|
VL TEE Congenital Cardiac Abnormalities
|
Facility
|
IP
|
$4,666.00
|
|
|
Service Code
|
CPT 93315
|
| Hospital Charge Code |
1483324
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$2,286.34 |
| Max. Negotiated Rate |
$4,292.72 |
| Rate for Payer: Aetna Commercial |
$4,199.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,012.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,472.98
|
| Rate for Payer: Cash Price |
$1,399.80
|
| Rate for Payer: Cigna Commercial |
$4,292.72
|
| Rate for Payer: Health EOS Commercial |
$4,152.74
|
| Rate for Payer: HFN Commercial |
$4,292.72
|
| Rate for Payer: Multiplan Commercial |
$3,732.80
|
| Rate for Payer: NAPHCARE Commercial |
$2,799.60
|
| Rate for Payer: Preferred Network Access Commercial |
$4,292.72
|
| Rate for Payer: Quartz Beloit One Network |
$2,286.34
|
| Rate for Payer: Quartz Commercial |
$2,799.60
|
| Rate for Payer: WEA Trust Commercial |
$2,566.30
|
| Rate for Payer: WPS Commercial |
$3,456.11
|
|
|
VL TEE Ongoing assess of Cardiac Pump
|
Professional
|
Both
|
$6,012.00
|
|
|
Service Code
|
CPT 93318
|
| Hospital Charge Code |
1483327
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$1,402.68 |
| Max. Negotiated Rate |
$5,711.40 |
| Rate for Payer: Aetna Commercial |
$5,711.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,170.32
|
| Rate for Payer: Cash Price |
$1,803.60
|
| Rate for Payer: Cash Price |
$1,803.60
|
| Rate for Payer: Cash Price |
$1,803.60
|
| Rate for Payer: Cigna Commercial |
$5,711.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$3,006.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,607.20
|
| Rate for Payer: Health EOS Commercial |
$5,470.92
|
| Rate for Payer: HFN Commercial |
$5,711.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,402.68
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,402.68
|
| Rate for Payer: Multiplan Commercial |
$4,809.60
|
| Rate for Payer: Preferred Network Access Commercial |
$5,711.40
|
| Rate for Payer: Quartz Beloit One Network |
$2,645.28
|
| Rate for Payer: Quartz Commercial |
$3,426.84
|
| Rate for Payer: The Alliance Commercial |
$3,006.00
|
| Rate for Payer: WEA Trust Commercial |
$3,306.60
|
| Rate for Payer: WPS Commercial |
$4,453.09
|
|
|
VL TEE Ongoing assess of Cardiac Pump
|
Facility
|
IP
|
$6,012.00
|
|
|
Service Code
|
CPT 93318
|
| Hospital Charge Code |
1483327
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$2,945.88 |
| Max. Negotiated Rate |
$5,531.04 |
| Rate for Payer: Aetna Commercial |
$5,410.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,170.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,186.36
|
| Rate for Payer: Cash Price |
$1,803.60
|
| Rate for Payer: Cigna Commercial |
$5,531.04
|
| Rate for Payer: Health EOS Commercial |
$5,350.68
|
| Rate for Payer: HFN Commercial |
$5,531.04
|
| Rate for Payer: Multiplan Commercial |
$4,809.60
|
| Rate for Payer: NAPHCARE Commercial |
$3,607.20
|
| Rate for Payer: Preferred Network Access Commercial |
$5,531.04
|
| Rate for Payer: Quartz Beloit One Network |
$2,945.88
|
| Rate for Payer: Quartz Commercial |
$3,607.20
|
| Rate for Payer: WEA Trust Commercial |
$3,306.60
|
| Rate for Payer: WPS Commercial |
$4,453.09
|
|
|
VL TEE Ongoing assess of Cardiac Pump
|
Facility
|
OP
|
$6,012.00
|
|
|
Service Code
|
CPT 93318
|
| Hospital Charge Code |
1483327
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$545.28 |
| Max. Negotiated Rate |
$5,531.04 |
| Rate for Payer: Aetna Commercial |
$5,410.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,170.32
|
| Rate for Payer: Aetna Managed Medicare |
$545.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,907.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,006.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,885.76
|
| Rate for Payer: Anthem Medicare Advantage |
$545.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,186.36
|
| 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 |
$1,803.60
|
| Rate for Payer: Cash Price |
$1,803.60
|
| Rate for Payer: Cigna Commercial |
$5,531.04
