|
VL Echo Congenital Limited
|
Facility
OP
|
$1,819.00
|
|
|
Service Code
|
CPT 93304 TC
|
| Hospital Charge Code |
1482979
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$509.32 |
| Max. Negotiated Rate |
$7,276.00 |
| Rate for Payer: Aetna Commercial |
$1,637.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,564.34
|
| Rate for Payer: Aetna Managed Medicare |
$509.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,182.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$909.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$873.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$964.07
|
| Rate for Payer: Cash Price |
$545.70
|
| Rate for Payer: Cash Price |
$545.70
|
| Rate for Payer: Cigna Commercial |
$1,673.48
|
| Rate for Payer: Health EOS Commercial |
$1,618.91
|
| Rate for Payer: HFN Commercial |
$1,673.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,364.25
|
| Rate for Payer: Multiplan Commercial |
$1,455.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,091.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,673.48
|
| Rate for Payer: Quartz Beloit One Network |
$891.31
|
| Rate for Payer: Quartz Commercial |
$1,182.35
|
| Rate for Payer: Quartz Medicare Advantage |
$1,091.40
|
| Rate for Payer: The Alliance Commercial |
$7,276.00
|
| Rate for Payer: United Healthcare PPO |
$1,364.25
|
| Rate for Payer: WEA Trust Commercial |
$1,000.45
|
| Rate for Payer: WPS Commercial |
$1,347.33
|
|
|
VL Echo Congenital Limited
|
Professional
|
$1,819.00
|
|
|
Service Code
|
CPT 93304 TC
|
| Hospital Charge Code |
1482979
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$115.14 |
| Max. Negotiated Rate |
$1,728.05 |
| Rate for Payer: Aetna Commercial |
$1,728.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,564.34
|
| Rate for Payer: Aetna Managed Medicare |
$115.14
|
| Rate for Payer: Anthem Medicare Advantage |
$115.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$115.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$115.14
|
| Rate for Payer: Cash Price |
$545.70
|
| Rate for Payer: Cash Price |
$545.70
|
| Rate for Payer: Cigna Commercial |
$1,728.05
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$909.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$115.14
|
| Rate for Payer: Health EOS Commercial |
$1,655.29
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$430.02
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$430.02
|
| Rate for Payer: Independent Care Health Plan Medicare |
$115.14
|
| Rate for Payer: Multiplan Commercial |
$1,455.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,728.05
|
| Rate for Payer: Quartz Beloit One Network |
$800.36
|
| Rate for Payer: Quartz Commercial |
$1,036.83
|
| Rate for Payer: Quartz Medicare Advantage |
$115.14
|
| Rate for Payer: The Alliance Commercial |
$437.53
|
| Rate for Payer: United Healthcare Medicare Advantage |
$115.14
|
| Rate for Payer: WEA Trust Commercial |
$1,000.45
|
| Rate for Payer: WPS Commercial |
$460.56
|
|
|
VL Echo Congenital Limited
|
Facility
IP
|
$1,819.00
|
|
|
Service Code
|
CPT 93304 TC
|
| Hospital Charge Code |
1482979
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$891.31 |
| Max. Negotiated Rate |
$1,673.48 |
| Rate for Payer: Aetna Commercial |
$1,637.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$964.07
|
| Rate for Payer: Cash Price |
$545.70
|
| Rate for Payer: Cigna Commercial |
$1,673.48
|
| Rate for Payer: Health EOS Commercial |
$1,618.91
|
| Rate for Payer: HFN Commercial |
$1,673.48
|
| Rate for Payer: Multiplan Commercial |
$1,455.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,091.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,673.48
|
| Rate for Payer: Quartz Beloit One Network |
$891.31
|
| Rate for Payer: Quartz Commercial |
$1,091.40
|
| Rate for Payer: WEA Trust Commercial |
$1,000.45
|
| Rate for Payer: WPS Commercial |
$1,347.33
|
|
|
VL Echo Doppler
|
Facility
IP
|
$905.00
|
|
|
Service Code
|
CPT 93320 TC
|
| Hospital Charge Code |
1482982
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$443.45 |
| Max. Negotiated Rate |
