|
VL Guided Pericardiocentesis
|
Facility
|
OP
|
$1,431.00
|
|
|
Service Code
|
CPT 76930
|
| Hospital Charge Code |
3077328
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$400.68 |
| Max. Negotiated Rate |
$5,724.00 |
| Rate for Payer: Aetna Commercial |
$1,287.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,230.66
|
| Rate for Payer: Aetna Managed Medicare |
$400.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$930.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$715.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$686.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$758.43
|
| Rate for Payer: Cash Price |
$429.30
|
| Rate for Payer: Cigna Commercial |
$1,316.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$800.79
|
| Rate for Payer: Health EOS Commercial |
$1,273.59
|
| Rate for Payer: HFN Commercial |
$1,316.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,073.25
|
| Rate for Payer: Multiplan Commercial |
$1,144.80
|
| Rate for Payer: NAPHCARE Commercial |
$858.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,316.52
|
| Rate for Payer: Quartz Beloit One Network |
$701.19
|
| Rate for Payer: Quartz Commercial |
$930.15
|
| Rate for Payer: Quartz Medicare Advantage |
$858.60
|
| Rate for Payer: The Alliance Commercial |
$5,724.00
|
| Rate for Payer: United Healthcare PPO |
$1,073.25
|
| Rate for Payer: WEA Trust Commercial |
$787.05
|
| Rate for Payer: WPS Commercial |
$1,059.94
|
|
|
VL Guided Pericardiocentesis
|
Facility
|
IP
|
$1,431.00
|
|
|
Service Code
|
CPT 76930
|
| Hospital Charge Code |
3077328
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$701.19 |
| Max. Negotiated Rate |
$1,316.52 |
| Rate for Payer: Aetna Commercial |
$1,287.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,230.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$758.43
|
| Rate for Payer: Cash Price |
$429.30
|
| Rate for Payer: Cigna Commercial |
$1,316.52
|
| Rate for Payer: Health EOS Commercial |
$1,273.59
|
| Rate for Payer: HFN Commercial |
$1,316.52
|
| Rate for Payer: Multiplan Commercial |
$1,144.80
|
| Rate for Payer: NAPHCARE Commercial |
$858.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,316.52
|
| Rate for Payer: Quartz Beloit One Network |
$701.19
|
| Rate for Payer: Quartz Commercial |
$858.60
|
| Rate for Payer: WEA Trust Commercial |
$787.05
|
| Rate for Payer: WPS Commercial |
$1,059.94
|
|
|
VL Guided Pericardiocentesis
|
Professional
|
Both
|
$1,431.00
|
|
|
Service Code
|
CPT 76930
|
| Hospital Charge Code |
3077328
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$629.64 |
| Max. Negotiated Rate |
$1,359.45 |
| Rate for Payer: Aetna Commercial |
$1,359.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,230.66
|
| Rate for Payer: Cash Price |
$429.30
|
| Rate for Payer: Cigna Commercial |
$1,359.45
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$715.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$858.60
|
| Rate for Payer: Health EOS Commercial |
$1,302.21
|
| Rate for Payer: HFN Commercial |
$1,359.45
|
| Rate for Payer: Multiplan Commercial |
$1,144.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,359.45
|
| Rate for Payer: Quartz Beloit One Network |
$629.64
|
| Rate for Payer: Quartz Commercial |
$815.67
|
| Rate for Payer: The Alliance Commercial |
$715.50
|
| Rate for Payer: WEA Trust Commercial |
$787.05
|
| Rate for Payer: WPS Commercial |
$1,059.94
|
|
|
VL Iliac Vasculature Duplex Comp Bilat
|
Facility
|
OP
|
$1,975.00
|
|
|
Service Code
|
CPT 93978 TC
|
| Hospital Charge Code |
2544897
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$242.20 |
| Max. Negotiated Rate |
$1,817.00 |
| Rate for Payer: Aetna Commercial |
$1,777.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,698.50
|
| Rate for Payer: Aetna Managed Medicare |
$242.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,283.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$987.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$948.00
|
| Rate for Payer: Anthem Medicare Advantage |
$242.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,046.75
|
| 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 |
$592.50
|
| Rate for Payer: Cash Price |
$592.50
|
| Rate for Payer: Cigna Commercial |
$1,817.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$242.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,105.21
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$242.20
|