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$545.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,364.32
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$545.28
|
| Rate for Payer: Health EOS Commercial |
$5,350.68
|
| Rate for Payer: HFN Commercial |
$5,531.04
|
| 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 |
$4,809.60
|
| Rate for Payer: NAPHCARE Commercial |
$817.92
|
| Rate for Payer: Preferred Network Access Commercial |
$5,531.04
|
| Rate for Payer: Quartz Beloit One Network |
$2,945.88
|
| Rate for Payer: Quartz Commercial |
$3,907.80
|
| Rate for Payer: Quartz Medicare Advantage |
$545.28
|
| Rate for Payer: The Alliance Commercial |
$2,181.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$545.28
|
| Rate for Payer: United Healthcare PPO |
$4,509.00
|
| Rate for Payer: WEA Trust Commercial |
$3,306.60
|
| Rate for Payer: Wellcare Medicare |
$545.28
|
| Rate for Payer: WPS Commercial |
$4,453.09
|
|
|
VL TEE Placement of Probe only
|
Facility
|
IP
|
$3,917.00
|
|
|
Service Code
|
CPT 93313
|
| Hospital Charge Code |
1483330
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$1,919.33 |
| Max. Negotiated Rate |
$3,603.64 |
| Rate for Payer: Aetna Commercial |
$3,525.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,368.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,076.01
|
| Rate for Payer: Cash Price |
$1,175.10
|
| Rate for Payer: Cigna Commercial |
$3,603.64
|
| Rate for Payer: Health EOS Commercial |
$3,486.13
|
| Rate for Payer: HFN Commercial |
$3,603.64
|
| Rate for Payer: Multiplan Commercial |
$3,133.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,350.20
|
| Rate for Payer: Preferred Network Access Commercial |
$3,603.64
|
| Rate for Payer: Quartz Beloit One Network |
$1,919.33
|
| Rate for Payer: Quartz Commercial |
$2,350.20
|
| Rate for Payer: WEA Trust Commercial |
$2,154.35
|
| Rate for Payer: WPS Commercial |
$2,901.32
|
|
|
VL TEE Placement of Probe only
|
Professional
|
Both
|
$3,917.00
|
|
|
Service Code
|
CPT 93313
|
| Hospital Charge Code |
1483330
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$38.55 |
| Max. Negotiated Rate |
$3,721.15 |
| Rate for Payer: Aetna Commercial |
$3,721.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,368.62
|
| Rate for Payer: Cash Price |
$1,175.10
|
| Rate for Payer: Cash Price |
$1,175.10
|
| Rate for Payer: Cash Price |
$1,175.10
|
| Rate for Payer: Cigna Commercial |
$3,721.15
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,958.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,350.20
|
| Rate for Payer: Health EOS Commercial |
$3,564.47
|
| Rate for Payer: HFN Commercial |
$3,721.15
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$38.55
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$38.55
|
| Rate for Payer: Multiplan Commercial |
$3,133.60
|
| Rate for Payer: Preferred Network Access Commercial |
$3,721.15
|
| Rate for Payer: Quartz Beloit One Network |
$1,723.48
|
| Rate for Payer: Quartz Commercial |
$2,232.69
|
| Rate for Payer: The Alliance Commercial |
$1,958.50
|
| Rate for Payer: WEA Trust Commercial |
$2,154.35
|
| Rate for Payer: WPS Commercial |
$2,901.32
|
|
|
VL TEE Placement of Probe only
|
Facility
|
OP
|
$3,917.00
|
|
|
Service Code
|
CPT 93313
|
| Hospital Charge Code |
1483330
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$545.28 |
| Max. Negotiated Rate |
$3,603.64 |
| Rate for Payer: Aetna Commercial |
$3,525.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,368.62
|
| Rate for Payer: Aetna Managed Medicare |
$545.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,546.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,958.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,880.16
|
| Rate for Payer: Anthem Medicare Advantage |
$545.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,076.01
|
| 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 |
$1,175.10
|
| Rate for Payer: Cash Price |
$1,175.10
|
| Rate for Payer: Cigna Commercial |
$3,603.64