$832.60 |
| Rate for Payer: Aetna Commercial |
$814.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$479.65
|
| Rate for Payer: Cash Price |
$271.50
|
| Rate for Payer: Cigna Commercial |
$832.60
|
| Rate for Payer: Health EOS Commercial |
$805.45
|
| Rate for Payer: HFN Commercial |
$832.60
|
| Rate for Payer: Multiplan Commercial |
$724.00
|
| Rate for Payer: NAPHCARE Commercial |
$543.00
|
| Rate for Payer: Preferred Network Access Commercial |
$832.60
|
| Rate for Payer: Quartz Beloit One Network |
$443.45
|
| Rate for Payer: Quartz Commercial |
$543.00
|
| Rate for Payer: WEA Trust Commercial |
$497.75
|
| Rate for Payer: WPS Commercial |
$670.33
|
|
|
VL Echo Doppler
|
Facility
OP
|
$905.00
|
|
|
Service Code
|
CPT 93320 TC
|
| Hospital Charge Code |
1482982
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$253.40 |
| Max. Negotiated Rate |
$3,620.00 |
| Rate for Payer: Aetna Commercial |
$814.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$778.30
|
| Rate for Payer: Aetna Managed Medicare |
$253.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$588.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$452.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$434.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$479.65
|
| Rate for Payer: Cash Price |
$271.50
|
| Rate for Payer: Cash Price |
$271.50
|
| Rate for Payer: Cigna Commercial |
$832.60
|
| Rate for Payer: Health EOS Commercial |
$805.45
|
| Rate for Payer: HFN Commercial |
$832.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$678.75
|
| Rate for Payer: Multiplan Commercial |
$724.00
|
| Rate for Payer: NAPHCARE Commercial |
$543.00
|
| Rate for Payer: Preferred Network Access Commercial |
$832.60
|
| Rate for Payer: Quartz Beloit One Network |
$443.45
|
| Rate for Payer: Quartz Commercial |
$588.25
|
| Rate for Payer: Quartz Medicare Advantage |
$543.00
|
| Rate for Payer: The Alliance Commercial |
$3,620.00
|
| Rate for Payer: United Healthcare PPO |
$678.75
|
| Rate for Payer: WEA Trust Commercial |
$497.75
|
| Rate for Payer: WPS Commercial |
$670.33
|
|
|
VL Echo Doppler
|
Professional
|
$905.00
|
|
|
Service Code
|
CPT 93320 TC
|
| Hospital Charge Code |
1482982
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$31.66 |
| Max. Negotiated Rate |
$859.75 |
| Rate for Payer: Aetna Commercial |
$859.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$778.30
|
| Rate for Payer: Aetna Managed Medicare |
$31.66
|
| Rate for Payer: Anthem Medicare Advantage |
$31.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$31.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$31.66
|
| Rate for Payer: Cash Price |
$271.50
|
| Rate for Payer: Cash Price |
$271.50
|
| Rate for Payer: Cigna Commercial |
$859.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$452.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$31.66
|
| Rate for Payer: Health EOS Commercial |
$823.55
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$119.84
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$119.84
|
| Rate for Payer: Independent Care Health Plan Medicare |
$31.66
|
| Rate for Payer: Multiplan Commercial |
$724.00
|
| Rate for Payer: Preferred Network Access Commercial |
$859.75
|
| Rate for Payer: Quartz Beloit One Network |
$398.20
|
| Rate for Payer: Quartz Commercial |
$515.85
|
| Rate for Payer: Quartz Medicare Advantage |
$31.66
|
| Rate for Payer: The Alliance Commercial |
$120.31
|
| Rate for Payer: United Healthcare Medicare Advantage |
$31.66
|
| Rate for Payer: WEA Trust Commercial |
$497.75
|
| Rate for Payer: WPS Commercial |
$126.64
|
|
|
VL Echo During Therap/Diag Intervention
|
Professional
|
$1,753.00
|
|
|
Service Code
|
CPT 93662 TC
|
| Hospital Charge Code |
2944148
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$771.32 |
| Max. Negotiated Rate |
$1,665.35 |
| Rate for Payer: Aetna Commercial |
$1,665.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,507.58
|
| Rate for Payer: Cash Price |
$525.90
|
| Rate for Payer: Cash Price |
$525.90
|
| Rate for Payer: Cigna Commercial |
$1,665.35
