.40
|
| Rate for Payer: Preferred Network Access Commercial |
$21,729.48
|
| Rate for Payer: Quartz Beloit One Network |
$11,573.31
|
| Rate for Payer: Quartz Commercial |
$15,352.35
|
| Rate for Payer: Quartz Medicare Advantage |
$14,171.40
|
| Rate for Payer: The Alliance Commercial |
$94,476.00
|
| Rate for Payer: WEA Trust Commercial |
$12,990.45
|
| Rate for Payer: WPS Commercial |
$17,494.59
|
|
|
VASCULAR GRAFT 34MM X 15CM GELWEAVE VALSALVA 730034ADP
|
Facility
IP
|
$23,619.00
|
|
| Hospital Charge Code |
6234137
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$11,573.31 |
| Max. Negotiated Rate |
$21,729.48 |
| Rate for Payer: Aetna Commercial |
$21,257.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$12,518.07
|
| Rate for Payer: Cash Price |
$7,085.70
|
| Rate for Payer: Cigna Commercial |
$21,729.48
|
| Rate for Payer: Health EOS Commercial |
$21,020.91
|
| Rate for Payer: HFN Commercial |
$21,729.48
|
| Rate for Payer: Multiplan Commercial |
$18,895.20
|
| Rate for Payer: NAPHCARE Commercial |
$14,171.40
|
| Rate for Payer: Preferred Network Access Commercial |
$21,729.48
|
| Rate for Payer: Quartz Beloit One Network |
$11,573.31
|
| Rate for Payer: Quartz Commercial |
$14,171.40
|
| Rate for Payer: WEA Trust Commercial |
$12,990.45
|
| Rate for Payer: WPS Commercial |
$17,494.59
|
|
|
VASCULAR GRAFT HYBRID 6-7MM X 50CM 0650HYB0705A
|
Facility
OP
|
$15,313.00
|
|
| Hospital Charge Code |
3525502
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,287.64 |
| Max. Negotiated Rate |
$61,252.00 |
| Rate for Payer: Aetna Commercial |
$13,781.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$13,169.18
|
| Rate for Payer: Aetna Managed Medicare |
$4,287.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$9,953.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$7,656.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,350.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$8,115.89
|
| Rate for Payer: Cash Price |
$4,593.90
|
| Rate for Payer: Cigna Commercial |
$14,087.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$8,569.15
|
| Rate for Payer: Health EOS Commercial |
$13,628.57
|
| Rate for Payer: HFN Commercial |
$14,087.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$11,484.75
|
| Rate for Payer: Multiplan Commercial |
$12,250.40
|
| Rate for Payer: NAPHCARE Commercial |
$9,187.80
|
| Rate for Payer: Preferred Network Access Commercial |
$14,087.96
|
| Rate for Payer: Quartz Beloit One Network |
$7,503.37
|
| Rate for Payer: Quartz Commercial |
$9,953.45
|
| Rate for Payer: Quartz Medicare Advantage |
$9,187.80
|
| Rate for Payer: The Alliance Commercial |
$61,252.00
|
| Rate for Payer: WEA Trust Commercial |
$8,422.15
|
| Rate for Payer: WPS Commercial |
$11,342.34
|
|
|
VASCULAR GRAFT HYBRID 6-7MM X 50CM 0650HYB0705A
|
Facility
IP
|
$15,313.00
|
|
| Hospital Charge Code |
3525502
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,503.37 |
| Max. Negotiated Rate |
$14,087.96 |
| Rate for Payer: Aetna Commercial |
$13,781.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$8,115.89
|
| Rate for Payer: Cash Price |
$4,593.90
|
| Rate for Payer: Cigna Commercial |
$14,087.96
|
| Rate for Payer: Health EOS Commercial |
$13,628.57
|
| Rate for Payer: HFN Commercial |
$14,087.96
|
| Rate for Payer: Multiplan Commercial |
$12,250.40
|
| Rate for Payer: NAPHCARE Commercial |
$9,187.80
|
| Rate for Payer: Preferred Network Access Commercial |
$14,087.96
|
| Rate for Payer: Quartz Beloit One Network |
$7,503.37
|
| Rate for Payer: Quartz Commercial |
$9,187.80
|
| Rate for Payer: WEA Trust Commercial |
$8,422.15
|
| Rate for Payer: WPS Commercial |
$11,342.34
|
|
|
VASCULAR GRAFT HYBRID 6-8MM X 50CM 0650HYB0805A
|
Facility
OP
|
$15,313.00
|
|
| Hospital Charge Code |
3525503
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,287.64 |
| Max. Negotiated Rate |
$61,252.00 |
| Rate for Payer: Aetna Commercial |
$13,781.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$13,169.18
|
| Rate for Payer: Aetna Managed Medicare |