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$545.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,191.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$545.28
|
| Rate for Payer: Health EOS Commercial |
$3,486.13
|
| Rate for Payer: HFN Commercial |
$3,603.64
|
| 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 |
$3,133.60
|
| Rate for Payer: NAPHCARE Commercial |
$817.92
|
| Rate for Payer: Preferred Network Access Commercial |
$3,603.64
|
| Rate for Payer: Quartz Beloit One Network |
$1,919.33
|
| Rate for Payer: Quartz Commercial |
$2,546.05
|
| Rate for Payer: Quartz Medicare Advantage |
$545.28
|
| Rate for Payer: The Alliance Commercial |
$2,181.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$545.28
|
| Rate for Payer: United Healthcare PPO |
$2,937.75
|
| Rate for Payer: WEA Trust Commercial |
$2,154.35
|
| Rate for Payer: Wellcare Medicare |
$545.28
|
| Rate for Payer: WPS Commercial |
$2,901.32
|
|
|
VL Thoracic Outlet Study
|
Professional
|
Both
|
$808.00
|
|
|
Service Code
|
CPT 93923 TC
|
| Hospital Charge Code |
1483336
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$130.88 |
| Max. Negotiated Rate |
$767.60 |
| Rate for Payer: Aetna Commercial |
$767.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$694.88
|
| Rate for Payer: Cash Price |
$242.40
|
| Rate for Payer: Cash Price |
$242.40
|
| Rate for Payer: Cash Price |
$242.40
|
| Rate for Payer: Cigna Commercial |
$767.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$130.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$484.80
|
| Rate for Payer: Health EOS Commercial |
$735.28
|
| Rate for Payer: HFN Commercial |
$767.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$374.36
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$374.36
|
| Rate for Payer: Multiplan Commercial |
$646.40
|
| Rate for Payer: Preferred Network Access Commercial |
$767.60
|
| Rate for Payer: Quartz Beloit One Network |
$355.52
|
| Rate for Payer: Quartz Commercial |
$460.56
|
| Rate for Payer: The Alliance Commercial |
$404.00
|
| Rate for Payer: United Healthcare Medicaid |
$130.88
|
| Rate for Payer: WEA Trust Commercial |
$444.40
|
| Rate for Payer: WPS Commercial |
$598.49
|
|
|
VL Thoracic Outlet Study
|
Facility
|
IP
|
$808.00
|
|
|
Service Code
|
CPT 93923 TC
|
| Hospital Charge Code |
1483336
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$395.92 |
| Max. Negotiated Rate |
$743.36 |
| Rate for Payer: Aetna Commercial |
$727.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$694.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$428.24
|
| Rate for Payer: Cash Price |
$242.40
|
| Rate for Payer: Cigna Commercial |
$743.36
|
| Rate for Payer: Health EOS Commercial |
$719.12
|
| Rate for Payer: HFN Commercial |
$743.36
|
| Rate for Payer: Multiplan Commercial |
$646.40
|
| Rate for Payer: NAPHCARE Commercial |
$484.80
|
| Rate for Payer: Preferred Network Access Commercial |
$743.36
|
| Rate for Payer: Quartz Beloit One Network |
$395.92
|
| Rate for Payer: Quartz Commercial |
$484.80
|
| Rate for Payer: WEA Trust Commercial |
$444.40
|
| Rate for Payer: WPS Commercial |
$598.49
|
|
|
VL Thoracic Outlet Study
|
Facility
|
OP
|
$808.00
|
|
|
Service Code
|
CPT 93923 TC
|
| Hospital Charge Code |
1483336
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$154.39 |
| Max. Negotiated Rate |
$743.36 |
| Rate for Payer: Aetna Commercial |
$727.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$694.88
|
| Rate for Payer: Aetna Managed Medicare |
$154.39
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$525.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$404.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$387.84
|
| Rate for Payer: Anthem Medicare Advantage |
$154.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$428.24
|
| 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 |
$242.40
|
| Rate for Payer: Cash Price |
$242.40
|
| Rate for Payer: Cigna Commercial |
$743.36
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$154.39
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$452.16
