|
VL Carotid Duplex Bilateral
|
Facility
OP
|
$1,791.00
|
|
|
Service Code
|
CPT 93880 TC
|
| Hospital Charge Code |
1482841
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$501.48 |
| Max. Negotiated Rate |
$7,164.00 |
| Rate for Payer: Aetna Commercial |
$1,611.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,540.26
|
| Rate for Payer: Aetna Managed Medicare |
$501.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,164.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$895.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$859.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$949.23
|
| Rate for Payer: Cash Price |
$537.30
|
| Rate for Payer: Cigna Commercial |
$1,647.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,002.24
|
| Rate for Payer: Health EOS Commercial |
$1,593.99
|
| Rate for Payer: HFN Commercial |
$1,647.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,343.25
|
| Rate for Payer: Multiplan Commercial |
$1,432.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,074.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,647.72
|
| Rate for Payer: Quartz Beloit One Network |
$877.59
|
| Rate for Payer: Quartz Commercial |
$1,164.15
|
| Rate for Payer: Quartz Medicare Advantage |
$1,074.60
|
| Rate for Payer: The Alliance Commercial |
$7,164.00
|
| Rate for Payer: United Healthcare PPO |
$1,343.25
|
| Rate for Payer: WEA Trust Commercial |
$985.05
|
| Rate for Payer: WPS Commercial |
$1,326.59
|
|
|
VL Carotid Duplex Left or Limited
|
Facility
IP
|
$739.00
|
|
|
Service Code
|
CPT 93882 TC,LT
|
| Hospital Charge Code |
5288657
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$362.11 |
| Max. Negotiated Rate |
$679.88 |
| Rate for Payer: Aetna Commercial |
$665.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$391.67
|
| Rate for Payer: Cash Price |
$221.70
|
| Rate for Payer: Cigna Commercial |
$679.88
|
| Rate for Payer: Health EOS Commercial |
$657.71
|
| Rate for Payer: HFN Commercial |
$679.88
|
| Rate for Payer: Multiplan Commercial |
$591.20
|
| Rate for Payer: NAPHCARE Commercial |
$443.40
|
| Rate for Payer: Preferred Network Access Commercial |
$679.88
|
| Rate for Payer: Quartz Beloit One Network |
$362.11
|
| Rate for Payer: Quartz Commercial |
$443.40
|
| Rate for Payer: WEA Trust Commercial |
$406.45
|
| Rate for Payer: WPS Commercial |
$547.38
|
|
|
VL Carotid Duplex Left or Limited
|
Professional
|
$739.00
|
|
|
Service Code
|
CPT 93882 TC,LT
|
| Hospital Charge Code |
5288657
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$325.16 |
| Max. Negotiated Rate |
$702.05 |
| Rate for Payer: Aetna Commercial |
$702.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$635.54
|
| Rate for Payer: Cash Price |
$221.70
|
| Rate for Payer: Cash Price |
$221.70
|
| Rate for Payer: Cigna Commercial |
$702.05
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$369.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$443.40
|
| Rate for Payer: Health EOS Commercial |
$672.49
|
| Rate for Payer: Multiplan Commercial |
$591.20
|
| Rate for Payer: Preferred Network Access Commercial |
$702.05
|
| Rate for Payer: Quartz Beloit One Network |
$325.16
|
| Rate for Payer: Quartz Commercial |
$421.23
|
| Rate for Payer: The Alliance Commercial |
$369.50
|
| Rate for Payer: WEA Trust Commercial |
$406.45
|
| Rate for Payer: WPS Commercial |
$547.38
|
|
|
VL Carotid Duplex Left or Limited
|
Facility
OP
|
$739.00
|
|
|
Service Code
|
CPT 93882 TC,LT
|
| Hospital Charge Code |
5288657
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$206.92 |
| Max. Negotiated Rate |
$2,956.00 |
| Rate for Payer: Aetna Commercial |
$665.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$635.54
|
| Rate for Payer: Aetna Managed Medicare |
$206.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$480.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$369.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$354.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$391.67