| Rate for Payer: Health EOS Commercial |
$1,757.75
|
| Rate for Payer: HFN Commercial |
$1,817.00
|
| 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 |
$1,580.00
|
| Rate for Payer: NAPHCARE Commercial |
$363.30
|
| Rate for Payer: Preferred Network Access Commercial |
$1,817.00
|
| Rate for Payer: Quartz Beloit One Network |
$967.75
|
| Rate for Payer: Quartz Commercial |
$1,283.75
|
| Rate for Payer: Quartz Medicare Advantage |
$242.20
|
| Rate for Payer: The Alliance Commercial |
$968.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$242.20
|
| Rate for Payer: United Healthcare PPO |
$1,481.25
|
| Rate for Payer: WEA Trust Commercial |
$1,086.25
|
| Rate for Payer: Wellcare Medicare |
$242.20
|
| Rate for Payer: WPS Commercial |
$1,462.88
|
|
|
VL Iliac Vasculature Duplex Comp Bilat
|
Facility
|
IP
|
$1,975.00
|
|
|
Service Code
|
CPT 93978 TC
|
| Hospital Charge Code |
2544897
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$967.75 |
| Max. Negotiated Rate |
$1,817.00 |
| Rate for Payer: Aetna Commercial |
$1,777.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,698.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,046.75
|
| Rate for Payer: Cash Price |
$592.50
|
| Rate for Payer: Cigna Commercial |
$1,817.00
|
| Rate for Payer: Health EOS Commercial |
$1,757.75
|
| Rate for Payer: HFN Commercial |
$1,817.00
|
| Rate for Payer: Multiplan Commercial |
$1,580.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,185.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,817.00
|
| Rate for Payer: Quartz Beloit One Network |
$967.75
|
| Rate for Payer: Quartz Commercial |
$1,185.00
|
| Rate for Payer: WEA Trust Commercial |
$1,086.25
|
| Rate for Payer: WPS Commercial |
$1,462.88
|
|
|
VL Iliac Vasculature Duplex Comp Bilat
|
Professional
|
Both
|
$1,975.00
|
|
|
Service Code
|
CPT 93978 TC
|
| Hospital Charge Code |
2544897
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$163.95 |
| Max. Negotiated Rate |
$1,876.25 |
| Rate for Payer: Aetna Commercial |
$1,876.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,698.50
|
| Rate for Payer: Cash Price |
$592.50
|
| Rate for Payer: Cash Price |
$592.50
|
| Rate for Payer: Cash Price |
$592.50
|
| Rate for Payer: Cigna Commercial |
$1,876.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$163.95
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,185.00
|
| Rate for Payer: Health EOS Commercial |
$1,797.25
|
| Rate for Payer: HFN Commercial |
$1,876.25
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$508.92
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$508.92
|
| Rate for Payer: Multiplan Commercial |
$1,580.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,876.25
|
| Rate for Payer: Quartz Beloit One Network |
$869.00
|
| Rate for Payer: Quartz Commercial |
$1,125.75
|
| Rate for Payer: The Alliance Commercial |
$987.50
|
| Rate for Payer: United Healthcare Medicaid |
$163.95
|
| Rate for Payer: WEA Trust Commercial |
$1,086.25
|
| Rate for Payer: WPS Commercial |
$1,462.88
|
|
|
VL Iliac Vasculature Duplex Left
|
Professional
|
Both
|
$1,234.00
|
|
|
Service Code
|
CPT 93979 LT,TC
|
| Hospital Charge Code |
2544899
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$118.89 |
| Max. Negotiated Rate |
$1,172.30 |
| Rate for Payer: Aetna Commercial |
$1,172.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,061.24
|
| Rate for Payer: Cash Price |
$370.20
|
| Rate for Payer: Cash Price |
$370.20
|
| Rate for Payer: Cash Price |
$370.20
|
| Rate for Payer: Cigna Commercial |
$1,172.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$118.89
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$740.40
|
| Rate for Payer: Health EOS Commercial |
$1,122.94
|
| Rate for Payer: HFN Commercial |
$1,172.30
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$412.23
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$412.23
|
| Rate for Payer: Multiplan Commercial |
$987.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,172.30
|
| Rate for Payer: Quartz Beloit One Network |
$542.96
|
| Rate for Payer: Quartz Commercial |
$703.38
|
| Rate for Payer: The Alliance Commercial |
$617.00
|
| Rate for Payer: United Healthcare Medicaid |
$118.89
|
| Rate for Payer: WEA Trust Commercial |
$678.70
|
| Rate for Payer: WPS Commercial |
$914.02
|
|
|
VL Iliac Vasculature Duplex Left
|
Facility
|
OP
|
$1,234.00
|
|
|
Service Code
|
CPT 93979 LT,TC
|
| Hospital Charge Code |
2544899