$4,287.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$9,953.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$7,656.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,350.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$8,115.89
|
| Rate for Payer: Cash Price |
$4,593.90
|
| Rate for Payer: Cigna Commercial |
$14,087.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$8,569.15
|
| Rate for Payer: Health EOS Commercial |
$13,628.57
|
| Rate for Payer: HFN Commercial |
$14,087.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$11,484.75
|
| Rate for Payer: Multiplan Commercial |
$12,250.40
|
| Rate for Payer: NAPHCARE Commercial |
$9,187.80
|
| Rate for Payer: Preferred Network Access Commercial |
$14,087.96
|
| Rate for Payer: Quartz Beloit One Network |
$7,503.37
|
| Rate for Payer: Quartz Commercial |
$9,953.45
|
| Rate for Payer: Quartz Medicare Advantage |
$9,187.80
|
| Rate for Payer: The Alliance Commercial |
$61,252.00
|
| Rate for Payer: WEA Trust Commercial |
$8,422.15
|
| Rate for Payer: WPS Commercial |
$11,342.34
|
|
|
VASCULAR GRAFT HYBRID 6-8MM X 50CM 0650HYB0805A
|
Facility
IP
|
$15,313.00
|
|
| Hospital Charge Code |
3525503
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,503.37 |
| Max. Negotiated Rate |
$14,087.96 |
| Rate for Payer: Aetna Commercial |
$13,781.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$8,115.89
|
| Rate for Payer: Cash Price |
$4,593.90
|
| Rate for Payer: Cigna Commercial |
$14,087.96
|
| Rate for Payer: Health EOS Commercial |
$13,628.57
|
| Rate for Payer: HFN Commercial |
$14,087.96
|
| Rate for Payer: Multiplan Commercial |
$12,250.40
|
| Rate for Payer: NAPHCARE Commercial |
$9,187.80
|
| Rate for Payer: Preferred Network Access Commercial |
$14,087.96
|
| Rate for Payer: Quartz Beloit One Network |
$7,503.37
|
| Rate for Payer: Quartz Commercial |
$9,187.80
|
| Rate for Payer: WEA Trust Commercial |
$8,422.15
|
| Rate for Payer: WPS Commercial |
$11,342.34
|
|
|
Vascular Interpretation
|
Facility
IP
|
$138.00
|
|
|
Service Code
|
CPT 93930 26
|
| Hospital Charge Code |
5376700
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$67.62 |
| Max. Negotiated Rate |
$126.96 |
| Rate for Payer: Aetna Commercial |
$124.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$73.14
|
| Rate for Payer: Cash Price |
$41.40
|
| Rate for Payer: Cigna Commercial |
$126.96
|
| Rate for Payer: Health EOS Commercial |
$122.82
|
| Rate for Payer: HFN Commercial |
$126.96
|
| Rate for Payer: Multiplan Commercial |
$110.40
|
| Rate for Payer: NAPHCARE Commercial |
$82.80
|
| Rate for Payer: Preferred Network Access Commercial |
$126.96
|
| Rate for Payer: Quartz Beloit One Network |
$67.62
|
| Rate for Payer: Quartz Commercial |
$82.80
|
| Rate for Payer: WEA Trust Commercial |
$75.90
|
| Rate for Payer: WPS Commercial |
$102.22
|
|
|
Vascular Interpretation
|
Facility
IP
|
$104.00
|
|
|
Service Code
|
CPT 93926 26
|
| Hospital Charge Code |
5376658
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$50.96 |
| Max. Negotiated Rate |
$95.68 |
| Rate for Payer: Aetna Commercial |
$93.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$55.12
|
| Rate for Payer: Cash Price |
$31.20
|
| Rate for Payer: Cigna Commercial |
$95.68
|
| Rate for Payer: Health EOS Commercial |
$92.56
|
| Rate for Payer: HFN Commercial |
$95.68
|
| Rate for Payer: Multiplan Commercial |
$83.20
|
| Rate for Payer: NAPHCARE Commercial |
$62.40
|
| Rate for Payer: Preferred Network Access Commercial |
$95.68
|
| Rate for Payer: Quartz Beloit One Network |
$50.96
|
| Rate for Payer: Quartz Commercial |
$62.40
|
| Rate for Payer: WEA Trust Commercial |
$57.20
|
| Rate for Payer: WPS Commercial |
$77.03
|
|
|
Vascular Interpretation
|
Facility
IP
|
$160.00
|
|
|
Service Code
|
CPT 93923 26
|
| Hospital Charge Code |
5376739
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$78.40 |
| Max. Negotiated Rate |
$147.20 |
| Rate for Payer: Aetna Commercial |
$144.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$84.80
|
| Rate for Payer: Cash Price |
$48.00
|
| Rate for Payer: Cigna Commercial |