|
| Rate for Payer: Cash Price |
$221.70
|
| Rate for Payer: Cigna Commercial |
$679.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$413.54
|
| Rate for Payer: Health EOS Commercial |
$657.71
|
| Rate for Payer: HFN Commercial |
$679.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$554.25
|
| Rate for Payer: Multiplan Commercial |
$591.20
|
| Rate for Payer: NAPHCARE Commercial |
$443.40
|
| Rate for Payer: Preferred Network Access Commercial |
$679.88
|
| Rate for Payer: Quartz Beloit One Network |
$362.11
|
| Rate for Payer: Quartz Commercial |
$480.35
|
| Rate for Payer: Quartz Medicare Advantage |
$443.40
|
| Rate for Payer: The Alliance Commercial |
$2,956.00
|
| Rate for Payer: United Healthcare PPO |
$554.25
|
| Rate for Payer: WEA Trust Commercial |
$406.45
|
| Rate for Payer: WPS Commercial |
$547.38
|
|
|
VL Carotid Duplex Right or Limited
|
Professional
|
$739.00
|
|
|
Service Code
|
CPT 93882 TC,RT
|
| Hospital Charge Code |
5288655
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$325.16 |
| Max. Negotiated Rate |
$702.05 |
| Rate for Payer: Aetna Commercial |
$702.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$635.54
|
| Rate for Payer: Cash Price |
$221.70
|
| Rate for Payer: Cash Price |
$221.70
|
| Rate for Payer: Cigna Commercial |
$702.05
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$369.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$443.40
|
| Rate for Payer: Health EOS Commercial |
$672.49
|
| Rate for Payer: Multiplan Commercial |
$591.20
|
| Rate for Payer: Preferred Network Access Commercial |
$702.05
|
| Rate for Payer: Quartz Beloit One Network |
$325.16
|
| Rate for Payer: Quartz Commercial |
$421.23
|
| Rate for Payer: The Alliance Commercial |
$369.50
|
| Rate for Payer: WEA Trust Commercial |
$406.45
|
| Rate for Payer: WPS Commercial |
$547.38
|
|
|
VL Carotid Duplex Right or Limited
|
Facility
IP
|
$739.00
|
|
|
Service Code
|
CPT 93882 TC,RT
|
| Hospital Charge Code |
5288655
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$362.11 |
| Max. Negotiated Rate |
$679.88 |
| Rate for Payer: Aetna Commercial |
$665.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$391.67
|
| Rate for Payer: Cash Price |
$221.70
|
| Rate for Payer: Cigna Commercial |
$679.88
|
| Rate for Payer: Health EOS Commercial |
$657.71
|
| Rate for Payer: HFN Commercial |
$679.88
|
| Rate for Payer: Multiplan Commercial |
$591.20
|
| Rate for Payer: NAPHCARE Commercial |
$443.40
|
| Rate for Payer: Preferred Network Access Commercial |
$679.88
|
| Rate for Payer: Quartz Beloit One Network |
$362.11
|
| Rate for Payer: Quartz Commercial |
$443.40
|
| Rate for Payer: WEA Trust Commercial |
$406.45
|
| Rate for Payer: WPS Commercial |
$547.38
|
|
|
VL Carotid Duplex Right or Limited
|
Facility
OP
|
$739.00
|
|
|
Service Code
|
CPT 93882 TC,RT
|
| Hospital Charge Code |
5288655
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$206.92 |
| Max. Negotiated Rate |
$2,956.00 |
| Rate for Payer: Aetna Commercial |
$665.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$635.54
|
| Rate for Payer: Aetna Managed Medicare |
$206.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$480.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$369.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$354.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$391.67
|
| Rate for Payer: Cash Price |
$221.70
|
| Rate for Payer: Cigna Commercial |
$679.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$413.54
|
| Rate for Payer: Health EOS Commercial |
$657.71
|
| Rate for Payer: HFN Commercial |
$679.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$554.25
|
| Rate for Payer: Multiplan Commercial |
$591.20
|
| Rate for Payer: NAPHCARE Commercial |
$443.40
|
| Rate for Payer: Preferred Network Access Commercial |
$679.88
|
| Rate for Payer: Quartz Beloit One Network |
$362.11
|
| Rate for Payer: Quartz Commercial |