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$108.67 |
| Max. Negotiated Rate |
$1,135.28 |
| Rate for Payer: Aetna Commercial |
$1,110.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,061.24
|
| Rate for Payer: Aetna Managed Medicare |
$108.67
|
| 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: Anthem Medicare Advantage |
$108.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$654.02
|
| 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 |
$370.20
|
| Rate for Payer: Cash Price |
$370.20
|
| Rate for Payer: Cigna Commercial |
$1,135.28
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$108.67
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$690.55
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$108.67
|
| 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 |
$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 |
$987.20
|
| Rate for Payer: NAPHCARE Commercial |
$163.00
|
| 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 |
$108.67
|
| Rate for Payer: The Alliance Commercial |
$434.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$108.67
|
| Rate for Payer: United Healthcare PPO |
$925.50
|
| Rate for Payer: WEA Trust Commercial |
$678.70
|
| Rate for Payer: Wellcare Medicare |
$108.67
|
| Rate for Payer: WPS Commercial |
$914.02
|
|
|
VL Iliac Vasculature Duplex Left
|
Facility
|
IP
|
$1,234.00
|
|
|
Service Code
|
CPT 93979 LT,TC
|
| Hospital Charge Code |
2544899
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$604.66 |
| Max. Negotiated Rate |
$1,135.28 |
| Rate for Payer: Aetna Commercial |
$1,110.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,061.24
|
| 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: Health EOS Commercial |
$1,098.26
|
| Rate for Payer: HFN Commercial |
$1,135.28
|
| 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 |
$740.40
|
| Rate for Payer: WEA Trust Commercial |
$678.70
|
| Rate for Payer: WPS Commercial |
$914.02
|
|
|
VL Iliac Vasculature Duplex Right
|
Facility
|
OP
|
$1,234.00
|
|
|
Service Code
|
CPT 93979 RT,TC
|
| Hospital Charge Code |
2544901
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$108.67 |
| Max. Negotiated Rate |
$1,135.28 |
| Rate for Payer: Aetna Commercial |
$1,110.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,061.24
|
| Rate for Payer: Aetna Managed Medicare |
$108.67
|
| 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: Anthem Medicare Advantage |
$108.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$654.02
|
| 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 |
$370.20
|
| Rate for Payer: Cash Price |
$370.20
|
| Rate for Payer: Cigna Commercial |
$1,135.28
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$108.67
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$690.55
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$108.67
|
| 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 |
$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 |
$987.20
|
| Rate for Payer: NAPHCARE Commercial |
$163.00
|
| 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 |
$108.67
|
| Rate for Payer: The Alliance Commercial |
$434.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$108.67
|
| Rate for Payer: United Healthcare PPO |
$925.50
|
| Rate for Payer: WEA Trust Commercial |
$678.70
|
| Rate for Payer: Wellcare Medicare |
$108.67
|
| Rate for Payer: WPS Commercial |
$914.02
|
|
|
VL Iliac Vasculature Duplex Right
|
Facility
|
IP
|
$1,234.00
|
|
|
Service Code
|
CPT 93979 RT,TC
|
| Hospital Charge Code |
2544901
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$604.66 |
| Max. Negotiated Rate |
$1,135.28 |
| Rate for Payer: Aetna Commercial |
$1,110.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,061.24
|
| 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: Health EOS Commercial |
$1,098.26
|
| Rate for Payer: HFN Commercial |
$1,135.28
|
| 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 |
$740.40
|
| Rate for Payer: WEA Trust Commercial |
$678.70
|
| Rate for Payer: WPS Commercial |
$914.02
|
|
|
VL Iliac Vasculature Duplex Right
|
Professional
|
Both
|
$1,234.00
|
|
|
Service Code
|
CPT 93979 RT,TC
|
| Hospital Charge Code |
2544901
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$118.89 |
| Max. Negotiated Rate |
$1,172.30 |
| Rate for Payer: Aetna Commercial |
$1,172.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,061.24
|
| Rate for Payer: Cash Price |
$370.20
|
| Rate for Payer: Cash Price |
$370.20
|