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$876.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,051.80
|
| Rate for Payer: Health EOS Commercial |
$1,595.23
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$810.95
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$810.95
|
| Rate for Payer: Multiplan Commercial |
$1,402.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,665.35
|
| Rate for Payer: Quartz Beloit One Network |
$771.32
|
| Rate for Payer: Quartz Commercial |
$999.21
|
| Rate for Payer: The Alliance Commercial |
$876.50
|
| Rate for Payer: WEA Trust Commercial |
$964.15
|
| Rate for Payer: WPS Commercial |
$1,298.45
|
|
|
VL Echo During Therap/Diag Intervention
|
Facility
IP
|
$1,753.00
|
|
|
Service Code
|
CPT 93662 TC
|
| Hospital Charge Code |
2944148
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$858.97 |
| Max. Negotiated Rate |
$1,612.76 |
| Rate for Payer: Aetna Commercial |
$1,577.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$929.09
|
| Rate for Payer: Cash Price |
$525.90
|
| Rate for Payer: Cigna Commercial |
$1,612.76
|
| Rate for Payer: Health EOS Commercial |
$1,560.17
|
| Rate for Payer: HFN Commercial |
$1,612.76
|
| Rate for Payer: Multiplan Commercial |
$1,402.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,051.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,612.76
|
| Rate for Payer: Quartz Beloit One Network |
$858.97
|
| Rate for Payer: Quartz Commercial |
$1,051.80
|
| Rate for Payer: WEA Trust Commercial |
$964.15
|
| Rate for Payer: WPS Commercial |
$1,298.45
|
|
|
VL Echo During Therap/Diag Intervention
|
Facility
OP
|
$1,753.00
|
|
|
Service Code
|
CPT 93662 TC
|
| Hospital Charge Code |
2944148
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$490.84 |
| Max. Negotiated Rate |
$7,012.00 |
| Rate for Payer: Aetna Commercial |
$1,577.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,507.58
|
| Rate for Payer: Aetna Managed Medicare |
$490.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,139.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$876.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$841.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$929.09
|
| Rate for Payer: Cash Price |
$525.90
|
| Rate for Payer: Cash Price |
$525.90
|
| Rate for Payer: Cigna Commercial |
$1,612.76
|
| Rate for Payer: Health EOS Commercial |
$1,560.17
|
| Rate for Payer: HFN Commercial |
$1,612.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,314.75
|
| Rate for Payer: Multiplan Commercial |
$1,402.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,051.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,612.76
|
| Rate for Payer: Quartz Beloit One Network |
$858.97
|
| Rate for Payer: Quartz Commercial |
$1,139.45
|
| Rate for Payer: Quartz Medicare Advantage |
$1,051.80
|
| Rate for Payer: The Alliance Commercial |
$7,012.00
|
| Rate for Payer: United Healthcare PPO |
$1,314.75
|
| Rate for Payer: WEA Trust Commercial |
$964.15
|
| Rate for Payer: WPS Commercial |
$1,298.45
|
|
|
VL Echo Limited
|
Facility
OP
|
$1,524.00
|
|
|
Service Code
|
CPT 93308 TC
|
| Hospital Charge Code |
1482988
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$426.72 |
| Max. Negotiated Rate |
$6,096.00 |
| Rate for Payer: Aetna Commercial |
$1,371.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,310.64
|
| Rate for Payer: Aetna Managed Medicare |
$426.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$990.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$762.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$731.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$807.72
|
| Rate for Payer: Cash Price |
$457.20
|
| Rate for Payer: Cash Price |
$457.20
|
| Rate for Payer: Cigna Commercial |
$1,402.08
|
| Rate for Payer: Health EOS Commercial |
$1,356.36
|
| Rate for Payer: HFN Commercial |
$1,402.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,143.00
|
| Rate for Payer: Multiplan Commercial |
$1,219.20
|
| Rate for Payer: NAPHCARE Commercial |
$914.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,402.08