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$154.39
|
| Rate for Payer: Health EOS Commercial |
$719.12
|
| Rate for Payer: HFN Commercial |
$743.36
|
| 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 |
$646.40
|
| Rate for Payer: NAPHCARE Commercial |
$231.58
|
| Rate for Payer: Preferred Network Access Commercial |
$743.36
|
| Rate for Payer: Quartz Beloit One Network |
$395.92
|
| Rate for Payer: Quartz Commercial |
$525.20
|
| Rate for Payer: Quartz Medicare Advantage |
$154.39
|
| Rate for Payer: The Alliance Commercial |
$617.56
|
| Rate for Payer: United Healthcare Medicare Advantage |
$154.39
|
| Rate for Payer: United Healthcare PPO |
$606.00
|
| Rate for Payer: WEA Trust Commercial |
$444.40
|
| Rate for Payer: Wellcare Medicare |
$154.39
|
| Rate for Payer: WPS Commercial |
$598.49
|
|
|
VL UE Arterial Duplex Bilateral
|
Professional
|
Both
|
$1,630.00
|
|
|
Service Code
|
CPT 93930 TC
|
| Hospital Charge Code |
1483372
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$165.60 |
| Max. Negotiated Rate |
$1,548.50 |
| Rate for Payer: Aetna Commercial |
$1,548.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,401.80
|
| Rate for Payer: Cash Price |
$489.00
|
| Rate for Payer: Cash Price |
$489.00
|
| Rate for Payer: Cash Price |
$489.00
|
| Rate for Payer: Cigna Commercial |
$1,548.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$165.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$978.00
|
| Rate for Payer: Health EOS Commercial |
$1,483.30
|
| Rate for Payer: HFN Commercial |
$1,548.50
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$566.53
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$566.53
|
| Rate for Payer: Multiplan Commercial |
$1,304.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,548.50
|
| Rate for Payer: Quartz Beloit One Network |
$717.20
|
| Rate for Payer: Quartz Commercial |
$929.10
|
| Rate for Payer: The Alliance Commercial |
$815.00
|
| Rate for Payer: United Healthcare Medicaid |
$165.60
|
| Rate for Payer: WEA Trust Commercial |
$896.50
|
| Rate for Payer: WPS Commercial |
$1,207.34
|
|
|
VL UE Arterial Duplex Bilateral
|
Facility
|
OP
|
$1,630.00
|
|
|
Service Code
|
CPT 93930 TC
|
| Hospital Charge Code |
1483372
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$242.20 |
| Max. Negotiated Rate |
$1,499.60 |
| Rate for Payer: Aetna Commercial |
$1,467.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,401.80
|
| Rate for Payer: Aetna Managed Medicare |
$242.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,059.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$815.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$782.40
|
| Rate for Payer: Anthem Medicare Advantage |
$242.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$863.90
|
| 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 |
$489.00
|
| Rate for Payer: Cash Price |
$489.00
|
| Rate for Payer: Cigna Commercial |
$1,499.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$242.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$912.15
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$242.20
|
| Rate for Payer: Health EOS Commercial |
$1,450.70
|
| Rate for Payer: HFN Commercial |
$1,499.60
|
| 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 |
$1,304.00
|
| Rate for Payer: NAPHCARE Commercial |
$363.30
|
| Rate for Payer: Preferred Network Access Commercial |
$1,499.60
|
| Rate for Payer: Quartz Beloit One Network |
$798.70
|
| Rate for Payer: Quartz Commercial |
$1,059.50
|
| 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 |
$1,222.50
|
| Rate for Payer: WEA Trust Commercial |
$896.50
|
| Rate for Payer: Wellcare Medicare |
$242.20
|
| Rate for Payer: WPS Commercial |
$1,207.34
|
|
|
VL UE Arterial Duplex Bilateral
|
Facility
|
IP
|
$1,630.00
|
|
|
Service Code
|
CPT 93930 TC
|
| Hospital Charge Code |
1483372
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$798.70 |
| Max. Negotiated Rate |
$1,499.60 |
| Rate for Payer: Aetna Commercial |