| Rate for Payer: Cash Price |
$370.20
|
| Rate for Payer: Cigna Commercial |
$1,172.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$118.89
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$740.40
|
| Rate for Payer: Health EOS Commercial |
$1,122.94
|
| Rate for Payer: HFN Commercial |
$1,172.30
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$412.23
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$412.23
|
| Rate for Payer: Multiplan Commercial |
$987.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,172.30
|
| Rate for Payer: Quartz Beloit One Network |
$542.96
|
| Rate for Payer: Quartz Commercial |
$703.38
|
| Rate for Payer: The Alliance Commercial |
$617.00
|
| Rate for Payer: United Healthcare Medicaid |
$118.89
|
| Rate for Payer: WEA Trust Commercial |
$678.70
|
| Rate for Payer: WPS Commercial |
$914.02
|
|
|
VL LE Arterial Duplex Bilateral
|
Professional
|
Both
|
$2,194.00
|
|
|
Service Code
|
CPT 93925 TC
|
| Hospital Charge Code |
1483081
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$205.54 |
| Max. Negotiated Rate |
$2,084.30 |
| Rate for Payer: Aetna Commercial |
$2,084.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,886.84
|
| Rate for Payer: Cash Price |
$658.20
|
| Rate for Payer: Cash Price |
$658.20
|
| Rate for Payer: Cash Price |
$658.20
|
| Rate for Payer: Cigna Commercial |
$2,084.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$205.54
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,316.40
|
| Rate for Payer: Health EOS Commercial |
$1,996.54
|
| Rate for Payer: HFN Commercial |
$2,084.30
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$733.60
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$733.60
|
| Rate for Payer: Multiplan Commercial |
$1,755.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,084.30
|
| Rate for Payer: Quartz Beloit One Network |
$965.36
|
| Rate for Payer: Quartz Commercial |
$1,250.58
|
| Rate for Payer: The Alliance Commercial |
$1,097.00
|
| Rate for Payer: United Healthcare Medicaid |
$205.54
|
| Rate for Payer: WEA Trust Commercial |
$1,206.70
|
| Rate for Payer: WPS Commercial |
$1,625.10
|
|
|
VL LE Arterial Duplex Bilateral
|
Facility
|
OP
|
$2,194.00
|
|
|
Service Code
|
CPT 93925 TC
|
| Hospital Charge Code |
1483081
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$242.20 |
| Max. Negotiated Rate |
$2,018.48 |
| Rate for Payer: Aetna Commercial |
$1,974.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,886.84
|
| Rate for Payer: 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 DHI/DHP/ASO |
$1,227.76
|
| 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: The Alliance Commercial |
$968.80
|
| 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
|
|
|
VL LE Arterial Duplex Bilateral
|
Facility
|
IP
|
$2,194.00
|
|
|
Service Code
|
CPT 93925 TC
|
| Hospital Charge Code |
1483081
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$1,075.06 |
| Max. Negotiated Rate |
$2,018.48 |
| Rate for Payer: Aetna Commercial |
$1,974.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,886.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,162.82
|
| Rate for Payer: Cash Price |
$658.20
|
| Rate for Payer: Cigna Commercial |
$2,018.48
|
| Rate for Payer: Health EOS Commercial |
$1,952.66
|
| Rate for Payer: HFN Commercial |
$2,018.48
|
| Rate for Payer: Multiplan Commercial |
$1,755.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,316.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,018.48
|
| Rate for Payer: Quartz Beloit One Network |
$1,075.06
|
| Rate for Payer: Quartz Commercial |
$1,316.40
|
| Rate for Payer: WEA Trust Commercial |
$1,206.70
|
| Rate for Payer: WPS Commercial |
$1,625.10
|
|
|
VL LE Arterial Duplex Left
|
Facility
|
IP
|
$1,227.00
|
|
|
Service Code
|
CPT 93926 TC
|
| Hospital Charge Code |
1483084
|
|
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: Aetna Gatekeeper/Not Gatekeeper |
$1,055.22
|
| 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
|
|
|
VL LE Arterial Duplex Left
|
Professional
|
Both
|
$1,227.00
|
|
|
Service Code
|
CPT 93926 TC
|
| Hospital Charge Code |
1483084
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$145.78 |
| Max. Negotiated Rate |
$1,165.65 |
| Rate for Payer: Aetna Commercial |
$1,165.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,055.22
|
| Rate for Payer: Cash Price |
$368.10
|
| Rate for Payer: Cash Price |
$368.10
|
| Rate for Payer: Cash Price |
$368.10
|