$480.35
|
| Rate for Payer: Quartz Medicare Advantage |
$443.40
|
| Rate for Payer: The Alliance Commercial |
$2,956.00
|
| Rate for Payer: United Healthcare PPO |
$554.25
|
| Rate for Payer: WEA Trust Commercial |
$406.45
|
| Rate for Payer: WPS Commercial |
$547.38
|
|
|
VL Duplex Arterial/Venous Visceral
|
Facility
IP
|
$1,539.00
|
|
|
Service Code
|
CPT 93975 TC
|
| Hospital Charge Code |
1482916
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$754.11 |
| Max. Negotiated Rate |
$1,415.88 |
| Rate for Payer: Aetna Commercial |
$1,385.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$815.67
|
| Rate for Payer: Cash Price |
$461.70
|
| Rate for Payer: Cigna Commercial |
$1,415.88
|
| Rate for Payer: Health EOS Commercial |
$1,369.71
|
| Rate for Payer: HFN Commercial |
$1,415.88
|
| Rate for Payer: Multiplan Commercial |
$1,231.20
|
| Rate for Payer: NAPHCARE Commercial |
$923.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,415.88
|
| Rate for Payer: Quartz Beloit One Network |
$754.11
|
| Rate for Payer: Quartz Commercial |
$923.40
|
| Rate for Payer: WEA Trust Commercial |
$846.45
|
| Rate for Payer: WPS Commercial |
$1,139.94
|
|
|
VL Duplex Arterial/Venous Visceral
|
Professional
|
$1,539.00
|
|
|
Service Code
|
CPT 93975 TC
|
| Hospital Charge Code |
1482916
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$203.24 |
| Max. Negotiated Rate |
$1,462.05 |
| Rate for Payer: Aetna Commercial |
$1,462.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,323.54
|
| Rate for Payer: Aetna Managed Medicare |
$203.24
|
| Rate for Payer: Anthem Medicare Advantage |
$203.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$203.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$203.24
|
| Rate for Payer: Cash Price |
$461.70
|
| Rate for Payer: Cash Price |
$461.70
|
| Rate for Payer: Cigna Commercial |
$1,462.05
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$769.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$203.24
|
| Rate for Payer: Health EOS Commercial |
$1,400.49
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$752.14
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$752.14
|
| Rate for Payer: Independent Care Health Plan Medicare |
$203.24
|
| Rate for Payer: Multiplan Commercial |
$1,231.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,462.05
|
| Rate for Payer: Quartz Beloit One Network |
$677.16
|
| Rate for Payer: Quartz Commercial |
$877.23
|
| Rate for Payer: Quartz Medicare Advantage |
$203.24
|
| Rate for Payer: The Alliance Commercial |
$508.10
|
| Rate for Payer: United Healthcare Medicare Advantage |
$203.24
|
| Rate for Payer: WEA Trust Commercial |
$846.45
|
| Rate for Payer: WPS Commercial |
$812.96
|
|
|
VL Duplex Arterial/Venous Visceral
|
Facility
OP
|
$1,539.00
|
|
|
Service Code
|
CPT 93975 TC
|
| Hospital Charge Code |
1482916
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$430.92 |
| Max. Negotiated Rate |
$6,156.00 |
| Rate for Payer: Aetna Commercial |
$1,385.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,323.54
|
| Rate for Payer: Aetna Managed Medicare |
$430.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,000.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$769.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$738.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$815.67
|
| Rate for Payer: Cash Price |
$461.70
|
| Rate for Payer: Cigna Commercial |
$1,415.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$861.22
|
| Rate for Payer: Health EOS Commercial |
$1,369.71
|
| Rate for Payer: HFN Commercial |
$1,415.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,154.25
|
| Rate for Payer: Multiplan Commercial |
$1,231.20
|
| Rate for Payer: NAPHCARE Commercial |
$923.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,415.88
|
| Rate for Payer: Quartz Beloit One Network |
$754.11
|
| Rate for Payer: Quartz Commercial |
$1,000.35
|
| Rate for Payer: Quartz Medicare Advantage |