|
| Rate for Payer: Quartz Beloit One Network |
$746.76
|
| Rate for Payer: Quartz Commercial |
$990.60
|
| Rate for Payer: Quartz Medicare Advantage |
$914.40
|
| Rate for Payer: The Alliance Commercial |
$6,096.00
|
| Rate for Payer: United Healthcare PPO |
$1,143.00
|
| Rate for Payer: WEA Trust Commercial |
$838.20
|
| Rate for Payer: WPS Commercial |
$1,128.83
|
|
|
VL Echo Limited
|
Professional
|
$1,524.00
|
|
|
Service Code
|
CPT 93308 TC
|
| Hospital Charge Code |
1482988
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$70.72 |
| Max. Negotiated Rate |
$1,447.80 |
| Rate for Payer: Aetna Commercial |
$1,447.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,310.64
|
| Rate for Payer: Aetna Managed Medicare |
$70.72
|
| Rate for Payer: Anthem Medicare Advantage |
$70.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$70.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$70.72
|
| Rate for Payer: Cash Price |
$457.20
|
| Rate for Payer: Cash Price |
$457.20
|
| Rate for Payer: Cigna Commercial |
$1,447.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$762.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$70.72
|
| Rate for Payer: Health EOS Commercial |
$1,386.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$256.77
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$256.77
|
| Rate for Payer: Independent Care Health Plan Medicare |
$70.72
|
| Rate for Payer: Multiplan Commercial |
$1,219.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,447.80
|
| Rate for Payer: Quartz Beloit One Network |
$670.56
|
| Rate for Payer: Quartz Commercial |
$868.68
|
| Rate for Payer: Quartz Medicare Advantage |
$70.72
|
| Rate for Payer: The Alliance Commercial |
$268.74
|
| Rate for Payer: United Healthcare Medicare Advantage |
$70.72
|
| Rate for Payer: WEA Trust Commercial |
$838.20
|
| Rate for Payer: WPS Commercial |
$282.88
|
|
|
VL Echo Limited
|
Facility
IP
|
$1,524.00
|
|
|
Service Code
|
CPT 93308 TC
|
| Hospital Charge Code |
1482988
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$746.76 |
| Max. Negotiated Rate |
$1,402.08 |
| Rate for Payer: Aetna Commercial |
$1,371.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$807.72
|
| Rate for Payer: Cash Price |
$457.20
|
| Rate for Payer: Cigna Commercial |
$1,402.08
|
| Rate for Payer: Health EOS Commercial |
$1,356.36
|
| Rate for Payer: HFN Commercial |
$1,402.08
|
| Rate for Payer: Multiplan Commercial |
$1,219.20
|
| Rate for Payer: NAPHCARE Commercial |
$914.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,402.08
|
| Rate for Payer: Quartz Beloit One Network |
$746.76
|
| Rate for Payer: Quartz Commercial |
$914.40
|
| Rate for Payer: WEA Trust Commercial |
$838.20
|
| Rate for Payer: WPS Commercial |
$1,128.83
|
|
|
VL Echo Limited w/ Contrast
|
Professional
|
$1,524.00
|
|
|
Service Code
|
CPT 93308 TC
|
| Hospital Charge Code |
4628611
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$70.72 |
| Max. Negotiated Rate |
$1,447.80 |
| Rate for Payer: Aetna Commercial |
$1,447.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,310.64
|
| Rate for Payer: Aetna Managed Medicare |
$70.72
|
| Rate for Payer: Anthem Medicare Advantage |
$70.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$70.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$70.72
|
| Rate for Payer: Cash Price |
$457.20
|
| Rate for Payer: Cash Price |
$457.20
|
| Rate for Payer: Cigna Commercial |
$1,447.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$762.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$70.72
|
| Rate for Payer: Health EOS Commercial |
$1,386.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$256.77
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$256.77
|
| Rate for Payer: Independent Care Health Plan Medicare |
$70.72
|
| Rate for Payer: Multiplan Commercial |
$1,219.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,447.80
|
| Rate for Payer: Quartz Beloit One Network |
$670.56
|
| Rate for Payer: Quartz Commercial |
$868.68
|
| Rate for Payer: Quartz Medicare Advantage |
$70.72
|