| Rate for Payer: Cigna Commercial |
$1,165.65
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$145.78
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$736.20
|
| Rate for Payer: Health EOS Commercial |
$1,116.57
|
| Rate for Payer: HFN Commercial |
$1,165.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$428.86
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$428.86
|
| Rate for Payer: Multiplan Commercial |
$981.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,165.65
|
| Rate for Payer: Quartz Beloit One Network |
$539.88
|
| Rate for Payer: Quartz Commercial |
$699.39
|
| Rate for Payer: The Alliance Commercial |
$613.50
|
| Rate for Payer: United Healthcare Medicaid |
$145.78
|
| Rate for Payer: WEA Trust Commercial |
$674.85
|
| Rate for Payer: WPS Commercial |
$908.84
|
|
|
VL LE Arterial Duplex Left
|
Facility
|
OP
|
$1,227.00
|
|
|
Service Code
|
CPT 93926 TC
|
| Hospital Charge Code |
1483084
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$108.67 |
| 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 |
$108.67
|
| 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 |
$108.67
|
| 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 |
$108.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$108.67
|
| 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 |
$108.67
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$686.63
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$108.67
|
| 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 |
$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 |
$981.60
|
| Rate for Payer: NAPHCARE Commercial |
$163.00
|
| 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 |
$108.67
|
| Rate for Payer: The Alliance Commercial |
$434.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$108.67
|
| Rate for Payer: United Healthcare PPO |
$920.25
|
| Rate for Payer: WEA Trust Commercial |
$674.85
|
| Rate for Payer: Wellcare Medicare |
$108.67
|
| Rate for Payer: WPS Commercial |
$908.84
|
|
|
VL LE Arterial Duplex Right
|
Facility
|
IP
|
$1,227.00
|
|
|
Service Code
|
CPT 93926 TC
|
| Hospital Charge Code |
1483087
|
|
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: Aetna Gatekeeper/Not Gatekeeper |
$1,055.22
|
| 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
|
|
|
VL LE Arterial Duplex Right
|
Facility
|
OP
|
$1,227.00
|
|
|
Service Code
|
CPT 93926 TC
|
| Hospital Charge Code |
1483087
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$108.67 |
| 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 |
$108.67
|
| 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 |
$108.67
|
| 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 |
$108.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$108.67
|
| 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 |
$108.67
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$686.63
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$108.67
|
| 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 |
$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 |
$981.60
|
| Rate for Payer: NAPHCARE Commercial |
$163.00
|
| 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 |
$108.67
|
| Rate for Payer: The Alliance Commercial |
$434.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$108.67
|
| Rate for Payer: United Healthcare PPO |
$920.25
|
| Rate for Payer: WEA Trust Commercial |
$674.85
|
| Rate for Payer: Wellcare Medicare |
$108.67
|
| Rate for Payer: WPS Commercial |
$908.84
|
|
|
VL LE Arterial Duplex Right
|
Professional
|
Both
|
$1,227.00
|
|
|
Service Code
|
CPT 93926 TC
|
| Hospital Charge Code |
1483087
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$145.78 |
| Max. Negotiated Rate |
$1,165.65 |
| Rate for Payer: Aetna Commercial |
$1,165.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,055.22
|
| Rate for Payer: Cash Price |
$368.10
|
| Rate for Payer: Cash Price |
$368.10
|
| Rate for Payer: Cash Price |
$368.10
|
| Rate for Payer: Cigna Commercial |
$1,165.65
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$145.78
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$736.20
|
| Rate for Payer: Health EOS Commercial |
$1,116.57
|
| Rate for Payer: HFN Commercial |
$1,165.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$428.86
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$428.86
|
| Rate for Payer: Multiplan Commercial |
$981.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,165.65
|