$147.20
|
| Rate for Payer: Health EOS Commercial |
$142.40
|
| Rate for Payer: HFN Commercial |
$147.20
|
| Rate for Payer: Multiplan Commercial |
$128.00
|
| Rate for Payer: NAPHCARE Commercial |
$96.00
|
| Rate for Payer: Preferred Network Access Commercial |
$147.20
|
| Rate for Payer: Quartz Beloit One Network |
$78.40
|
| Rate for Payer: Quartz Commercial |
$96.00
|
| Rate for Payer: WEA Trust Commercial |
$88.00
|
| Rate for Payer: WPS Commercial |
$118.51
|
|
|
Vascular Interpretation
|
Facility
OP
|
$138.00
|
|
|
Service Code
|
CPT 93930 26
|
| Hospital Charge Code |
5376700
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$38.64 |
| Max. Negotiated Rate |
$552.00 |
| Rate for Payer: Aetna Commercial |
$124.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$118.68
|
| Rate for Payer: Aetna Managed Medicare |
$38.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$89.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$69.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$66.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$73.14
|
| Rate for Payer: Cash Price |
$41.40
|
| Rate for Payer: Cigna Commercial |
$126.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$77.22
|
| Rate for Payer: Health EOS Commercial |
$122.82
|
| Rate for Payer: HFN Commercial |
$126.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$103.50
|
| Rate for Payer: Multiplan Commercial |
$110.40
|
| Rate for Payer: NAPHCARE Commercial |
$82.80
|
| Rate for Payer: Preferred Network Access Commercial |
$126.96
|
| Rate for Payer: Quartz Beloit One Network |
$67.62
|
| Rate for Payer: Quartz Commercial |
$89.70
|
| Rate for Payer: Quartz Medicare Advantage |
$82.80
|
| Rate for Payer: The Alliance Commercial |
$552.00
|
| Rate for Payer: WEA Trust Commercial |
$75.90
|
| Rate for Payer: WPS Commercial |
$102.22
|
|
|
Vascular Interpretation
|
Facility
IP
|
$272.00
|
|
|
Service Code
|
CPT 93978 26
|
| Hospital Charge Code |
5376639
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$133.28 |
| Max. Negotiated Rate |
$250.24 |
| Rate for Payer: Health EOS Commercial |
$242.08
|
| Rate for Payer: Aetna Commercial |
$244.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$144.16
|
| Rate for Payer: Cash Price |
$81.60
|
| Rate for Payer: Cigna Commercial |
$250.24
|
| Rate for Payer: HFN Commercial |
$250.24
|
| Rate for Payer: Multiplan Commercial |
$217.60
|
| Rate for Payer: NAPHCARE Commercial |
$163.20
|
| Rate for Payer: Preferred Network Access Commercial |
$250.24
|
| Rate for Payer: Quartz Beloit One Network |
$133.28
|
| Rate for Payer: Quartz Commercial |
$163.20
|
| Rate for Payer: WEA Trust Commercial |
$149.60
|
| Rate for Payer: WPS Commercial |
$201.47
|
|
|
Vascular Interpretation
|
Facility
OP
|
$104.00
|
|
|
Service Code
|
CPT 93926 26
|
| Hospital Charge Code |
5376658
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$29.12 |
| Max. Negotiated Rate |
$416.00 |
| Rate for Payer: Aetna Commercial |
$93.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$89.44
|
| Rate for Payer: Aetna Managed Medicare |
$29.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$67.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$52.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$49.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$55.12
|
| Rate for Payer: Cash Price |
$31.20
|
| Rate for Payer: Cigna Commercial |
$95.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$58.20
|
| Rate for Payer: Health EOS Commercial |
$92.56
|
| Rate for Payer: HFN Commercial |
$95.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$78.00
|
| Rate for Payer: Multiplan Commercial |
$83.20
|
| Rate for Payer: NAPHCARE Commercial |
$62.40
|
| Rate for Payer: Preferred Network Access Commercial |
$95.68
|
| Rate for Payer: Quartz Beloit One Network |
$50.96
|
| Rate for Payer: Quartz Commercial |
$67.60
|
| Rate for Payer: Quartz Medicare Advantage |
$62.40
|
| Rate for Payer: The Alliance Commercial |
$416.00
|
| Rate for Payer: WEA Trust Commercial |
$57.20
|