$1,467.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,401.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$863.90
|
| Rate for Payer: Cash Price |
$489.00
|
| Rate for Payer: Cigna Commercial |
$1,499.60
|
| Rate for Payer: Health EOS Commercial |
$1,450.70
|
| Rate for Payer: HFN Commercial |
$1,499.60
|
| Rate for Payer: Multiplan Commercial |
$1,304.00
|
| Rate for Payer: NAPHCARE Commercial |
$978.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,499.60
|
| Rate for Payer: Quartz Beloit One Network |
$798.70
|
| Rate for Payer: Quartz Commercial |
$978.00
|
| Rate for Payer: WEA Trust Commercial |
$896.50
|
| Rate for Payer: WPS Commercial |
$1,207.34
|
|
|
VL UE Arterial Duplex Left
|
Professional
|
Both
|
$1,135.00
|
|
|
Service Code
|
CPT 93931 TC
|
| Hospital Charge Code |
1483375
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$118.97 |
| Max. Negotiated Rate |
$1,078.25 |
| Rate for Payer: Aetna Commercial |
$1,078.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$976.10
|
| Rate for Payer: Cash Price |
$340.50
|
| Rate for Payer: Cash Price |
$340.50
|
| Rate for Payer: Cash Price |
$340.50
|
| Rate for Payer: Cigna Commercial |
$1,078.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$118.97
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$681.00
|
| Rate for Payer: Health EOS Commercial |
$1,032.85
|
| Rate for Payer: HFN Commercial |
$1,078.25
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$355.79
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$355.79
|
| Rate for Payer: Multiplan Commercial |
$908.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,078.25
|
| Rate for Payer: Quartz Beloit One Network |
$499.40
|
| Rate for Payer: Quartz Commercial |
$646.95
|
| Rate for Payer: The Alliance Commercial |
$567.50
|
| Rate for Payer: United Healthcare Medicaid |
$118.97
|
| Rate for Payer: WEA Trust Commercial |
$624.25
|
| Rate for Payer: WPS Commercial |
$840.69
|
|
|
VL UE Arterial Duplex Left
|
Facility
|
IP
|
$1,135.00
|
|
|
Service Code
|
CPT 93931 TC
|
| Hospital Charge Code |
1483375
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$556.15 |
| Max. Negotiated Rate |
$1,044.20 |
| Rate for Payer: Aetna Commercial |
$1,021.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$976.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$601.55
|
| Rate for Payer: Cash Price |
$340.50
|
| Rate for Payer: Cigna Commercial |
$1,044.20
|
| Rate for Payer: Health EOS Commercial |
$1,010.15
|
| Rate for Payer: HFN Commercial |
$1,044.20
|
| Rate for Payer: Multiplan Commercial |
$908.00
|
| Rate for Payer: NAPHCARE Commercial |
$681.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,044.20
|
| Rate for Payer: Quartz Beloit One Network |
$556.15
|
| Rate for Payer: Quartz Commercial |
$681.00
|
| Rate for Payer: WEA Trust Commercial |
$624.25
|
| Rate for Payer: WPS Commercial |
$840.69
|
|
|
VL UE Arterial Duplex Left
|
Facility
|
OP
|
$1,135.00
|
|
|
Service Code
|
CPT 93931 TC
|
| Hospital Charge Code |
1483375
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$108.67 |
| Max. Negotiated Rate |
$1,044.20 |
| Rate for Payer: Aetna Commercial |
$1,021.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$976.10
|
| Rate for Payer: Aetna Managed Medicare |
$108.67
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$737.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$567.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$544.80
|
| Rate for Payer: Anthem Medicare Advantage |
$108.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$601.55
|
| 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 |
$340.50
|
| Rate for Payer: Cash Price |
$340.50
|
| Rate for Payer: Cigna Commercial |
$1,044.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$108.67
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$635.15
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$108.67
|
| Rate for Payer: Health EOS Commercial |
$1,010.15
|
| Rate for Payer: HFN Commercial |
$1,044.20
|
| 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 |
$908.00