| Rate for Payer: The Alliance Commercial |
$268.74
|
| Rate for Payer: United Healthcare Medicare Advantage |
$70.72
|
| Rate for Payer: WEA Trust Commercial |
$838.20
|
| Rate for Payer: WPS Commercial |
$282.88
|
|
|
VL Echo Limited w/ Contrast
|
Facility
IP
|
$1,524.00
|
|
|
Service Code
|
CPT 93308 TC
|
| Hospital Charge Code |
4628611
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$746.76 |
| Max. Negotiated Rate |
$1,402.08 |
| Rate for Payer: Multiplan Commercial |
$1,219.20
|
| Rate for Payer: Aetna Commercial |
$1,371.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$807.72
|
| Rate for Payer: Cash Price |
$457.20
|
| Rate for Payer: Cigna Commercial |
$1,402.08
|
| Rate for Payer: Health EOS Commercial |
$1,356.36
|
| Rate for Payer: HFN Commercial |
$1,402.08
|
| Rate for Payer: NAPHCARE Commercial |
$914.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,402.08
|
| Rate for Payer: Quartz Beloit One Network |
$746.76
|
| Rate for Payer: Quartz Commercial |
$914.40
|
| Rate for Payer: WEA Trust Commercial |
$838.20
|
| Rate for Payer: WPS Commercial |
$1,128.83
|
|
|
VL Echo Limited w/ Contrast
|
Facility
OP
|
$1,524.00
|
|
|
Service Code
|
CPT 93308 TC
|
| Hospital Charge Code |
4628611
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$426.72 |
| Max. Negotiated Rate |
$6,096.00 |
| Rate for Payer: Aetna Commercial |
$1,371.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,310.64
|
| Rate for Payer: Aetna Managed Medicare |
$426.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$990.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$762.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$731.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$807.72
|
| Rate for Payer: Cash Price |
$457.20
|
| Rate for Payer: Cash Price |
$457.20
|
| Rate for Payer: Cigna Commercial |
$1,402.08
|
| Rate for Payer: Health EOS Commercial |
$1,356.36
|
| Rate for Payer: HFN Commercial |
$1,402.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,143.00
|
| Rate for Payer: Multiplan Commercial |
$1,219.20
|
| Rate for Payer: NAPHCARE Commercial |
$914.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,402.08
|
| Rate for Payer: Quartz Beloit One Network |
$746.76
|
| Rate for Payer: Quartz Commercial |
$990.60
|
| Rate for Payer: Quartz Medicare Advantage |
$914.40
|
| Rate for Payer: The Alliance Commercial |
$6,096.00
|
| Rate for Payer: United Healthcare PPO |
$1,143.00
|
| Rate for Payer: WEA Trust Commercial |
$838.20
|
| Rate for Payer: WPS Commercial |
$1,128.83
|
|
|
VL Echo Stress Test
|
Facility
IP
|
$4,308.00
|
|
|
Service Code
|
CPT 93350 TC
|
| Hospital Charge Code |
1482805
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$2,110.92 |
| Max. Negotiated Rate |
$3,963.36 |
| Rate for Payer: Aetna Commercial |
$3,877.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,283.24
|
| Rate for Payer: Cash Price |
$1,292.40
|
| Rate for Payer: Cigna Commercial |
$3,963.36
|
| Rate for Payer: Health EOS Commercial |
$3,834.12
|
| Rate for Payer: HFN Commercial |
$3,963.36
|
| Rate for Payer: Multiplan Commercial |
$3,446.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,584.80
|
| Rate for Payer: Preferred Network Access Commercial |
$3,963.36
|
| Rate for Payer: Quartz Beloit One Network |
$2,110.92
|
| Rate for Payer: Quartz Commercial |
$2,584.80
|
| Rate for Payer: WEA Trust Commercial |
$2,369.40
|
| Rate for Payer: WPS Commercial |
$3,190.94
|
|
|
VL Echo Stress Test
|
Professional
|
$4,308.00
|
|
|
Service Code
|
CPT 93350 TC
|
| Hospital Charge Code |
1482805
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$113.21 |
| Max. Negotiated Rate |
$4,092.60 |
| Rate for Payer: Aetna Commercial |
$4,092.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,704.88
|
| Rate for Payer: Aetna Managed Medicare |
$113.21
|
| Rate for Payer: Anthem Medicare Advantage |
$113.21
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$113.21
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$113.21
|
| Rate for Payer: Cash Price |
$1,292.40
|
| Rate for Payer: Cash Price |
$1,292.40
|