| Rate for Payer: WPS Commercial |
$77.03
|
|
|
Vascular Interpretation
|
Facility
IP
|
$104.00
|
|
|
Service Code
|
CPT 93926 26
|
| Hospital Charge Code |
5376651
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$50.96 |
| Max. Negotiated Rate |
$95.68 |
| Rate for Payer: Aetna Commercial |
$93.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$55.12
|
| Rate for Payer: Cash Price |
$31.20
|
| Rate for Payer: Cigna Commercial |
$95.68
|
| Rate for Payer: Health EOS Commercial |
$92.56
|
| Rate for Payer: HFN Commercial |
$95.68
|
| Rate for Payer: Multiplan Commercial |
$83.20
|
| Rate for Payer: NAPHCARE Commercial |
$62.40
|
| Rate for Payer: Preferred Network Access Commercial |
$95.68
|
| Rate for Payer: Quartz Beloit One Network |
$50.96
|
| Rate for Payer: Quartz Commercial |
$62.40
|
| Rate for Payer: WEA Trust Commercial |
$57.20
|
| Rate for Payer: WPS Commercial |
$77.03
|
|
|
Vascular Interpretation
|
Facility
OP
|
$136.00
|
|
|
Service Code
|
CPT 93931 26
|
| Hospital Charge Code |
5376703
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$38.08 |
| Max. Negotiated Rate |
$544.00 |
| Rate for Payer: Aetna Commercial |
$122.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$116.96
|
| Rate for Payer: Aetna Managed Medicare |
$38.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$88.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$68.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$65.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$72.08
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cigna Commercial |
$125.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$76.11
|
| Rate for Payer: Health EOS Commercial |
$121.04
|
| Rate for Payer: HFN Commercial |
$125.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$102.00
|
| Rate for Payer: Multiplan Commercial |
$108.80
|
| Rate for Payer: NAPHCARE Commercial |
$81.60
|
| Rate for Payer: Preferred Network Access Commercial |
$125.12
|
| Rate for Payer: Quartz Beloit One Network |
$66.64
|
| Rate for Payer: Quartz Commercial |
$88.40
|
| Rate for Payer: Quartz Medicare Advantage |
$81.60
|
| Rate for Payer: The Alliance Commercial |
$544.00
|
| Rate for Payer: WEA Trust Commercial |
$74.80
|
| Rate for Payer: WPS Commercial |
$100.74
|
|
|
Vascular Interpretation
|
Facility
OP
|
$272.00
|
|
|
Service Code
|
CPT 93978 26
|
| Hospital Charge Code |
5376639
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$76.16 |
| Max. Negotiated Rate |
$1,088.00 |
| Rate for Payer: Aetna Commercial |
$244.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$233.92
|
| Rate for Payer: Aetna Managed Medicare |
$76.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$176.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$136.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$130.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$144.16
|
| Rate for Payer: Cash Price |
$81.60
|
| Rate for Payer: Cigna Commercial |
$250.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$152.21
|
| Rate for Payer: Health EOS Commercial |
$242.08
|
| Rate for Payer: HFN Commercial |
$250.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$204.00
|
| Rate for Payer: Multiplan Commercial |
$217.60
|
| Rate for Payer: NAPHCARE Commercial |
$163.20
|
| Rate for Payer: Preferred Network Access Commercial |
$250.24
|
| Rate for Payer: Quartz Beloit One Network |
$133.28
|
| Rate for Payer: Quartz Commercial |
$176.80
|
| Rate for Payer: Quartz Medicare Advantage |
$163.20
|
| Rate for Payer: The Alliance Commercial |
$1,088.00
|
| Rate for Payer: WEA Trust Commercial |
$149.60
|
| Rate for Payer: WPS Commercial |
$201.47
|
|
|
Vascular Interpretation
|
Facility
OP
|
$160.00
|
|
|
Service Code
|
CPT 93923 26
|
| Hospital Charge Code |
5376739
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$44.80 |
| Max. Negotiated Rate |
$640.00 |
| Rate for Payer: Aetna Commercial |
$144.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$137.60
|
| Rate for Payer: Aetna Managed Medicare |