|
| Rate for Payer: NAPHCARE Commercial |
$163.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,044.20
|
| Rate for Payer: Quartz Beloit One Network |
$556.15
|
| Rate for Payer: Quartz Commercial |
$737.75
|
| 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 |
$851.25
|
| Rate for Payer: WEA Trust Commercial |
$624.25
|
| Rate for Payer: Wellcare Medicare |
$108.67
|
| Rate for Payer: WPS Commercial |
$840.69
|
|
|
VL UE Arterial Duplex Right
|
Facility
|
OP
|
$1,135.00
|
|
|
Service Code
|
CPT 93931 TC
|
| Hospital Charge Code |
1483378
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$108.67 |
| Max. Negotiated Rate |
$1,044.20 |
| Rate for Payer: Aetna Commercial |
$1,021.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$976.10
|
| Rate for Payer: Aetna Managed Medicare |
$108.67
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$737.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$567.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$544.80
|
| Rate for Payer: Anthem Medicare Advantage |
$108.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$601.55
|
| 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 |
$340.50
|
| Rate for Payer: Cash Price |
$340.50
|
| Rate for Payer: Cigna Commercial |
$1,044.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$108.67
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$635.15
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$108.67
|
| Rate for Payer: Health EOS Commercial |
$1,010.15
|
| Rate for Payer: HFN Commercial |
$1,044.20
|
| 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 |
$908.00
|
| Rate for Payer: NAPHCARE Commercial |
$163.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,044.20
|
| Rate for Payer: Quartz Beloit One Network |
$556.15
|
| Rate for Payer: Quartz Commercial |
$737.75
|
| 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 |
$851.25
|
| Rate for Payer: WEA Trust Commercial |
$624.25
|
| Rate for Payer: Wellcare Medicare |
$108.67
|
| Rate for Payer: WPS Commercial |
$840.69
|
|
|
VL UE Arterial Duplex Right
|
Professional
|
Both
|
$1,630.00
|
|
|
Service Code
|
CPT 93930 TC,RT
|
| Hospital Charge Code |
3115223
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$165.60 |
| Max. Negotiated Rate |
$1,548.50 |
| Rate for Payer: Aetna Commercial |
$1,548.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,401.80
|
| Rate for Payer: Cash Price |
$489.00
|
| Rate for Payer: Cash Price |
$489.00
|
| Rate for Payer: Cash Price |
$489.00
|
| Rate for Payer: Cigna Commercial |
$1,548.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$165.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$978.00
|
| Rate for Payer: Health EOS Commercial |
$1,483.30
|
| Rate for Payer: HFN Commercial |
$1,548.50
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$697.35
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$697.35
|
| Rate for Payer: Multiplan Commercial |
$1,304.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,548.50
|
| Rate for Payer: Quartz Beloit One Network |
$717.20
|
| Rate for Payer: Quartz Commercial |
$929.10
|
| Rate for Payer: The Alliance Commercial |
$815.00
|
| Rate for Payer: United Healthcare Medicaid |
$165.60
|
| Rate for Payer: WEA Trust Commercial |
$896.50
|
| Rate for Payer: WPS Commercial |
$1,207.34
|
|
|
VL UE Arterial Duplex Right
|
Professional
|
Both
|
$1,135.00
|
|
|
Service Code
|
CPT 93931 TC
|
| Hospital Charge Code |
1483378
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$118.97 |
| Max. Negotiated Rate |
$1,078.25 |
| Rate for Payer: Aetna Commercial |
$1,078.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$976.10
|
| Rate for Payer: Cash Price |
$340.50
|
| Rate for Payer: Cash Price |
$340.50
|
| Rate for Payer: Cash Price |
$340.50
|
| Rate for Payer: Cigna Commercial |
$1,078.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$118.97
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$681.00
|
| Rate for Payer: Health EOS Commercial |
$1,032.85
|
| Rate for Payer: HFN Commercial |
$1,078.25