| Rate for Payer: Cigna Commercial |
$4,092.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,154.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$113.21
|
| Rate for Payer: Health EOS Commercial |
$3,920.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$417.28
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$417.28
|
| Rate for Payer: Independent Care Health Plan Medicare |
$113.21
|
| Rate for Payer: Multiplan Commercial |
$3,446.40
|
| Rate for Payer: Preferred Network Access Commercial |
$4,092.60
|
| Rate for Payer: Quartz Beloit One Network |
$1,895.52
|
| Rate for Payer: Quartz Commercial |
$2,455.56
|
| Rate for Payer: Quartz Medicare Advantage |
$113.21
|
| Rate for Payer: The Alliance Commercial |
$430.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$113.21
|
| Rate for Payer: WEA Trust Commercial |
$2,369.40
|
| Rate for Payer: WPS Commercial |
$452.84
|
|
|
VL Echo Stress Test
|
Facility
OP
|
$4,308.00
|
|
|
Service Code
|
CPT 93350 TC
|
| Hospital Charge Code |
1482805
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$1,206.24 |
| Max. Negotiated Rate |
$17,232.00 |
| Rate for Payer: Aetna Commercial |
$3,877.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,704.88
|
| Rate for Payer: Aetna Managed Medicare |
$1,206.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,800.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,154.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,067.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,283.24
|
| Rate for Payer: Cash Price |
$1,292.40
|
| Rate for Payer: Cash Price |
$1,292.40
|
| Rate for Payer: Cigna Commercial |
$3,963.36
|
| Rate for Payer: Health EOS Commercial |
$3,834.12
|
| Rate for Payer: HFN Commercial |
$3,963.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,231.00
|
| Rate for Payer: Multiplan Commercial |
$3,446.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,584.80
|
| Rate for Payer: Preferred Network Access Commercial |
$3,963.36
|
| Rate for Payer: Quartz Beloit One Network |
$2,110.92
|
| Rate for Payer: Quartz Commercial |
$2,800.20
|
| Rate for Payer: Quartz Medicare Advantage |
$2,584.80
|
| Rate for Payer: The Alliance Commercial |
$17,232.00
|
| Rate for Payer: United Healthcare PPO |
$3,231.00
|
| Rate for Payer: WEA Trust Commercial |
$2,369.40
|
| Rate for Payer: WPS Commercial |
$3,190.94
|
|
|
VL Echo Stress Test Chemical
|
Facility
OP
|
$4,308.00
|
|
|
Service Code
|
CPT 93350 TC
|
| Hospital Charge Code |
2558804
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$1,206.24 |
| Max. Negotiated Rate |
$17,232.00 |
| Rate for Payer: Aetna Commercial |
$3,877.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,704.88
|
| Rate for Payer: Aetna Managed Medicare |
$1,206.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,800.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,154.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,067.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,283.24
|
| Rate for Payer: Cash Price |
$1,292.40
|
| Rate for Payer: Cash Price |
$1,292.40
|
| Rate for Payer: Cigna Commercial |
$3,963.36
|
| Rate for Payer: Health EOS Commercial |
$3,834.12
|
| Rate for Payer: HFN Commercial |
$3,963.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,231.00
|
| Rate for Payer: Multiplan Commercial |
$3,446.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,584.80
|
| Rate for Payer: Preferred Network Access Commercial |
$3,963.36
|
| Rate for Payer: Quartz Beloit One Network |
$2,110.92
|
| Rate for Payer: Quartz Commercial |
$2,800.20
|
| Rate for Payer: Quartz Medicare Advantage |
$2,584.80
|
| Rate for Payer: The Alliance Commercial |
$17,232.00
|
| Rate for Payer: United Healthcare PPO |
$3,231.00
|
| Rate for Payer: WEA Trust Commercial |
$2,369.40
|
| Rate for Payer: WPS Commercial |
$3,190.94
|
|
|
VL Echo Stress Test Chemical
|
Professional
|
$4,308.00
|
|
|
Service Code
|
CPT 93350 TC
|
| Hospital Charge Code |
2558804
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$113.21 |
| Max. Negotiated Rate |
$4,092.60 |
| Rate for Payer: Aetna Commercial |