$44.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$104.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$80.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$76.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$84.80
|
| Rate for Payer: Cash Price |
$48.00
|
| Rate for Payer: Cigna Commercial |
$147.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$89.54
|
| Rate for Payer: Health EOS Commercial |
$142.40
|
| Rate for Payer: HFN Commercial |
$147.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$120.00
|
| Rate for Payer: Multiplan Commercial |
$128.00
|
| Rate for Payer: NAPHCARE Commercial |
$96.00
|
| Rate for Payer: Preferred Network Access Commercial |
$147.20
|
| Rate for Payer: Quartz Beloit One Network |
$78.40
|
| Rate for Payer: Quartz Commercial |
$104.00
|
| Rate for Payer: Quartz Medicare Advantage |
$96.00
|
| Rate for Payer: The Alliance Commercial |
$640.00
|
| Rate for Payer: WEA Trust Commercial |
$88.00
|
| Rate for Payer: WPS Commercial |
$118.51
|
|
|
Vascular Interpretation
|
Facility
IP
|
$136.00
|
|
|
Service Code
|
CPT 93931 26
|
| Hospital Charge Code |
5376703
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$66.64 |
| Max. Negotiated Rate |
$125.12 |
| Rate for Payer: Aetna Commercial |
$122.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$72.08
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cigna Commercial |
$125.12
|
| Rate for Payer: Health EOS Commercial |
$121.04
|
| Rate for Payer: HFN Commercial |
$125.12
|
| Rate for Payer: Multiplan Commercial |
$108.80
|
| Rate for Payer: NAPHCARE Commercial |
$81.60
|
| Rate for Payer: Preferred Network Access Commercial |
$125.12
|
| Rate for Payer: Quartz Beloit One Network |
$66.64
|
| Rate for Payer: Quartz Commercial |
$81.60
|
| Rate for Payer: WEA Trust Commercial |
$74.80
|
| Rate for Payer: WPS Commercial |
$100.74
|
|
|
Vascular Interpretation
|
Facility
OP
|
$104.00
|
|
|
Service Code
|
CPT 93926 26
|
| Hospital Charge Code |
5376651
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$29.12 |
| Max. Negotiated Rate |
$416.00 |
| Rate for Payer: Aetna Commercial |
$93.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$89.44
|
| Rate for Payer: Aetna Managed Medicare |
$29.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$67.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$52.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$49.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$55.12
|
| Rate for Payer: Cash Price |
$31.20
|
| Rate for Payer: Cigna Commercial |
$95.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$58.20
|
| Rate for Payer: Health EOS Commercial |
$92.56
|
| Rate for Payer: HFN Commercial |
$95.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$78.00
|
| Rate for Payer: Multiplan Commercial |
$83.20
|
| Rate for Payer: NAPHCARE Commercial |
$62.40
|
| Rate for Payer: Preferred Network Access Commercial |
$95.68
|
| Rate for Payer: Quartz Beloit One Network |
$50.96
|
| Rate for Payer: Quartz Commercial |
$67.60
|
| Rate for Payer: Quartz Medicare Advantage |
$62.40
|
| Rate for Payer: The Alliance Commercial |
$416.00
|
| Rate for Payer: WEA Trust Commercial |
$57.20
|
| Rate for Payer: WPS Commercial |
$77.03
|
|
|
VASCULAR RETRIEVAL (G07187)
|
Facility
IP
|
$4,658.00
|
|
| Hospital Charge Code |
2973633
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,282.42 |
| Max. Negotiated Rate |
$4,285.36 |
| Rate for Payer: Aetna Commercial |
$4,192.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,468.74
|
| Rate for Payer: Cash Price |
$1,397.40
|
| Rate for Payer: Cigna Commercial |
$4,285.36
|
| Rate for Payer: Health EOS Commercial |
$4,145.62
|
| Rate for Payer: HFN Commercial |
$4,285.36
|
| Rate for Payer: Multiplan Commercial |
$3,726.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,794.80
|
| Rate for Payer: Preferred Network Access Commercial |
$4,285.36
|
| Rate for Payer: Quartz Beloit One Network |
$2,282.42
|
| Rate for Payer: Quartz Commercial |
$2,794.80
|
| Rate for Payer: WEA Trust Commercial |
$2,561.90
|
| Rate for Payer: WPS Commercial |
$3,450.18
|
|