$923.40
|
| Rate for Payer: The Alliance Commercial |
$6,156.00
|
| Rate for Payer: United Healthcare PPO |
$1,154.25
|
| Rate for Payer: WEA Trust Commercial |
$846.45
|
| Rate for Payer: WPS Commercial |
$1,139.94
|
|
|
VL Duplex Arterial/Venous Visceral Limit
|
Facility
OP
|
$626.00
|
|
|
Service Code
|
CPT 93976 TC
|
| Hospital Charge Code |
1482919
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$175.28 |
| Max. Negotiated Rate |
$2,504.00 |
| Rate for Payer: Aetna Commercial |
$563.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$538.36
|
| Rate for Payer: Aetna Managed Medicare |
$175.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$406.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$313.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$300.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$331.78
|
| Rate for Payer: Cash Price |
$187.80
|
| Rate for Payer: Cigna Commercial |
$575.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$350.31
|
| Rate for Payer: Health EOS Commercial |
$557.14
|
| Rate for Payer: HFN Commercial |
$575.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$469.50
|
| Rate for Payer: Multiplan Commercial |
$500.80
|
| Rate for Payer: NAPHCARE Commercial |
$375.60
|
| Rate for Payer: Preferred Network Access Commercial |
$575.92
|
| Rate for Payer: Quartz Beloit One Network |
$306.74
|
| Rate for Payer: Quartz Commercial |
$406.90
|
| Rate for Payer: Quartz Medicare Advantage |
$375.60
|
| Rate for Payer: The Alliance Commercial |
$2,504.00
|
| Rate for Payer: United Healthcare PPO |
$469.50
|
| Rate for Payer: WEA Trust Commercial |
$344.30
|
| Rate for Payer: WPS Commercial |
$463.68
|
|
|
VL Duplex Arterial/Venous Visceral Limit
|
Facility
IP
|
$626.00
|
|
|
Service Code
|
CPT 93976 TC
|
| Hospital Charge Code |
1482919
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$306.74 |
| Max. Negotiated Rate |
$575.92 |
| Rate for Payer: Aetna Commercial |
$563.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$331.78
|
| Rate for Payer: Cash Price |
$187.80
|
| Rate for Payer: Cigna Commercial |
$575.92
|
| Rate for Payer: Health EOS Commercial |
$557.14
|
| Rate for Payer: HFN Commercial |
$575.92
|
| Rate for Payer: Multiplan Commercial |
$500.80
|
| Rate for Payer: NAPHCARE Commercial |
$375.60
|
| Rate for Payer: Preferred Network Access Commercial |
$575.92
|
| Rate for Payer: Quartz Beloit One Network |
$306.74
|
| Rate for Payer: Quartz Commercial |
$375.60
|
| Rate for Payer: WEA Trust Commercial |
$344.30
|
| Rate for Payer: WPS Commercial |
$463.68
|
|
|
VL Duplex Arterial/Venous Visceral Limit
|
Professional
|
$626.00
|
|
|
Service Code
|
CPT 93976 TC
|
| Hospital Charge Code |
1482919
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$116.43 |
| Max. Negotiated Rate |
$594.70 |
| Rate for Payer: Aetna Commercial |
$594.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$538.36
|
| Rate for Payer: Aetna Managed Medicare |
$116.43
|
| Rate for Payer: Anthem Medicare Advantage |
$116.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$116.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$116.43
|
| Rate for Payer: Cash Price |
$187.80
|
| Rate for Payer: Cash Price |
$187.80
|
| Rate for Payer: Cigna Commercial |
$594.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$313.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$116.43
|
| Rate for Payer: Health EOS Commercial |
$569.66
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$426.57
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$426.57
|
| Rate for Payer: Independent Care Health Plan Medicare |
$116.43
|
| Rate for Payer: Multiplan Commercial |
$500.80
|
| Rate for Payer: Preferred Network Access Commercial |
$594.70
|
| Rate for Payer: Quartz Beloit One Network |
$275.44
|
| Rate for Payer: Quartz Commercial |
$356.82
|
| Rate for Payer: Quartz Medicare Advantage |
$116.43
|
| Rate for Payer: The Alliance Commercial |