$4,092.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,704.88
|
| Rate for Payer: Aetna Managed Medicare |
$113.21
|
| Rate for Payer: Anthem Medicare Advantage |
$113.21
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$113.21
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$113.21
|
| Rate for Payer: Cash Price |
$1,292.40
|
| Rate for Payer: Cash Price |
$1,292.40
|
| Rate for Payer: Cigna Commercial |
$4,092.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,154.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$113.21
|
| Rate for Payer: Health EOS Commercial |
$3,920.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$417.28
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$417.28
|
| Rate for Payer: Independent Care Health Plan Medicare |
$113.21
|
| Rate for Payer: Multiplan Commercial |
$3,446.40
|
| Rate for Payer: Preferred Network Access Commercial |
$4,092.60
|
| Rate for Payer: Quartz Beloit One Network |
$1,895.52
|
| Rate for Payer: Quartz Commercial |
$2,455.56
|
| Rate for Payer: Quartz Medicare Advantage |
$113.21
|
| Rate for Payer: The Alliance Commercial |
$430.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$113.21
|
| Rate for Payer: WEA Trust Commercial |
$2,369.40
|
| Rate for Payer: WPS Commercial |
$452.84
|
|
|
VL Echo Stress Test Chemical
|
Facility
IP
|
$4,308.00
|
|
|
Service Code
|
CPT 93350 TC
|
| Hospital Charge Code |
2558804
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$2,110.92 |
| Max. Negotiated Rate |
$3,963.36 |
| Rate for Payer: Aetna Commercial |
$3,877.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,283.24
|
| Rate for Payer: Cash Price |
$1,292.40
|
| Rate for Payer: Cigna Commercial |
$3,963.36
|
| Rate for Payer: Health EOS Commercial |
$3,834.12
|
| Rate for Payer: HFN Commercial |
$3,963.36
|
| Rate for Payer: Multiplan Commercial |
$3,446.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,584.80
|
| Rate for Payer: Preferred Network Access Commercial |
$3,963.36
|
| Rate for Payer: Quartz Beloit One Network |
$2,110.92
|
| Rate for Payer: Quartz Commercial |
$2,584.80
|
| Rate for Payer: WEA Trust Commercial |
$2,369.40
|
| Rate for Payer: WPS Commercial |
$3,190.94
|
|
|
VL Guided Needle Placement 7694226
|
Professional
|
$376.00
|
|
|
Service Code
|
CPT 76942 26
|
| Hospital Charge Code |
5374702
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$29.25 |
| Max. Negotiated Rate |
$357.20 |
| Rate for Payer: Aetna Commercial |
$357.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$323.36
|
| Rate for Payer: Aetna Managed Medicare |
$29.25
|
| Rate for Payer: Anthem Medicare Advantage |
$29.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$29.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$29.25
|
| Rate for Payer: Cash Price |
$112.80
|
| Rate for Payer: Cash Price |
$112.80
|
| Rate for Payer: Cigna Commercial |
$357.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$188.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$29.25
|
| Rate for Payer: Health EOS Commercial |
$342.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$106.04
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$106.04
|
| Rate for Payer: Independent Care Health Plan Medicare |
$29.25
|
| Rate for Payer: Multiplan Commercial |
$300.80
|
| Rate for Payer: Preferred Network Access Commercial |
$357.20
|
| Rate for Payer: Quartz Beloit One Network |
$165.44
|
| Rate for Payer: Quartz Commercial |
$214.32
|
| Rate for Payer: Quartz Medicare Advantage |
$29.25
|
| Rate for Payer: The Alliance Commercial |
$111.15
|
| Rate for Payer: United Healthcare Medicare Advantage |
$29.25
|
| Rate for Payer: WEA Trust Commercial |
$206.80
|
| Rate for Payer: WPS Commercial |
$146.25
|
|
|
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: 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: 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: 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
|
$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: 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
|
|