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$355.79
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$355.79
|
| Rate for Payer: Multiplan Commercial |
$908.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,078.25
|
| Rate for Payer: Quartz Beloit One Network |
$499.40
|
| Rate for Payer: Quartz Commercial |
$646.95
|
| Rate for Payer: The Alliance Commercial |
$567.50
|
| Rate for Payer: United Healthcare Medicaid |
$118.97
|
| Rate for Payer: WEA Trust Commercial |
$624.25
|
| Rate for Payer: WPS Commercial |
$840.69
|
|
|
VL UE Arterial Duplex Right
|
Facility
|
IP
|
$1,135.00
|
|
|
Service Code
|
CPT 93931 TC
|
| Hospital Charge Code |
1483378
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$556.15 |
| Max. Negotiated Rate |
$1,044.20 |
| Rate for Payer: Aetna Commercial |
$1,021.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$976.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$601.55
|
| Rate for Payer: Cash Price |
$340.50
|
| Rate for Payer: Cigna Commercial |
$1,044.20
|
| Rate for Payer: Health EOS Commercial |
$1,010.15
|
| Rate for Payer: HFN Commercial |
$1,044.20
|
| Rate for Payer: Multiplan Commercial |
$908.00
|
| Rate for Payer: NAPHCARE Commercial |
$681.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,044.20
|
| Rate for Payer: Quartz Beloit One Network |
$556.15
|
| Rate for Payer: Quartz Commercial |
$681.00
|
| Rate for Payer: WEA Trust Commercial |
$624.25
|
| Rate for Payer: WPS Commercial |
$840.69
|
|
|
VL UE Arterial Duplex Right
|
Facility
|
IP
|
$1,630.00
|
|
|
Service Code
|
CPT 93930 TC,RT
|
| Hospital Charge Code |
3115223
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$798.70 |
| Max. Negotiated Rate |
$1,499.60 |
| Rate for Payer: Aetna Commercial |
$1,467.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,401.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$863.90
|
| Rate for Payer: Cash Price |
$489.00
|
| Rate for Payer: Cigna Commercial |
$1,499.60
|
| Rate for Payer: Health EOS Commercial |
$1,450.70
|
| Rate for Payer: HFN Commercial |
$1,499.60
|
| Rate for Payer: Multiplan Commercial |
$1,304.00
|
| Rate for Payer: NAPHCARE Commercial |
$978.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,499.60
|
| Rate for Payer: Quartz Beloit One Network |
$798.70
|
| Rate for Payer: Quartz Commercial |
$978.00
|
| Rate for Payer: WEA Trust Commercial |
$896.50
|
| Rate for Payer: WPS Commercial |
$1,207.34
|
|
|
VL UE Arterial Duplex Right
|
Facility
|
OP
|
$1,630.00
|
|
|
Service Code
|
CPT 93930 TC,RT
|
| Hospital Charge Code |
3115223
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$242.20 |
| Max. Negotiated Rate |
$1,499.60 |
| Rate for Payer: Aetna Commercial |
$1,467.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,401.80
|
| Rate for Payer: Aetna Managed Medicare |
$242.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,059.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$815.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$782.40
|
| Rate for Payer: Anthem Medicare Advantage |
$242.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$863.90
|
| 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 |
$489.00
|
| Rate for Payer: Cash Price |
$489.00
|
| Rate for Payer: Cigna Commercial |
$1,499.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$242.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$912.15
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$242.20
|
| Rate for Payer: Health EOS Commercial |
$1,450.70
|
| Rate for Payer: HFN Commercial |
$1,499.60
|
| 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 |
$1,304.00
|
| Rate for Payer: NAPHCARE Commercial |
$363.30
|
| Rate for Payer: Preferred Network Access Commercial |
$1,499.60
|
| Rate for Payer: Quartz Beloit One Network |
$798.70
|
| Rate for Payer: Quartz Commercial |
$1,059.50
|
| 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 |
$1,222.50
|
| Rate for Payer: WEA Trust Commercial |
$896.50
|
| Rate for Payer: Wellcare Medicare |
$242.20
|
| Rate for Payer: WPS Commercial |