$291.08
|
| Rate for Payer: United Healthcare Medicare Advantage |
$116.43
|
| Rate for Payer: WEA Trust Commercial |
$344.30
|
| Rate for Payer: WPS Commercial |
$465.72
|
|
|
VL Duplex Hemodialysis Access Flow
|
Facility
OP
|
$1,207.00
|
|
|
Service Code
|
CPT 93990 TC
|
| Hospital Charge Code |
1482922
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$337.96 |
| Max. Negotiated Rate |
$4,828.00 |
| Rate for Payer: Aetna Commercial |
$1,086.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,038.02
|
| Rate for Payer: Aetna Managed Medicare |
$337.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$784.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$603.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$579.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$639.71
|
| Rate for Payer: Cash Price |
$362.10
|
| Rate for Payer: Cigna Commercial |
$1,110.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$675.44
|
| Rate for Payer: Health EOS Commercial |
$1,074.23
|
| Rate for Payer: HFN Commercial |
$1,110.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$905.25
|
| Rate for Payer: Multiplan Commercial |
$965.60
|
| Rate for Payer: NAPHCARE Commercial |
$724.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,110.44
|
| Rate for Payer: Quartz Beloit One Network |
$591.43
|
| Rate for Payer: Quartz Commercial |
$784.55
|
| Rate for Payer: Quartz Medicare Advantage |
$724.20
|
| Rate for Payer: The Alliance Commercial |
$4,828.00
|
| Rate for Payer: United Healthcare PPO |
$905.25
|
| Rate for Payer: WEA Trust Commercial |
$663.85
|
| Rate for Payer: WPS Commercial |
$894.02
|
|
|
VL Duplex Hemodialysis Access Flow
|
Professional
|
$1,207.00
|
|
|
Service Code
|
CPT 93990 TC
|
| Hospital Charge Code |
1482922
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$118.68 |
| Max. Negotiated Rate |
$1,146.65 |
| Rate for Payer: Aetna Commercial |
$1,146.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,038.02
|
| Rate for Payer: Aetna Managed Medicare |
$118.68
|
| Rate for Payer: Anthem Medicare Advantage |
$118.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$118.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$118.68
|
| Rate for Payer: Cash Price |
$362.10
|
| Rate for Payer: Cash Price |
$362.10
|
| Rate for Payer: Cigna Commercial |
$1,146.65
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$603.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$118.68
|
| Rate for Payer: Health EOS Commercial |
$1,098.37
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$440.47
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$440.47
|
| Rate for Payer: Independent Care Health Plan Medicare |
$118.68
|
| Rate for Payer: Multiplan Commercial |
$965.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,146.65
|
| Rate for Payer: Quartz Beloit One Network |
$531.08
|
| Rate for Payer: Quartz Commercial |
$687.99
|
| Rate for Payer: Quartz Medicare Advantage |
$118.68
|
| Rate for Payer: The Alliance Commercial |
$296.70
|
| Rate for Payer: United Healthcare Medicare Advantage |
$118.68
|
| Rate for Payer: WEA Trust Commercial |
$663.85
|
| Rate for Payer: WPS Commercial |
$474.72
|
|
|
VL Duplex Hemodialysis Access Flow
|
Facility
IP
|
$1,207.00
|
|
|
Service Code
|
CPT 93990 TC
|
| Hospital Charge Code |
1482922
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$591.43 |
| Max. Negotiated Rate |
$1,110.44 |
| Rate for Payer: Aetna Commercial |
$1,086.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$639.71
|
| Rate for Payer: Cash Price |
$362.10
|
| Rate for Payer: Cigna Commercial |
$1,110.44
|
| Rate for Payer: Health EOS Commercial |
$1,074.23
|
| Rate for Payer: HFN Commercial |
$1,110.44
|
| Rate for Payer: Multiplan Commercial |
$965.60
|
| Rate for Payer: NAPHCARE Commercial |
$724.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,110.44
|
| Rate for Payer: Quartz Beloit One Network |
$591.43
|