| Rate for Payer: Quartz Beloit One Network |
$539.88
|
| Rate for Payer: Quartz Commercial |
$699.39
|
| Rate for Payer: The Alliance Commercial |
$613.50
|
| Rate for Payer: United Healthcare Medicaid |
$145.78
|
| Rate for Payer: WEA Trust Commercial |
$674.85
|
| Rate for Payer: WPS Commercial |
$908.84
|
|
|
VL LE Arterial Graft Patency Bilateral
|
Professional
|
Both
|
$2,194.00
|
|
|
Service Code
|
CPT 93925 TC
|
| Hospital Charge Code |
5238990
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$205.54 |
| Max. Negotiated Rate |
$2,084.30 |
| Rate for Payer: Aetna Commercial |
$2,084.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,886.84
|
| Rate for Payer: Cash Price |
$658.20
|
| Rate for Payer: Cash Price |
$658.20
|
| Rate for Payer: Cash Price |
$658.20
|
| Rate for Payer: Cigna Commercial |
$2,084.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$205.54
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,316.40
|
| Rate for Payer: Health EOS Commercial |
$1,996.54
|
| Rate for Payer: HFN Commercial |
$2,084.30
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$733.60
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$733.60
|
| Rate for Payer: Multiplan Commercial |
$1,755.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,084.30
|
| Rate for Payer: Quartz Beloit One Network |
$965.36
|
| Rate for Payer: Quartz Commercial |
$1,250.58
|
| Rate for Payer: The Alliance Commercial |
$1,097.00
|
| Rate for Payer: United Healthcare Medicaid |
$205.54
|
| Rate for Payer: WEA Trust Commercial |
$1,206.70
|
| Rate for Payer: WPS Commercial |
$1,625.10
|
|
|
VL LE Arterial Graft Patency Bilateral
|
Facility
|
OP
|
$2,194.00
|
|
|
Service Code
|
CPT 93925 TC
|
| Hospital Charge Code |
5238990
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$242.20 |
| Max. Negotiated Rate |
$2,018.48 |
| Rate for Payer: Aetna Commercial |
$1,974.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,886.84
|
| Rate for Payer: 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 DHI/DHP/ASO |
$1,227.76
|
| 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: The Alliance Commercial |
$968.80
|
| 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
|
|
|
VL LE Arterial Graft Patency Bilateral
|
Facility
|
IP
|
$2,194.00
|
|
|
Service Code
|
CPT 93925 TC
|
| Hospital Charge Code |
5238990
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$1,075.06 |
| Max. Negotiated Rate |
$2,018.48 |
| Rate for Payer: Aetna Commercial |
$1,974.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,886.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,162.82
|
| Rate for Payer: Cash Price |
$658.20
|
| Rate for Payer: Cigna Commercial |
$2,018.48
|
| Rate for Payer: Health EOS Commercial |
$1,952.66
|
| Rate for Payer: HFN Commercial |
$2,018.48
|
| Rate for Payer: Multiplan Commercial |
$1,755.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,316.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,018.48
|
| Rate for Payer: Quartz Beloit One Network |
$1,075.06
|
| Rate for Payer: Quartz Commercial |
$1,316.40
|
| Rate for Payer: WEA Trust Commercial |
$1,206.70
|
| Rate for Payer: WPS Commercial |
$1,625.10
|
|
|
VL LE Arterial Graft Patency Left
|
Professional
|
Both
|
$1,227.00
|
|
|
Service Code
|
CPT 93926 TC
|
| Hospital Charge Code |
5238992
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$145.78 |
| Max. Negotiated Rate |
$1,165.65 |
| Rate for Payer: Aetna Commercial |
$1,165.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,055.22
|
| Rate for Payer: Cash Price |
$368.10
|
| Rate for Payer: Cash Price |
$368.10
|
| Rate for Payer: Cash Price |
$368.10
|
| Rate for Payer: Cigna Commercial |
$1,165.65
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$145.78
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$736.20
|
| Rate for Payer: Health EOS Commercial |
$1,116.57
|
| Rate for Payer: HFN Commercial |
$1,165.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$428.86
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$428.86
|
| Rate for Payer: Multiplan Commercial |
$981.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,165.65
|
| Rate for Payer: Quartz Beloit One Network |
$539.88
|
| Rate for Payer: Quartz Commercial |
$699.39
|
| Rate for Payer: The Alliance Commercial |
$613.50
|
| Rate for Payer: United Healthcare Medicaid |
$145.78
|
| Rate for Payer: WEA Trust Commercial |
$674.85
|
| Rate for Payer: WPS Commercial |
$908.84
|
|