$1,207.34
|
|
|
VL UE/LE Physiological Study
|
Facility
|
OP
|
$1,571.00
|
|
|
Service Code
|
CPT 93923 TC
|
| Hospital Charge Code |
1483390
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$154.39 |
| Max. Negotiated Rate |
$1,445.32 |
| Rate for Payer: Aetna Commercial |
$1,413.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,351.06
|
| Rate for Payer: Aetna Managed Medicare |
$154.39
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,021.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$785.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$754.08
|
| Rate for Payer: Anthem Medicare Advantage |
$154.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$832.63
|
| 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 |
$471.30
|
| Rate for Payer: Cash Price |
$471.30
|
| Rate for Payer: Cigna Commercial |
$1,445.32
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$154.39
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$879.13
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$154.39
|
| Rate for Payer: Health EOS Commercial |
$1,398.19
|
| Rate for Payer: HFN Commercial |
$1,445.32
|
| 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 |
$1,256.80
|
| Rate for Payer: NAPHCARE Commercial |
$231.58
|
| Rate for Payer: Preferred Network Access Commercial |
$1,445.32
|
| Rate for Payer: Quartz Beloit One Network |
$769.79
|
| Rate for Payer: Quartz Commercial |
$1,021.15
|
| Rate for Payer: Quartz Medicare Advantage |
$154.39
|
| Rate for Payer: The Alliance Commercial |
$617.56
|
| Rate for Payer: United Healthcare Medicare Advantage |
$154.39
|
| Rate for Payer: United Healthcare PPO |
$1,178.25
|
| Rate for Payer: WEA Trust Commercial |
$864.05
|
| Rate for Payer: Wellcare Medicare |
$154.39
|
| Rate for Payer: WPS Commercial |
$1,163.64
|
|
|
VL UE/LE Physiological Study
|
Professional
|
Both
|
$1,571.00
|
|
|
Service Code
|
CPT 93923 TC
|
| Hospital Charge Code |
1483390
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$130.88 |
| Max. Negotiated Rate |
$1,492.45 |
| Rate for Payer: Aetna Commercial |
$1,492.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,351.06
|
| Rate for Payer: Cash Price |
$471.30
|
| Rate for Payer: Cash Price |
$471.30
|
| Rate for Payer: Cash Price |
$471.30
|
| Rate for Payer: Cigna Commercial |
$1,492.45
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$130.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$942.60
|
| Rate for Payer: Health EOS Commercial |
$1,429.61
|
| Rate for Payer: HFN Commercial |
$1,492.45
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$374.36
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$374.36
|
| Rate for Payer: Multiplan Commercial |
$1,256.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,492.45
|
| Rate for Payer: Quartz Beloit One Network |
$691.24
|
| Rate for Payer: Quartz Commercial |
$895.47
|
| Rate for Payer: The Alliance Commercial |
$785.50
|
| Rate for Payer: United Healthcare Medicaid |
$130.88
|
| Rate for Payer: WEA Trust Commercial |
$864.05
|
| Rate for Payer: WPS Commercial |
$1,163.64
|
|
|
VL UE/LE Physiological Study
|
Facility
|
IP
|
$1,571.00
|
|
|
Service Code
|
CPT 93923 TC
|
| Hospital Charge Code |
1483390
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$769.79 |
| Max. Negotiated Rate |
$1,445.32 |
| Rate for Payer: Aetna Commercial |
$1,413.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,351.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$832.63
|
| Rate for Payer: Cash Price |
$471.30
|
| Rate for Payer: Cigna Commercial |
$1,445.32
|
| Rate for Payer: Health EOS Commercial |
$1,398.19
|
| Rate for Payer: HFN Commercial |
$1,445.32
|
| Rate for Payer: Multiplan Commercial |
$1,256.80
|
| Rate for Payer: NAPHCARE Commercial |
$942.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,445.32
|
| Rate for Payer: Quartz Beloit One Network |
$769.79
|
| Rate for Payer: Quartz Commercial |
$942.60
|
| Rate for Payer: WEA Trust Commercial |
$864.05
|
| Rate for Payer: WPS Commercial |
$1,163.64
|
|