| Rate for Payer: Quartz Commercial |
$724.20
|
| Rate for Payer: WEA Trust Commercial |
$663.85
|
| Rate for Payer: WPS Commercial |
$894.02
|
|
|
VL Echo 2D w M Mode w Doppler w/ Con
|
Facility
OP
|
$3,456.00
|
|
|
Service Code
|
CPT 93306 TC
|
| Hospital Charge Code |
4628608
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$967.68 |
| Max. Negotiated Rate |
$13,824.00 |
| Rate for Payer: Aetna Commercial |
$3,110.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,972.16
|
| Rate for Payer: Aetna Managed Medicare |
$967.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,246.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,728.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,658.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,831.68
|
| Rate for Payer: Cash Price |
$1,036.80
|
| Rate for Payer: Cash Price |
$1,036.80
|
| Rate for Payer: Cigna Commercial |
$3,179.52
|
| Rate for Payer: Health EOS Commercial |
$3,075.84
|
| Rate for Payer: HFN Commercial |
$3,179.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,592.00
|
| Rate for Payer: Multiplan Commercial |
$2,764.80
|
| Rate for Payer: NAPHCARE Commercial |
$2,073.60
|
| Rate for Payer: Preferred Network Access Commercial |
$3,179.52
|
| Rate for Payer: Quartz Beloit One Network |
$1,693.44
|
| Rate for Payer: Quartz Commercial |
$2,246.40
|
| Rate for Payer: Quartz Medicare Advantage |
$2,073.60
|
| Rate for Payer: The Alliance Commercial |
$13,824.00
|
| Rate for Payer: United Healthcare PPO |
$2,592.00
|
| Rate for Payer: WEA Trust Commercial |
$1,900.80
|
| Rate for Payer: WPS Commercial |
$2,559.86
|
|
|
VL Echo 2D w M Mode w Doppler w/ Con
|
Facility
IP
|
$3,456.00
|
|
|
Service Code
|
CPT 93306 TC
|
| Hospital Charge Code |
4628608
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$1,693.44 |
| Max. Negotiated Rate |
$3,179.52 |
| Rate for Payer: Aetna Commercial |
$3,110.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,831.68
|
| Rate for Payer: Cash Price |
$1,036.80
|
| Rate for Payer: Cigna Commercial |
$3,179.52
|
| Rate for Payer: Health EOS Commercial |
$3,075.84
|
| Rate for Payer: HFN Commercial |
$3,179.52
|
| Rate for Payer: Multiplan Commercial |
$2,764.80
|
| Rate for Payer: NAPHCARE Commercial |
$2,073.60
|
| Rate for Payer: Preferred Network Access Commercial |
$3,179.52
|
| Rate for Payer: Quartz Beloit One Network |
$1,693.44
|
| Rate for Payer: Quartz Commercial |
$2,073.60
|
| Rate for Payer: WEA Trust Commercial |
$1,900.80
|
| Rate for Payer: WPS Commercial |
$2,559.86
|
|
|
VL Echo 2D w M Mode w Doppler w/ Con
|
Professional
|
$3,456.00
|
|
|
Service Code
|
CPT 93306 TC
|
| Hospital Charge Code |
4628608
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$123.08 |
| Max. Negotiated Rate |
$3,283.20 |
| Rate for Payer: Aetna Commercial |
$3,283.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,972.16
|
| Rate for Payer: Aetna Managed Medicare |
$123.08
|
| Rate for Payer: Anthem Medicare Advantage |
$123.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$123.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$123.08
|
| Rate for Payer: Cash Price |
$1,036.80
|
| Rate for Payer: Cash Price |
$1,036.80
|
| Rate for Payer: Cigna Commercial |
$3,283.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,728.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$123.08
|
| Rate for Payer: Health EOS Commercial |
$3,144.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$454.42
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$454.42
|
| Rate for Payer: Independent Care Health Plan Medicare |
$123.08
|
| Rate for Payer: Multiplan Commercial |
$2,764.80
|
| Rate for Payer: Preferred Network Access Commercial |
$3,283.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,520.64
|
| Rate for Payer: Quartz Commercial |
$1,969.92
|
| Rate for Payer: Quartz Medicare Advantage |
$123.08
|
| Rate for Payer: The Alliance Commercial |
$467.70
|
| Rate for Payer: United Healthcare Medicare Advantage |
$123.08
|
| Rate for Payer: WEA Trust Commercial |
$1,900.80
|
| Rate for Payer: WPS Commercial |
$492.32
|
|
|
VL Echo Color Flow Velocity Mapping
|
Facility
IP
|
$842.00
|
|
|
Service Code
|
CPT 93325 TC
|
| Hospital Charge Code |
1482976
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$412.58 |
| Max. Negotiated Rate |
$774.64 |
| Rate for Payer: Aetna Commercial |
$757.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$446.26
|
| Rate for Payer: Cash Price |
$252.60
|
| Rate for Payer: Cigna Commercial |
$774.64
|
| Rate for Payer: Health EOS Commercial |
$749.38
|
| Rate for Payer: HFN Commercial |
$774.64
|
| Rate for Payer: Multiplan Commercial |
$673.60
|
| Rate for Payer: NAPHCARE Commercial |
$505.20
|
| Rate for Payer: Preferred Network Access Commercial |
$774.64
|
| Rate for Payer: Quartz Beloit One Network |
$412.58
|
| Rate for Payer: Quartz Commercial |
$505.20
|
| Rate for Payer: WEA Trust Commercial |
$463.10
|
| Rate for Payer: WPS Commercial |
$623.67
|
|
|
VL Echo Color Flow Velocity Mapping
|
Professional
|
$842.00
|
|
|
Service Code
|
CPT 93325 TC
|
| Hospital Charge Code |
1482976
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$19.64 |
| Max. Negotiated Rate |
$799.90 |
| Rate for Payer: Aetna Commercial |
$799.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$724.12
|
| Rate for Payer: Aetna Managed Medicare |
$19.64
|
| Rate for Payer: Anthem Medicare Advantage |
$19.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$19.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$19.64
|
| Rate for Payer: Cash Price |
$252.60
|
| Rate for Payer: Cash Price |
$252.60
|
| Rate for Payer: Cigna Commercial |
$799.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$421.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$19.64
|
| Rate for Payer: Health EOS Commercial |
$766.22
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$74.27
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$74.27
|
| Rate for Payer: Independent Care Health Plan Medicare |
$19.64
|
| Rate for Payer: Multiplan Commercial |
$673.60
|
| Rate for Payer: Preferred Network Access Commercial |
$799.90
|
| Rate for Payer: Quartz Beloit One Network |
$370.48
|
| Rate for Payer: Quartz Commercial |
$479.94
|
| Rate for Payer: Quartz Medicare Advantage |
$19.64
|
| Rate for Payer: The Alliance Commercial |
$74.63
|
| Rate for Payer: United Healthcare Medicare Advantage |
$19.64
|
| Rate for Payer: WEA Trust Commercial |
$463.10
|
| Rate for Payer: WPS Commercial |
$78.56
|
|
|
VL Echo Color Flow Velocity Mapping
|
Facility
OP
|
$842.00
|
|
|
Service Code
|
CPT 93325 TC
|
| Hospital Charge Code |
1482976
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$235.76 |
| Max. Negotiated Rate |
$3,368.00 |
| Rate for Payer: Aetna Commercial |
$757.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$724.12
|
| Rate for Payer: Aetna Managed Medicare |
$235.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$547.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$421.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$404.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$446.26
|
| Rate for Payer: Cash Price |
$252.60
|
| Rate for Payer: Cash Price |
$252.60
|
| Rate for Payer: Cigna Commercial |
$774.64
|
| Rate for Payer: Health EOS Commercial |
$749.38
|
| Rate for Payer: HFN Commercial |
$774.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$631.50
|
| Rate for Payer: Multiplan Commercial |
$673.60
|
| Rate for Payer: NAPHCARE Commercial |
$505.20
|
| Rate for Payer: Preferred Network Access Commercial |
$774.64
|
| Rate for Payer: Quartz Beloit One Network |
$412.58
|
| Rate for Payer: Quartz Commercial |
$547.30
|
| Rate for Payer: Quartz Medicare Advantage |
$505.20
|
| Rate for Payer: The Alliance Commercial |
$3,368.00
|
| Rate for Payer: United Healthcare PPO |
$631.50
|
| Rate for Payer: WEA Trust Commercial |
$463.10
|
| Rate for Payer: WPS Commercial |
$623.67
|
|
|
VL Echo Congenital Complete
|
Professional
|
$2,786.00
|
|
|
Service Code
|
CPT 93303 TC
|
| Hospital Charge Code |
1482802
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$153.34 |
| Max. Negotiated Rate |
$2,646.70 |
| Rate for Payer: Aetna Commercial |
$2,646.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,395.96
|
| Rate for Payer: Aetna Managed Medicare |
$153.34
|
| Rate for Payer: Anthem Medicare Advantage |
$153.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$153.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$153.34
|
| Rate for Payer: Cash Price |
$835.80
|
| Rate for Payer: Cash Price |
$835.80
|
| Rate for Payer: Cigna Commercial |
$2,646.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,393.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$153.34
|
| Rate for Payer: Health EOS Commercial |
$2,535.26
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$580.90
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$580.90
|
| Rate for Payer: Independent Care Health Plan Medicare |
$153.34
|
| Rate for Payer: Multiplan Commercial |
$2,228.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,646.70
|
| Rate for Payer: Quartz Beloit One Network |
$1,225.84
|
| Rate for Payer: Quartz Commercial |
$1,588.02
|
| Rate for Payer: Quartz Medicare Advantage |
$153.34
|
| Rate for Payer: The Alliance Commercial |
$582.69
|
| Rate for Payer: United Healthcare Medicare Advantage |
$153.34
|
| Rate for Payer: WEA Trust Commercial |
$1,532.30
|
| Rate for Payer: WPS Commercial |
$613.36
|
|
|
VL Echo Congenital Complete
|
Facility
OP
|
$2,786.00
|
|
|
Service Code
|
CPT 93303 TC
|
| Hospital Charge Code |
1482802
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$780.08 |
| Max. Negotiated Rate |
$11,144.00 |
| Rate for Payer: Aetna Commercial |
$2,507.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,395.96
|
| Rate for Payer: Aetna Managed Medicare |
$780.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,810.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,393.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,337.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,476.58
|
| Rate for Payer: Cash Price |
$835.80
|
| Rate for Payer: Cash Price |
$835.80
|
| Rate for Payer: Cigna Commercial |
$2,563.12
|
| Rate for Payer: Health EOS Commercial |
$2,479.54
|
| Rate for Payer: HFN Commercial |
$2,563.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,089.50
|
| Rate for Payer: Multiplan Commercial |
$2,228.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,671.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,563.12
|
| Rate for Payer: Quartz Beloit One Network |
$1,365.14
|
| Rate for Payer: Quartz Commercial |
$1,810.90
|
| Rate for Payer: Quartz Medicare Advantage |
$1,671.60
|
| Rate for Payer: The Alliance Commercial |
$11,144.00
|
| Rate for Payer: United Healthcare PPO |
$2,089.50
|
| Rate for Payer: WEA Trust Commercial |
$1,532.30
|
| Rate for Payer: WPS Commercial |
$2,063.59
|
|
|
VL Echo Congenital Complete
|
Facility
IP
|
$2,786.00
|
|
|
Service Code
|
CPT 93303 TC
|
| Hospital Charge Code |
1482802
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$1,365.14 |
| Max. Negotiated Rate |
$2,563.12 |
| Rate for Payer: Aetna Commercial |
$2,507.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,476.58
|
| Rate for Payer: Cash Price |
$835.80
|
| Rate for Payer: Cigna Commercial |
$2,563.12
|
| Rate for Payer: Health EOS Commercial |
$2,479.54
|
| Rate for Payer: HFN Commercial |
$2,563.12
|
| Rate for Payer: Multiplan Commercial |
$2,228.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,671.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,563.12
|
| Rate for Payer: Quartz Beloit One Network |
$1,365.14
|
| Rate for Payer: Quartz Commercial |
$1,671.60
|
| Rate for Payer: WEA Trust Commercial |
$1,532.30
|
| Rate for Payer: WPS Commercial |
$2,063.59
|
|
